Is a hysterectomy right for you? Here’s what to know

A hysterectomy is done to treat a number of conditions, including heavy bleeding and pelvic pain. And no, it doesn’t mean your sex life is over! Here’s what to expect.

Chances are, you know someone who has had, or is about to have, a hysterectomy.

More than 30,000 hysterectomies are performed in Australia each year.

If you’re about to have this surgical procedure, expect a frank discussion with your gynaecologist about what’s involved, Royal Women’s Hospital clinical lead of gynaecology Dr Kym Jansen says.

“There are different definitions for hysterectomy, and that’s where confusion can come in – it’s important patients know what’s involved,” Dr Jansen says.

So, what is a hysterectomy?

“A hysterectomy is an operation to remove your uterus – that part of a woman’s reproductive system often referred to as the womb,” Gynaecare Victoria gynaecologist Dr Claudia Cheng says.

“If you have a hysterectomy, you’ll no longer have menstrual periods, or be able to get pregnant. 

“But not having menstrual periods does not mean you are menopausal; it is only if we need to remove the ovaries that you become menopausal.”

What are the different types of hysterectomy?

“If you’re having a total hysterectomy, the cervix – the lower part of the uterus, near the vagina – is removed along with the uterus,” Dr Jansen explains.

“In a sub-total or partial hysterectomy, the uterus is removed without the cervix.

“A hysterectomy can also involve the removal of your uterus, cervix, ovaries and fallopian tubes, which is called a ‘total abdominal hysterectomy and bilateral salpingo-oophorectomy’.”

What are the reasons for a hysterectomy?

Hysterectomies are performed for various medical reasons including conditions causing heavy periods, such as fibroids, that haven’t responded to other treatment, Dr Cheng says.

“Also conditions that cause severe pain, such as endometriosis or adenomyosis; (and) a uterine prolapse, where the uterus descends into the vaginal canal,” she adds.

Dr Cheng says a hysterectomy can also be a medical necessity if you have cancer or pre-cancer of your cervix, uterus, ovaries or fallopian tubes.

How is a hysterectomy done?

There are different ways to perform hysterectomy surgery.

“Many (hysterectomies) are now performed using laparoscopic or keyhole surgery, where the uterus is removed through small cuts in the abdomen, which affords a much quicker recovery and less time in hospital,” Dr Jansen says.

A vaginal hysterectomy means your uterus is removed through your vagina, and an abdominal hysterectomy means the surgery occurs through a cut in your lower abdomen.

How do you know which type of hysterectomy you need?

The type of hysterectomy will depend on a number of factors including the reason, the size of the uterus, and your overall health.

“There’s usually a lot of discussion around treatment options for different conditions, and the reasons for and against a hysterectomy and what it means for the patient,” Dr Jansen says.

“Some people find a hysterectomy difficult emotionally, and worry about their sexuality or loss of fertility, so counselling is an important part of that.

“For others, their uterus is not something they are emotionally attached to, and the thought of their pain or troublesome symptoms disappearing is a relief.”

How long does it take to recover from a hysterectomy?

Depending on which form your surgery takes, you can be in hospital for two to four days after having a hysterectomy, and may have light vaginal bleeding for up to two weeks afterwards.

“Recovery is going to look a little different for everyone,” Dr Jansen says.

“While most women make a full recovery within a few weeks, it’s important to rest in hospital and to follow your doctor’s instructions when you get home.”

Will having a hysterectomy affect my sex life?

“It’s never been shown that a hysterectomy affects the sensation that you have while having intercourse,” Dr Jansen says.

“The operation doesn’t touch the clitoral area, which is where most of the sensation comes from during intercourse; it’s not different because the uterus is no longer there.”

What should I ask my doctor before a hysterectomy?

“There are many things to consider before having a hysterectomy, including how the hysterectomy is to be done – whether it’s to be keyhole, abdominal or vaginal surgery; how long your hospital stay and recovery time will be; and whether any other procedures are necessary,” Dr Cheng says.

“And, most importantly, what are the alternative treatment options?”

Dr Cheng says patients need to be “200 per cent sure” that they understand the impact on their fertility, and that they don’t desire to be pregnant in the future.

“For each person that sense of womanhood that is tied up in the uterus and the ability to have children is a very personal thing, and everyone feels differently about it,” she says.

“It’s essential (that) individuals make informed decisions and receive the necessary support throughout the process.”

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Written by Liz McGrath.