When it comes to major surgery, it’s normal to have questions. What is a hysterectomy? We’ve got the answers, and what you can expect.
A hysterectomy is an operation to remove the uterus.
As surgeries go, it’s extremely common and quite quick to perform.
But because a hysterectomy involves the womb and sometimes the other reproductive organs, it takes away someone’s ability to have children and can sometimes lead to early menopause.
This means that the news that you need a hysterectomy can come with an emotional punch that you probably wouldn’t feel if you had your appendix out.
It’s normal to have questions about the surgery, and we recommend that you write yours down so you can get all the answers you need when you talk to your doctors.
But here’s a breakdown of the most common types of hysterectomy and what you can expect as you get back on your feet.
In this article: 📝
- Why is a hysterectomy performed?
- What are the main types of hysterectomy?
- How many hours does a hysterectomy surgery take?
- How painful is hysterectomy recovery?
- Sex after a hysterectomy
- What happens to a woman’s body after a hysterectomy?
Why is a hysterectomy performed?
About 600,000 hysterectomies are performed in the US every year.
Part of the reason this number is so high is that there are a lot of different reasons to have one:
- To remove pelvic pain that’s still getting in the way of your life despite medication
- To stop very heavy periods that are difficult to manage
- Because of growths in the uterus like fibroids (which are knots of tissue and muscle which can cause heavy periods and pain)
- To remove or prevent cancer of the ovaries, uterus, cervix, or fallopian tubes
- To stop bleeding after an injury or trauma (for example, after a car accident)
- As a complication after giving birth (hysterectomies happen after about 1 in 1000 births and 1 in 200 C-sections)
- As a last resort to treat conditions like endometriosis
What are the main types of hysterectomy?
“Hysterectomy” means that the uterus is removed during surgery.
(-ectomy = taking away. Think tonsillectomy, lumpectomy…)
But the thing is, there’s more than one kind of hysterectomy and more than one way to do it.
When doctors are discussing the options, it can start to feel overwhelming.
But the good news is that the differences between the operations are simpler than the medical jargon makes it seem.
In a total hysterectomy (the most common type), the uterus and cervix are both removed.
Total hysterectomy with bilateral salpingo-oophorectomy
You don’t have to be able to pronounce this one to understand what it means:
- Hysterectomy = removing the uterus and cervix
- Salpingectomy = removing the fallopian tubes
- Oophorectomy = removing the ovaries
- Bilateral = doing it on both sides
During this surgery, the uterus, cervix, and both ovaries and fallopian tubes are removed.
Your healthcare team will usually go with this option if they’re treating cancer that might have spread or if they’re worried about it developing (for example, if you carry the BRCA gene that puts you at increased risk).
It’s also quite common for doctors to remove the ovaries during a hysterectomy if the patient has already gone through menopause.
For younger patients, there are more benefits to keeping the ovaries, since the hormones they produce can help to prevent conditions like osteoporosis when you’re older and are also important for your sex drive.
In this surgery, all of the reproductive organs in the pelvis are removed, along with some of the surrounding tissue, including the lymph nodes and fatty tissue, and sometimes parts of the vagina.
Partial (or subtotal, or supracervical) hysterectomy
A partial hysterectomy removes the uterus but keeps the cervix.
This is a reasonably unusual approach because removing the cervix doesn’t usually affect your ability to have (and enjoy!) sex.
But it’s a decision that’s always made by the patient in discussion with their healthcare team.
As well as different kinds of hysterectomy, there are different ways to do the surgery.
Again, this is something that you’ll decide with your doctor.
The choice depends on your preference, what kind of hysterectomy you need, and the reasons why it’s being recommended.
Here, the uterus is removed through a cut in the vagina.
Patients are often able to go home to recover on the same day.
This is a “keyhole surgery” where the surgeon’s instruments and a camera are inserted through small cuts in your belly.
The uterus is then taken out through a cut in the vagina or through the keyholes.
This surgery should have a shorter and less painful recovery time.
Many people just need to spend one night in the hospital.
This option has a longer recovery time but is often the only option to treat cancer or for an emergency hysterectomy.
Patients usually have to stay in the hospital for longer — sometimes up to a week.
You’ll have a scar similar to a C-section scar — up to 8 inches long just above your pubic bone.
How many hours does a hysterectomy surgery take?
Like all surgeries, your doctors won’t be able to promise how long a hysterectomy will take before they get started.
Depending on the type of operation, a textbook hysterectomy takes between one and three hours.
You’ll then have to spend some time in recovery before being moved to a ward or being discharged.
The length of time will depend on whether you’ve had a general anesthetic and need to come around or spinal anesthesia and need your legs to wake up again.
How painful is hysterectomy recovery?
Recovering from major surgery is never fun.
You shouldn’t feel reluctant to ask for painkillers, especially in the first few days after the operation.
When you wake up after the surgery, you’ll probably still have an IV and maybe a catheter to collect urine.
You might also have gauze in your vagina and a surgical drain to stop fluid from building up around the incision.
These should all be removed in the first day or two after surgery once you’re more mobile.
Although it hurts a lot to begin with, your nurses will probably try to get you up on your feet as soon as possible.
Gentle movement helps to speed up recovery and prevent complications like blood clots.
Speaking of movement, a physiotherapist might visit you to give you information about pelvic floor exercises (similar to doing Kegels after you give birth), which can also help you to heal.
After abdominal surgery, you can expect some bloating, which can cause surprisingly severe pain in your abdomen and shoulders.
It might also hurt when you go to the toilet.
Some people find that holding a pillow across their belly and their stitches helps with this, and you can ask for a stool softener if you’re constipated.
You can also expect to have some bleeding from your vagina.
It should be less than a period, but it may last for up to six weeks.
You’ll be in the recovery phase for the first six to eight weeks after a hysterectomy.
During this time, it’s important to keep moving, but even more so to stop if something hurts.
It’s best to avoid bending or lifting, and you’ll probably have to wait a few weeks before you’re allowed to drive again.
Before you go home, chat to your doctors about when you’re allowed to do what, if you need to come back to have your stitches removed, and whether you need any checkups after your surgery.
Finally, if you get a fever or if your bleeding and pain become more severe, head back to the hospital because you may have an infection.
Sex after a hysterectomy
Your docs will probably tell you not to have sex until after your scars have fully healed.
It’s normal to wonder what sex will be like, and if you can have an orgasm after a hysterectomy.
You can have a normal sex life after a hysterectomy, and a great orgasm, too (the operation doesn’t touch the clitoris).
But it might take some time to get your mojo back.
Hysterectomy side effects can include:
- Vaginal dryness
- Pain around your scars
- A lower libido (especially if your ovaries were removed)
And you might just find that sex feels different, and you have to figure out what works for you now.
Our best advice?
Take things slow and keep talking with your partner.
And there’s also some good news here.
Many women report that their sex life improved after a hysterectomy because they’re free from pain.
What happens to a woman’s body after a hysterectomy?
After any type of hysterectomy, you’ll no longer be able to get pregnant, and you won’t have periods.
If your ovaries were also removed, you will immediately go into what’s known as surgical menopause because the hormones produced by the ovaries are also taken away.
Surgical menopause causes the sudden onset of classic menopause symptoms and can be difficult to deal with (read: it can hit you like a train).
Ask your doctors about your options for hormone replacement therapy or advice on natural remedies that might help.
It can be a good idea to discuss this before the surgery so that you have a plan in place.
You won’t necessarily have surgical menopause after a partial or total hysterectomy because you’ll still have your ovaries.
But the evidence shows that you then have a higher chance of going into menopause earlier than the average age of 51.
Whatever your experience, you’re not alone.
You can find support with the Peanut Community.