What is a Hysterectomy?

A hysterectomy is a medical procedure in which the uterus is removed from a patient by an OBGYN surgery.

Each patient undergoes a hysterectomy for their own medical reason – and also has a different recovery process, both in the short term and long term.

Olivia Higgins, MD, is a minimally invasive OBGYN specialist with Rochester Regional Health and has performed many of these procedures. She explains how hysterectomies are performed, what patients should expect before and after the procedure, and other important questions.

What are the different types of hysterectomies?

Gynecologists are able to perform various hysterectomies depending on what a patient’s medical needs are. These procedures can be performed as laparoscopic (with or without robotic assistance), abdominal, or vaginal.

Total hysterectomy: removal of the uterus and the cervix

Total hysterectomy with bilateral salpingectomy: removal of the uterus, cervix, and fallopian tubes

Supracervical hysterectomy: removal of the uterus only, not the cervix

Patients are able to undergo a hysterectomy without removing their ovaries. The removal of the ovaries is a separate procedure called a bilateral oophorectomy.

“There is a uterus, a cervix, fallopian tubes, and ovaries – all of which can be removed either together or separately,” Dr. Higgins said. “It is dependent on the medical needs of each patient.”

Reasons for a hysterectomy

Patients undergo a hysterectomy for many reasons – both benign and non-benign.

Some benign disorders may include:

• abnormal uterine bleeding
• adenomyosis
• chronic pelvic pain
• endometriosis
• extremely painful periods
• prolonged menstrual bleeding
• uterine fibroids

Non-benign reasons for a hysterectomy are usually linked to gynecologic cancer, including uterine, cervical, or ovarian.

Some patients ask about having a hysterectomy as a method of birth control. Other procedures such as tubal ligation can be performed for that reason; hysterectomies are done for medically indicated reasons.

“No hysterectomy is elective,” Dr. Higgins said. “We do not perform a hysterectomy for contraception. All patients are required to sign a form stating the procedure is performed for medically necessary reasons, not contraception.”

How a hysterectomy is performed

Before the procedure

“As healthcare providers, we need to be very clear about why we are doing the surgery and, what we are removing, and how the process will go,” Dr. Higgins said.

Patients will meet with an OBGYN specialist about the procedure to have an evaluation and go through preoperative optimization. During the evaluation, they will discuss the goal of the patient’s care and what choosing a hysterectomy means – which may include discussing alternative medical strategies or interventions to manage their health condition.

They will also talk through any personal or family history to determine risk factors before surgery, show the patient which areas of their reproductive system will be removed or kept during the surgery, and remind about the best ways to improve their surgical outcome. This might include:

• taking current medications as directed
• quitting smoking
• stop or decrease alcohol drinking
• improve anemia
• maintaining regular physical exercise
• treat sleep apnea
• getting proper nutrition

After the consultation, a surgical coordinator will schedule a date and time for the procedure. This timeline will vary from patient to patient based on a number of factors.

Within 30 days of the surgery, the patient will return to go over the risks of the procedure, sign consent forms, and discuss any medications they are on. The patient will receive an instruction sheet about what they should and should not do leading up to the surgery

“I empower my patients to take time to fully understand what the surgery is,” Dr. Higgins said. “I really want them to ask questions. There is no such thing as a bad question.”

During the procedure

On the day of the hysterectomy surgery, the patient will arrive at the surgery center or hospital and check in with the nurses.

Patients are then sent to the Day of Surgery Area (DOSA) to meet with their surgical team, review the surgery together, and then prepare to go into the operating room.

The surgery itself takes 2-3 hours, after which most patients are sent to the recovery area for 2-4 hours. Often patients are able to go home the same day.

There are minor restrictions after having a hysterectomy, which are mostly based on medications. Patients should not drive within 24 hours of being on anesthesia, should not drive after taking any prescribed narcotics, and should avoid driving if they don’t feel comfortable with turning left, right, or hitting the brakes hard to stop.

The length of time a patient will be out of work depends on the individual, but ranges from 3 days for a hysteroscopy to 4-6 weeks for a laparoscopic hysterectomy.

Recovering from a hysterectomy

Once the patient is home and recovers for two weeks, they return to their OBGYN specialist to check in and ensure everything is healing well.

During the check-in appointment, patients will discuss:

• healing of their incision
• pain management
• bandage placement
• bloodwork/pathology
• eating/drinking
• bowel movements
• infection risk

How a hysterectomy can affect the body

Removing the uterus and/or any other organs or tissues in the body during a hysterectomy will affect the body in different ways.

All hysterectomies result in stopping a woman’s menstrual cycle. A surgeon does not need to remove the ovaries to stop a period. Once the uterus is removed from the body, the ovaries still remain attached to the pelvis by ligaments and a normal blood supply. Removing the ovaries would trigger other changes in the body because of the hormones produced by the ovaries, essentially causing surgical menopause.

For most patients, a hysterectomy will reduce pain – either chronic or acute that happens with sex. Often the health conditions that lead someone to have a hysterectomy cause pain, like endometriosis, adenomyosis, chronic pain, or fibroids.

After the uterus is removed, the other organs in your abdomen gradually fill the space where the uterus used to be. A patient’s bowels, bladder, and other organs will shift down.

“If patients are confused, they can ask questions,” Dr. Higgins said. “We want to empower our patients. Our team members always put the patient first and prioritize shared decision making so a patient never feels they are having a procedure they didn’t know they wanted.”