Knowing what a hysterectomy could mean for your future emotional and physical health (and whether you need a hysterectomy at all) is essential before undergoing the procedure.
Up to 600,000 women undergo a hysterectomy (the surgical removal of the uterus and sometimes other reproductive organs) every year in the United States, according to the Center for Disease Control and Prevention. Despite being one of the most common surgeries for women in the U.S., however, the procedure is often not well understood by patients, and many women believe myths about the procedure that influence their approach to it.
The majority of hysterectomies are not necessary
As a result, dispelling these myths and staying informed about hysterectomies is essential before you undergo one. For example, did you know that there are often alternatives to the procedure? And that many hysterectomies are performed unnecessarily?
To help you better understand the procedure, what follows is an overview of what a hysterectomy is. Then, you can read about 10 facts that can dispel some common myths about the procedure and give you some guidance regarding how to have a frank and productive talk with your gynecologist about the procedure.
Hysterectomy Overview
In the past, many women underwent hysterectomies in order to address what used to be called “hysteria.” In reality, the diagnosis was probably used for problems such as anxiety and depression.
Fortunately, doctors no longer use hysterectomies to treat mental health concerns. Instead, the surgery is used as a way to address a range of issues, from symptoms of fibroids (noncancerous tumors that grow in the uterus), heavy menstrual cycles, and uterine prolapse (when the uterus drops). For many of these conditions, hysterectomies are one of many treatment options.
Occasionally, a hysterectomy is a medical necessity. In particular, invasive cancers such as cancers of the uterus, cervix, vagina, fallopian tubes, or ovaries may require a hysterectomy as an essential and lifesaving procedure. In other instances, a hysterectomy can be a preventative measure, as in the case of women who have a genetic predisposition toward certain types of ovarian cancer.
While most women think of a hysterectomy as a removal of the uterus, there are actually three different kinds of surgeries that can be described as hysterectomies. The first, a partial hysterectomy, removes only the uterus. The second, a total hysterectomy, removes both the uterus and the cervix. More rarely, a radical hysterectomy is required, wherein the uterus, cervix, and upper vagina are removed.
10 Essential Facts about Hysterectomy
1. Your sex life isn’t over.
Sometimes, women fear they can never have sex again after their surgery. The truth is that your sex life can continue after a hysterectomy. You may just need some time to heal, and some specific guidance from your doctor.
You will likely have to wait 2-4 weeks to have sex again after a hysterectomy. In the case of cervix removal, you may need to wait six weeks for enough healing to occur to safely allow for intercourse. The most important thing, she emphasizes, is to have an open and detailed conversation with your doctor about what is allowed. Often, your doctor will want you to avoid vaginal intercourse, but may allow you to be intimate with your partner in other ways.
2. Hysterectomy is never a cure for endometriosis.
Endometriosis is the growth of uterine tissue outside the uterus. It can cause severe symptoms, such as severe cramping, chronic pain, and painful intercourse. And, according to the Office on Women’s Health at the U.S. Department of Health and Human Services, a hysterectomy is not a cure for the condition.
Instead, there are many less invasive options for dealing with endometriosis. For example, pain medication and hormone therapies can help to alleviate the symptoms of the condition. When surgery is required, most often a minimally invasive procedure that leaves the uterus intact is possible.
“I wish every day that my doctor told me that having a hysterectomy is absolutely NOT a cure for endometriosis,” says Lisa Schwartz about her total hysterectomy. Her hysterectomy at age 31, recommended by her gynecologist, did not even diminish her endometriosis symptoms.
3. A hysterectomy is not always necessary.
Before undergoing a hysterectomy, make sure the procedure is absolutely necessary. Very often (up to 90 percent of the time), there are other treatment options available.
For example, fibroids, and the fibroid pain they cause, can be alleviated through a minimally invasive procedure called Uterine Fibroid Embolization which uses tiny particles to block the blood flow to the fibroids. Myomectomy can also be used to surgically remove fibroids without removing the uterus. For women facing excessive bleeding, ablation can be used to freeze or burn the lining of the uterus. Knowing and discussing your options can help you to avoid any unnecessary hysterectomy.
UFE has the following benefits:
- Rapid recovery (just a few days).
- UFE is an organ-sparing procedure (your uterus is left intact).
- UFE is effective on most sizes and types of fibroids.
- Recurrence of treated fibroids is very rare.
- Multiple fibroids can be effectively treated at the same time.
- Studies have shown that nearly 90 percent of women who undergo UFE experience significant or complete resolution of their fibroid-related symptoms.
- UFE is covered by most major insurance companies.
4. Menopause is not a foregone conclusion.
Many women expect to hit menopause as soon as they have their hysterectomy. The reality, however, is that the simple removal of the uterus is not usually enough to trigger menopause. Instead, it is the removal of the ovaries, which produce the female hormones, that brings about what is called surgical menopause.
5. Hysterectomy is not always limited to the uterus.
Of course, removal of the ovaries and other reproductive organs such as the fallopian tubes is possible during a hysterectomy. When this happens, you will experience surgical menopause, which can cause symptoms more severe than natural menopause (Think hot flashes, loss of sex drive, etc.). Know ahead of time what your doctor plans to remove during your hysterectomy, what might change during the surgery, and how it might impact your future health.
6. Hormone therapy can both help and hurt after a hysterectomy.
If you do undergo surgical menopause after a hysterectomy, due to the removal of your ovaries, you may want to consider estrogen therapy. However, make sure you understand both the advantages and disadvantages of this therapy. While the therapy can help alleviate symptoms of menopause, it can also cause stroke, deep vein thrombosis, and heart disease.
7. A minimally invasive hysterectomy may be an option.
If you do find that a hysterectomy is medically necessary, you may benefit from a minimally invasive approach to the procedure. This approach puts you under general anesthesia but, instead of a large incision, uses small incisions.
The benefits of this procedure as less blood loss and shorter hospital stays. Called laparascopic surgery, it is responsible for 45 percent of hysterectomies. Before undergoing a hysterectomy, ask your doctor whether this is an option. And, pick a surgeon who has lots of experience with this procedure. If they do not have experience with the procedure and tell you that you are not a candidate for it, you may want to consider getting a second opinion from a doctor experienced in laparascopic procedures.
8. The morcellation technique has pros and cons to consider.
One of the processes that may be used during a minimally invasive hysterectomy is called morcellation. This procedure cuts the uterus into small sections for removal. Recently, morcellation came under fire because of evidence that it might spread cancer cells throughout the body. And, according to the Washington Post, one manufacturer recalled their devices as a result.
What you need to know is that morcellation does not cause cancer. Instead, for people with certain types of (rare) cancer, morcellation may spread their disease. However, one report found that a mere 27 out of 10,000 women were at risk of having cancer spread by morcellation. Just make sure you understand the risks and the benefits before agreeing to morcellation during your hysterectomy.
9. Hysterectomy can be used as a preventative measure.
At times, a hysterectomy can serve as a preventative measure for women at risk of developing ovarian cancer. In particular, women who have the BRCA1 or BRCA2 gene defects have a 45 to 65 percent risk of developing ovarian cancer, according to the National Cancer Institute. For these women, a hysterectomy involved the removal of the ovaries is often chosen as a preventative measure and can reduce the risk of dying from ovarian cancer by 80 percent.
10. Expect to undergo psychological as well as physical healing after a hysterectomy.
A hysterectomy will come with psychological healing as well as physical healing. It is normal to feel sad after the surgery. However, more severe sadness may be a sign of postoperative depression and require professional help. Seek assistance with insomnia, feelings of hopelessness, and loss of appetite.
“I have to come to terms with the reality that I can no longer have children,” says Schwartz. For her, the hysterectomy was an emotionally painful experience. “How you recover and how you feel after hysterectomy is a unique process and of course each woman is different,” she says.
