A hysterectomy is surgical intervention that consists of removing the uterus. Women who undergo this surgery lose their ability to become pregnant, something that can have many psychological and physical effects, especially in younger patients.
Why is this procedure performed?
One of the main reasons why women should have regular gynaecological check-ups is the prevention of certain diseases, including uterine cancer. In fact, one of the usual tests in gynaecological consultations is the Pap test (smear test), which consists of taking cells from the cervix for analysis.
Cervical cancer, although a rare disease, is one of the main causes for recommending a hysterectomy, although it is not the only one. As Dr. Rodolfo Díaz, gynaecologist at Quirónsalud Torrevieja and Alicante explains, there are multiple indications why a woman should have her uterus removed.
He explained, “Uterine cancer is possibly the most serious cause for which we must perform a hysterectomy. But there are also other benign diseases for which we must perform the same procedure. Some of them are fibroids, adenomyosis, endometriosis, heavy menstrual bleeding or functional metrorrhagia, and genital prolapse. In these cases, the goal of performing a simple hysterectomy is to improve the quality of life of patients.”
Hysterectomies can be:
- Subtotal hysterectomy. In this procedure, the upper part of the uterus is removed, but the cervix is left in place.
- Total hysterectomy. It is the most common hysterectomy, and in it the uterus and cervix are removed.
- Radical hysterectomy. In it, in addition to the uterus and cervix, the tissue surrounding the cervix, known as the parametrium, is also removed.
As the name suggests, a radical hysterectomy is the most serious and invasive, and is performed only in cases of cervical cancer.
Sometimes the ovaries are removed during the surgery but this depends on the reason for surgery, the age of the patient and her hormonal status.
In addition to the type of hysterectomy, the gynaecologist must also choose the most appropriate approach for each patient. The routes to perform a hysterectomy can be: Laparotomy (opening the abdominal wall) or laparoscopic: minimally invasive technique, in which the surgery is performed through small incisions. There is also the vaginal route in which the birth canal is used to remove the uterus.
The type of anaesthesia used will depend on the approach and will impact the recovery time of the patient. Dr Díaz explained, “For a laparoscopic and laparotomic hysterectomy, general anaesthesia is used. For the vaginal route, general or local anaesthesia can be used. If the route used is minimally invasive or vaginal, the patient can lead a normal life in two weeks. After a laparotomic hysterectomy or a total abdominal hysterectomy, recovery can take up to a month.”
What happens after the hysterectomy?
Some of the side effects of hysterectomy and its postoperative complications include the risk of bleeding, infections, fistulas, or injury to neighbouring organs in the pelvis.
Another obvious and direct consequence of the removal of the uterus is the inability to gestate an embryo and, therefore, to achieve a pregnancy, something that can affect women both physically and psychologically.
In premenopausal women, it is recommended to leave the ovaries intact to continue producing hormones and not to induce menopause with surgery. Even so, to become mothers, these patients must opt for techniques such as in vitro fertilization (embryo transfer will need to be carried out using a surrogate), uterus transplantation or adoption.
In postmenopausal women, the decision can be more straightforward. Explained Dr. Díaz, specialist in gynaecology at Quirónsalud Alicante y Torrevieja , “Once the menopause has arrived, the uterus has finished with its physiological function. Therefore, in the case of menopausal women, if there is an indication to remove the uterus, it can only lead to an improvement in the quality of life without any physical consequence. As for the psychological impact, it will depend a lot on each individual patient. ”
Gynaecological care and controls after a hysterectomy
For women whose main issue is pain, hysterectomy represents a significant improvement in their quality of life. Post operative recommendations, which can vary depending on the type of hysterectomy, usually include total rest, not lifting weights, not engaging in intense sports, or avoiding intercourse for a period of time.
On the other hand, all patients are recommended to perform pelvic floor exercises, maintain healthy and active lifestyle habits, and eat a balanced diet.