What is a hysterectomy?
According to the NHS, a hysterectomy is “a surgical procedure to remove the womb (uterus)”, used to treat conditions affecting the female productive system. Around 55,000 hysterectomies are performed in the UK each year, with between 30,000 and 40,000 taking place on the NHS. Hysterectomies are more common in women aged 40-50, but can happen to any adult woman.
Why are they needed?
There’s no one reason why a woman may need a hysterectomy. Long term pain, such as endometriosis (abnormal tissue forming outside the uterus), adenomyosis (the lining of the uterus breaking through the womb muscles) and pelvic inflammatory disease can lead to the procedure, as can heavy periods. Hysterectomies can also be performed in some cases of gynaecological cancer.
What types of hysterectomy are there?
There are various types of hysterectomy – the type you have depends on why you need the operation, and how much of your womb and reproductive system can be safely left in place. The main types are:
Total hysterectomy: Where the womb and cervix are removed completely. This is the most commonly performed operation.
Total hysterectomy with bilateral salpingo-oophorectomy: The womb, cervix, fallopian tubes and ovaries are all removed.
Subtotal hysterectomy: The main body of the womb is removed, but the cervix remains in place.
Radical hysterectomy: The womb and surrounding tissues, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue are removed.
How is the operation performed?
Hysterectomies can be performed one of three ways. A vaginal hysterectomy removes the womb through a cut at the top of the vagina; an abdominal hysterectomy removes the womb through a cut in the lower abdomen; and a laparoscopic hysterectomy (keyhole surgery) removes the womb through several small cuts in the abdomen.
SL spoke to Lydia Brain, who had a full hysterectomy using keyhole surgery aged 24 due to womb cancer. She told us there are a number of unexpected pains that come with such a procedure. “They use four instruments, including a camera through your stomach. One goes through your belly button, and they puff up your torso with lots of air so there’s space for them to see inside you,” she explained. “The air they fill your body with pulls on your muscles and ligaments, which hurts your whole body, but especially your shoulders. That’s the most painful part of surgery – waking up with the worst pain in your shoulders. You just have to wait for the air to come out naturally.”
Does a hysterectomy make you infertile?
While you can fertilise an egg without a uterus, you can’t carry a child without one. This is something that Lydia struggled with when first discovering she must undergo the procedure. “I tried so hard for six months to desperately save my fertility,” she told SL. “This was such a hard, awfully adult decision to contemplate as a 24-year-old single woman. Going from hoping to become a mum one day to it being taken away from me in an instant was devastating. It was one of the worst days of my life. I struggle to even look at pregnant women at the moment.”
Does a hysterectomy throw you into early menopause?
If you have a total or radical hysterectomy that sees your ovaries removed, you’ll experience menopause immediately after your operation, regardless of your age. This is known as a surgical menopause.
If a hysterectomy leaves one or both of your ovaries intact, there’s a chance you’ll experience menopause within five years of having the operation. Despite keeping her ovaries after her hysterectomy last June, Lydia says she’s currently suffering from symptoms associated with the menopause: “My hormones can cause problems – even though I still have my ovaries they take some time to adjust, so currently I’m living with menopausal symptoms.”
Although your hormone levels decrease after the menopause, your ovaries continue to produce testosterone – the hormone that plays an important part in stimulating sexual desire and pleasure – for up to 20 years.
Are there any other side effects?
Besides menopausal symptoms, women can expect some changes in bowel and bladder movements when going to the toilet straight after the procedure, and it will likely be quite painful. “The first time going to the toilet was agony,” Lydia told us. “It really hurts for a few days.”
Lydia also noted that, because she had been pumped full of air, she became very bloated for a week or so, which was “very uncomfortable”. The tightness from her sutures on her expanded stomach meant she couldn’t stand up straight for around a week.
In order to remove your womb, Lydia details how surgeons must cut your ligaments in your peritoneum (the membrane that forms the lining of your abdominal cavity). “This leads to your tummy not being able to hold your insides in as effectively,” she said. “Apparently your spine compresses slightly and you shrink a bit, up to an inch or two.”
There are, of course, emotional side effects from the surgery too. Many women feel a sense of loss after losing their womb, which is particularly acute in younger people who may not have had children yet – Lydia is now discussing starting therapy to deal with her feelings on this.
Talking to other women who have been through something similar may be of comfort – your GP might be able to recommend a local support group. The Hysterectomy Association also provide hysterectomy support services, including a one-to-one phone support line, counselling, and workshops that help you prepare for your hysterectomy prior to the surgery.
How long does it take to recover?
The length of time you stay in hospital depends on your age and general health. If you’ve had a vaginal or laparoscopic hysterectomy, you can usually leave between one and four days later. Abdominal hysterectomies may require you to stay in hospital a little longer.
Lydia was only in hospital for one night: “There was a lot of pressure left on me to leave hospital that day even though I really didn’t want to. I was ill for about six weeks, but I recovered pretty quickly. By that point I felt more like my normal self, and was able to get back to work and do light yoga. But I was left with fatigue for a good three months – I needed to rest more than normal. Altogether recovery time is 12-18 months, my ovaries are still showing off and I can feel the side effects of them every single day. Hopefully in another ten months or so this should be gone.”
Does a hysterectomy affect your sex life?
Many will be relieved to hear you can resume a normal sex life after surgery. Carey York-Best, MD for Massachusetts General Hospital says after surgery most women will be able to return to the same level of functioning post-op: “It’s safe to have an orgasm after the first few weeks but oral sex and vaginal penetration should be avoided for six to eight weeks in order to allow the vaginal cuff to heal up completely and to avoid the stitches from tearing open.”
The doctor also added: “Most women will have adequate lubrication and normal sexual responsiveness post hysterectomy. However, if a premenopausal woman has her ovaries removed at the time of surgery, the vagina will be drier and more delicate. In this case using vaginal oestrogen is very safe and very helpful to keep the tissues elastic and moist and would be recommended by your surgeon.”
Lydia said the first time she had sex after her operation was “weird,” but her main issue was the worry. “There was some pain, but not too much. It’s always in the back of your mind that you might damage your sutures, which makes it hard to enjoy the experience. I took it easy the first time and made sure the guy understood he needed to be careful.”
You can find out more about having a hysterectomy at NHS.uk.
You can read more about Lydia’s experience on her blog, YoungWildAndFibroblastic.com.
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