Removal of the uterus: duration, consequences of hysterectomy

Hysterectomy is an important operation for women since it involves removing the uterus (in part or in full). “It is an important act that must be considered, because there are several types of hysterectomy, which in addition to making one infertile, may or may not lead to menopause“, explains Dr. Brigitte Letombe, medical and obstetrician gynecologist. “The patient must therefore be well informed of all possible options to make an informed choice.“, insists the doctor. There is different forms of hysterectomy depending on the areas of the uterus removed. This is thesubtotal hysterectomy, total hysterectomytotal hysterectomy with salpingo-oophorectomy and radical hysterectomy, for cases of cancers very invasive.

Indications for hysterectomy

Removal of the uterus is mainly indicated in women aged over 50, suffering from a condition causing significant symptoms that medication could not treat. Indeed, for younger women, it is much less practiced, this means giving up carrying a child well before menopause. These pathologies are:

• Certain cancers of the female genital tract (cervix or body of the uterus), endometrium.
• Adenomyosis: “This is endometriosis inside the uterine cavity, which causes pain and bleeding“, recalls the gynecologist.
• A fibromyomatous or polymyomatous uterus (i.e. who has many myomas or fibroids). These terms are synonyms, which refer to a benign tumor developed in the uterine muscle and fibrous tissue of the uterus. “It is not always responsible for bleeding, but certain fibroids have repercussions on the uterine cavity and can cause menorrhagic periods. We operate in the case where the volume is increased and we cannot treat it by medically,” she specifies.
• Functional pathologiesas’endometrial enlargement or hyperplasiaor some polyps (abnormal growths), which are responsible for heavy bleeding during or outside periods. “We can treat them without having to remove the uterus, but when it recurs, we can perform a hysterectomy to relieve the patient.“.

This type of intervention is also performed to treat genital prolapse, that is to say a descent of organs towards the vagina, due to relaxation of tissues and muscles.

Subtotal hysterectomy

Hysterectomy is called subtotal when only the uterine body is removed. The cervix therefore remains in place.

Total hysterectomy

Total hysterectomy involves removing the body and cervix. If this operation (as well as subtotal hysterectomy) eliminates the possibility of carrying a child, it does not modify the hormonal cycle or the lubrication of the vagina since the ovaries are left in place.

Total hysterectomy with salpingo-oophorectomy

Total hysterectomy with salpingo-oophorectomy (also called hysterectomy with bilateral adnexectomy or non-conservative hysterectomy) consists of removing, in addition to the uterine body and the cervix, the fallopian tubes as well as the ovaries. This results in surgical menopause and therefore suppresses hormonal cycles.

Radical hysterectomy

This procedure is performed in the case of invasive gynecological cancers. It combines total hysterectomy with removal of the tubes and ovaries, as well as removal of the upper 1/3 of the vagina and pelvic lymph nodes. Like total hysterectomy with salpingo-oophorectomy, this procedure results in surgical menopause.

Who performs hysterectomy?

A general surgeon can perform a hysterectomy, but today these are increasingly obstetrician gynecologists who practice it, because it requires precise knowledge and training to operate on the ovaries via the vaginal route.

In practice, removal of the uterus can be carried out by several techniques, under general anesthesia: vaginally, laparoscopically or laparotomy. “L’vaginal operation (or lower route) is the most used, especially for total hysterectomiesexplains Doctor Brigitte Letombe. It has the advantage of not leaving a scar“. But for subtotal operations, the second option is preferred: it is the laparoscopic method. This involves inserting small tubes through the wall of the abdomen. There will then be very slight small scars at this level. We can sometimes combine the laparoscopic route and the vaginal route. The last option, laparotomy, consists of making an incision in the abdomen, as for a cesarean section. This is done when the uterus is too large, due to large fibroids. The operation usually lasts between 40 and 90 minutes, depending on several factors such as the size of the uterus and the type of hysterectomy. Hospitalization rarely lasts more than seven days, but you must then plan on a work stoppage of around a month.

Side effects after hysterectomy

After a hysterectomy, patients generally feel some pain which can be controlled by medication, and fatigue. In less than 10% of cases, there may be:

• vaginal bleeding,
• a superinfection,
• temporary urinary complications (incontinence) or intestinal complications (laziness of transit), especially after an enlarged hysterectomy.

These symptoms most often disappear within a few weeks. The main consequence of hysterectomy is absence of periods and lack of possibility of pregnancy. “Most patients think that they are necessarily menopausal after this procedure, but this is not necessarily the case!recalls the gynecologist. This only happens when the ovaries are removed, so in the case of total hysterectomy with bilateral adnexectomy and radical hysterectomy. There, menopause occurs immediately, causing the side effects that we know about, such as hot flashes, vaginal dryness, etc.“. In the case of a subtotal or total hysterectomy, there are therefore no these symptoms after the operation and menopause will naturally occur later. This is why we must carefully consider the need for an act leading to menopause. Sometimes it is necessary, but sometimes not: “Some surgeons, at the time of the operation, suggest that the patient remove everything ‘while we’re at it’, but It’s a decision to think about. since the symptoms of surgical menopause may be more pronounced than those of normal menopause. You should not let yourself be led by doctors if you are not sure of the procedure you want.“, she insists.

Full recovery following a hysterectomy varies from 6 to 8 weeks.

Recovery time and convalescence

Hysterectomy may require hospitalization for several days, especially with a laparotomy operation. “With laparoscopy, in general, you can be discharged the next day, but it depends on several factors.“, specifies the doctor. Following this procedure, the first two weeks of convalescence in particular require a lot of rest. “You have to live a life with as little effort as possible (without excessive sport) for three or four weeks, and count on a work stoppage of around a month.“, specifies our interlocutor. Complete recovery following a hysterectomy varies from 6 to 8 weeks.

Sex after a hysterectomy

Generally, it is better to wait one to two months after the intervention to resume sexual relationsbut it depends: “The surgeon’s opinion should be sought on the healing time.“, recommends the specialist.

Complications

Complications linked to a hysterectomy are exceptional : “these are those linked to the surgical procedure: bleeding, infections, thrombosis, phlebitis… but this is very rare“, explains the gynecologist. The risks of hemorrhage or infection can today be reduced by local treatment. The risks of phlebitis or pulmonary embolism are limited thanks to anticoagulant treatment administered during hospitalization.

Thanks to Dr Brigitte Letombe, medical and obstetrician gynecologist.