A hysterectomy can be performed vaginally, laparoscopically or as open surgery. When suitable, vaginal hysterectomy is considered the first option. Compared with open surgery, laparoscopy usually means a shorter hospital stay, and the return to daily life may be earlier. On the other hand, the operation takes longer and the risk of injury to the ureter (the tube that carries urine from the kidney to the bladder) is slightly higher. The method is chosen according to the person’s situation.
When is it considered?
Hysterectomy may be considered for fibroids, abnormal uterine bleeding that continues despite medication, adenomyosis, endometriosis, uterine prolapse and certain precancerous conditions. In most cases, medication or options that preserve the uterus are considered first. After a hysterectomy, pregnancy is not possible and menstrual periods stop. After operations in which the cervix is left in place, some women may continue to have light cyclical bleeding.
The cervix, fallopian tubes and ovaries
The cervix may be removed together with the uterus (total hysterectomy) or left in place (subtotal hysterectomy). When the cervix is left in place, or when the uterus is too large to be removed through the vagina, the uterus is often cut into small pieces inside the abdomen so that it can be removed. Rarely, the uterus contains a previously unknown malignant tumor; in that case, cutting it into pieces can spread the disease. This risk is discussed before surgery.
Hysterectomy does not mean that the ovaries are also removed. Whether the ovaries are preserved is decided separately according to age, risk factors and the type of condition. Removal of the fallopian tubes may also be recommended to reduce the risk of ovarian cancer.
Assessment before surgery
An examination and ultrasound are carried out, and MRI is requested if needed. Cervical screening results are reviewed; where necessary, a biopsy is taken from the lining of the uterus. Blood tests, current medicines (particularly blood thinners) and an anesthesia assessment are part of planning the operation. The possibility of switching to open surgery during the operation, if necessary, is discussed in advance.
After the operation
The operation is performed under general anesthesia. Afterwards, there may be gas-related pain in the abdomen and shoulders for a few days. Light vaginal bleeding or discharge may occur for a few weeks. The return to daily activities is gradual. After operations in which the cervix is removed, intercourse and heavy lifting are postponed for a time so that the stitches at the top of the vagina can heal; this period is determined at the follow-up examination.
Possible risks
As with any operation, bleeding, infection, blood clots and problems related to anesthesia may occur. Injury to the bladder, the ureter or the bowel and separation of the stitches at the top of the vagina are less common risks. Ureter injury is slightly more common with laparoscopy than with open surgery. If the ovaries are also removed before menopause, menopausal symptoms begin. The level of risk varies with the person’s health and previous surgery.