Hysterectomy: Procedure, Recovery Time & Risks

A hysterectomy is a surgical procedure to remove all or part of the uterus, and may be recommended for conditions like fibroids, endometriosis, chronic pelvic pain, cancer, or abnormal bleeding. In some cases, a hysterectomy may also include removal of the ovaries, fallopian tubes, or nearby tissues, depending on the condition being treated.

There are several types of hysterectomy, including total, partial, and radical, and the choice depends on the underlying condition and how severe it is. The surgery can be done through different approaches, such as abdominal, vaginal, laparoscopic, or robotic techniques.

Recovery after a hysterectomy depends on the type of surgery and the person’s overall health, and can take from a few weeks up to about two months. It is also important to consider possible risks, body changes, and warning signs after surgery when deciding whether this treatment is appropriate.

Indications for surgery

A hysterectomy may be recommended for the following reasons:

• Uterine fibroids or prolapse
• Chronic pelvic pain
• Endometriosis and adenomyosis
• Benign ovarian tumors or endometrial hyperplasia
• Cancer of the uterus, cervix, endometrium, or ovaries
• Pelvic inflammatory disease (PID)
• Uterine rupture or perforation
• Pelvic congestion syndrome

In addition, a hysterectomy may be indicated in the case of complicated septic abortion, gestational trophoblastic disease, or placenta accreta.

A hysterectomy may also be indicated in cases of abnormal uterine bleeding when other treatment options have proven ineffective at controlling the bleeding.

The type of hysterectomy performed will depend on the condition being treated, and may involve the removal of all or part of the uterus, ovaries, and fallopian tubes.

Main types

Different types of hysterectomy may be recommended in different situations, depending on the goal of the surgery and which structures need to be removed:

• Total hysterectomy: consists of the removal of the whole uterus, including the cervix.
• Partial hysterectomy: involves the removal of the body of the uterus while leaving the cervix intact.
• Radical hysterectomy: more common in cases of advanced stage cancer, this involves the removal of the uterus, cervix, upper portion of the vagina, and part of the surrounding tissues.

In some cases, such as severe endometriosis or advanced cancer, it may also be necessary to remove the fallopian tubes and the ovaries.

How to prepare

In preparing for a hysterectomy it is important to discuss any questions you may have about the surgery with your doctor, including what techniques will be used and what recovery will look like. You should also inform your doctor of any allergies or health problems you may have.

You should also let your doctor know about any medications, vitamins, supplements, or natural remedies you may be taking. In some cases, doctors will recommend stopping the use of anticoagulants a few days before surgery in order to avoid heavy bleeding.

Patients must be fasting for at least eight hours prior to surgery. It is also recommended to avoid smoking and drinking alcohol prior to a hysterectomy.

Make sure you complete all the tests ordered by your doctor and bring the results with you on the day of your surgery. These may include a preoperative risk assessment, blood tests, and imaging, such as a pelvic ultrasound, MRI, or an abdominal and pelvic CT scan.

Surgical procedure

A hysterectomy is done in the hospital under general anesthesia and is performed by a gynecological surgeon. The procedure typically lasts about 1 to 2 hours.   

Hysterectomy may be performed using different surgical techniques, including:

1. Abdominal hysterectomy

An abdominal hysterectomy is done through an incision in the abdomen, which can be vertical (from the navel to the pelvic region) or horizontal (similar to a c-section).

This technique is typically used for the removal of tumors, as it provides better visualization and makes it easier to identify the affected organs and tissues.

Abdominal hysterectomy, also called total abdominal hysterectomy, usually requires a hospital stay of around four days as well as a six week recovery period.

2. Vaginal hysterectomy

A vaginal hysterectomy is performed through an incision in the vagina to allow for removal of the uterus. This technique typically involves a 1 to 2 day hospital stay with recovery lasting about 2 to 3 weeks. 

This method may not be recommended in the case of an enlarged uterus. 

3. Laparoscopic hysterectomy

Laparoscopic hysterectomy involves small incisions in the umbilicus (navel) or the vagina in order to introduce a laparoscope (tiny camera) and other surgical instruments.

A laparoscopic hysterectomy also involves a hospital stay of 1 to 2 days and a faster recovery than with abdominal hysterectomy (about 2 to 3 weeks).

4. Robotic hysterectomy

Robotic hysterectomy is done by specialized machines through small incisions in the umbilicus or the vagina. Length of hospitalization and recovery time are the same as with laparoscopic hysterectomy. 

Recovering from surgery

Care instructions after a hysterectomy usually include:

• Get plenty of rest and avoid heavy lifting or high-impact activities for at least three months.

• Avoid having sex for about six weeks, or follow your doctor’s specific recommendation.

• Take short walks around the house several times a day to improve circulation and help prevent blood clots.

It is common to have some vaginal bleeding in the first few days after a hysterectomy. You should take all prescribed medications exactly as directed and at the scheduled times. These may include analgesics and anti-inflammatory drugs for pain control, as well as antibiotics to help prevent infection.

Body changes after surgery

Following a hysterectomy, a woman or person assigned female at birth (AFAB) will no longer menstruate and cannot become pregnant. A normal sex life is still possible, however, as libido and the ability to have sex remain.

Ovulation after hysterectomy

If the uterus is removed but the ovaries are not, you will still continue to ovulate. In this case the egg will be released into the peritoneal cavity, where it will be reabsorbed by the body. If the ovaries are removed along with the uterus, ovulation will no longer occur.

According to the American College of Obstetricians and Gynecologists (ACOG), removing both ovaries during a hysterectomy leads to immediate menopause due to loss of hormone production. This can lead to menopause symptoms such as hot flashes, decreased libido, vaginal dryness, insomnia, and irritability. 

Possible complications

Risks of hysterectomy include infection at the incision site and urinary tract infections (UTIs). According to the American College of Obstetricians and Gynecologists, more serious complications include heavy bleeding, blood clots, and injury to the urinary tract or nearby organs such as the bladder or bowel.

Allergic reactions to the anesthetic used during surgery are also possible, as with any procedure that requires anesthesia.

Warning signs

It is important to seek urgent medical attention for any ot the following symptoms:

• Persistent fever higher than 100.4ºF (38ºC)
• Frequent vomiting
• Severe abdominal pain that does not improve with the use of anti-inflammatories or analgesics as prescribed by your doctor
• Redness, bleeding, pus, or foul-smelling discharge in the area of the incision
• Vaginal bleeding that is heavier than a normal period

You should also seek urgent medical attention if you experience shortness of breath, chest pain, leg pain or swelling, or skin that is pale, blue-tinged, and cold to the touch.

These symptoms can be a sign of surgical complications and require urgent treatment in the Emergency Department to avoid further complications.