If you’re considering having a hysterectomy, we strongly advise seeking advice and discussing your options thoroughly with those closest to you, as well as your General Practitioner (GP) medical team and a councillor.
Community support groups are also a great way to connect with others going through similar experiences, helping you feel less alone.
A hysterectomy is a major operation, one which shouldn't be considered lightly. It should only be considered after considering all other options. It can only be performed when family plans are complete or when a person decides not to have or can no longer have children.
What is a hysterectomy?
A hysterectomy (total or partial) includes surgical removal of some or all of the reproductive organs. This includes the uterus, ovaries, fallopian tubes, the cervix or the surrounding structures. Oophorectomy is the name given for removal of a single ovary, where as a bilateral oophorectomy is the name given for the removal of both ovaries.
Is a hysterectomy right for me?
Your medical team should discuss your options thoroughly with you to determine whether this treatment would be most suited to you. The decision you and your medical team make will be based on various factors, including the severity of your symptoms, age, medical history, which organs are affected (to which extent), whether you’re looking to start a family and various other individualised circumstances, along with any possible side effects, risks and complications.
What is surgical menopause?
Surgical menopause is the name given for those who may undergo surgery which impacts their ovarian function causing them to enter an immediate, sudden menopause rather than going through the natural aging process.
Surgery to remove both ovaries causes an immediate withdrawal in hormones (hormone deficiency). This is because the ovaries are the main source of hormone production.
Hormone replacement therapy
Hormone Replacement Therapy (HRT) usually oestrogen, is given to replace the hormones your ovaries would have naturally produced to allow you to function and feel well.
HRT can also help with the menopausal side effects, by reducing symptoms and protecting against bone health.
Some side effects (including the loss of bone mineral density), may not return to normal and because of this, you may be at risk of developing osteoporosis (known as brittle bone syndrome).
Your GP or medical team will advise whether you require regular bone density scans (DEXA scan) to check for possible signs of thinning bones.
Progesterone is usually given to those who undergo surgery to remove their ovaries, leaving their uterus in place. If you still have a uterus, you will need progesterone and oestrogen combined (known as combined HRT). Progesterone is known for helping keep the lining of the uterus thin. Without progesterone, the lining of the uterus can continue to thicken which may lead to an increase in risk of uterine cancer.
If you have severe (later stages) endometriosis, your doctor may advise you to supplement progesterone as well as oestrogen.
Those who undergo a hysterectomy will also benefit from the replacement of testosterone. This is another important hormone which is usually produced by the ovaries. Testosterone can help improve energy levels, increase libido, cognitive performance, protect against cardiovascular problems, bone health and much more.
How is a hysterectomy performed?
There are several ways this type of surgery can be performed and sometimes, depending on the severity of the Endometriosis, treatment plans may be altered should your surgeon require different access.
This procedure is usually performed under general anaesthetic, where gas is used to pump into the abdomen, allowing for surgeons to see clearly inside. Small, sometimes tiny incisions are then made to the skin, usually inside or around the belly button, and either side of the pelvis and above the hair line. This allows for surgeons to look inside for the reproductive organs, using the laparoscope (a thin telescope-like instrument). Your medical team will free up these organs, removing them through the vaginal exit.
This procedure can be carried out either under general anaesthetic - where you will be unconscious during the procedure, under spinal anaesthetic – where you will be awake, but you will not feel any pain or by performing a spinal anaesthetic – where you will be unable to feel anything from the waist down. A vaginal hysterectomy is carried out without making any incisions to the skin by removing the reproductive organs through the vaginal exit. This is not a procedure used when performing a hysterectomy for significant Endometriosis.
This procedure is usually performed under general anaesthetic, where a larger incision is made to the skin (usually around 6 to 12 inches) either from the belly button down to the pubic bone, or across the knicker line.
Experienced Endometriosis specialist doctors are usually able to perform most surgeries using the preferred laparoscopy method (key-hole surgery). However, at times a laparotomy maybe required even with an experienced Endometriosis team.
How long can recovery take?
Recovery can take anywhere between a few weeks, several months and sometimes up to a year (or longer) before you begin to feel yourself again. This can really depend on your individualised circumstances; how invasive the surgery was and how well you adjust to hormones replacement.
It is important to allow yourself time to rest and asking a family member, partner, or a friend to take care of you could be helpful as you may experience post-op pain and inflammation.
What happens after surgery?
After your surgery, you should receive a follow up appointment with your medical team. It is here where your surgery will be discussed in detail along with any further treatment plans and management should you need it.
Will I need to attend routine cervical smear tests?
If you decide to have a partial hysterectomy - leaving your cervix in place, you will still be required to attend your routine smear test screening. A smear test will no longer be required for those who undergo a total hysterectomy, where the cervix is removed.
Below we have listed a handful of things you can do to reduce the risks of complications.
We recommend you
· Quit smoking and vaping
· Eat well and maintain a healthy weight
· Maintain some form of exercise