Any woman strives to preserve her health, however, some gynecological diseases may require serious treatment. When conservative therapy and less invasive methods do not bring results, extirpation of the uterus and adnexa may be necessary. This is not an easy decision, but in some cases it allows one to avoid complications and even save a life.

This surgery is performed only for strict indications, when preserving the organs is impossible or poses a threat to the woman’s health. Thanks to modern surgical methods, the intervention is carried out as safely as possible, and rehabilitation is relatively quick and comfortable, as far as possible.

If you have gynecological problems or doubt the necessity of surgical treatment, it is important to receive a consultation with a highly qualified gynecologist. At the medical center "Oxford Medical," specialists will help you find the best solution, taking into account your condition and needs. Make an appointment at a convenient time for you!

What is extirpation of the uterus and adnexa?

Extirpation of the uterus is the complete removal of the uterus along with its cervix. If the ovaries and fallopian tubes are removed together with the uterus, the surgery is called extirpation of the uterus with adnexa.

This is a radical surgical intervention used in cases when organ preservation is impossible or impractical. After the surgery, a woman’s menstrual cycle ceases, and if the ovaries are removed, surgical menopause occurs.

Indications for removing the uterus

The decision on the necessity of surgery is made after thorough examination, which includes laboratory tests, instrumental diagnostics (ultrasound, MRI, hysteroscopy), and consultations with doctors.

The main indications for removal of the uterus and adnexa:

  • Malignant neoplasms – cervical, endometrial, or ovarian cancer, when surgery is the only effective method of treatment.

  • Large uterine fibroid or multiple nodes causing heavy bleeding, severe pain, or dysfunction of adjacent organs.

  • Endometriosis involving the uterus and adnexa that does not respond to medication or minimally invasive treatment.

  • Uterine prolapse or descent, especially if it causes discomfort, dysfunction of the genitourinary system, or does not respond to conservative therapy.

  • Purulent inflammatory processes in the adnexa that pose a life threat and do not respond to medication.

  • Uncontrolled uterine bleeding, which may result from hormonal disorders, benign or malignant processes, and poses a serious health risk.

How is the surgery performed?

Extirpation of the uterus and adnexa is a surgical intervention that can be performed by several methods, depending on the diagnosis, general condition of the patient, and anatomical features. The main goal of the surgery is the safe removal of affected organs with minimal risk of complications and the best conditions for recovery.

Main methods of surgery

  1. Abdominal (open) hysterectomy – a classical method used when wide access to the internal organs is required. The surgery is performed through a horizontal or vertical incision on the anterior abdominal wall.

When used:

  • Large size of the uterus or presence of multiple fibroid nodes.

  • Suspected oncological process requiring a detailed inspection of the pelvic organs.

  • Adhesion process that complicates other surgical methods.

Advantages:

  • Provides the surgeon with maximum access to the organs.

  • Allows careful inspection of tissues for pathologies.

Disadvantages:

  • Longer recovery period.

  • Postoperative scar on the abdomen.

  • Higher risk of complications such as infections or adhesions.

  1. Laparoscopic hysterectomy – a minimally invasive method in which surgery is performed through several small punctures in the abdominal wall (5–10 mm). The surgeon uses special instruments and a laparoscope – a miniature camera transmitting the image to a screen.

When used:

  • Benign uterine diseases (fibroid, endometriosis) without significant enlargement of the organ.

  • Removal of the uterus without oncological pathology.

Advantages:

  • Minimal tissue trauma.

  • Lower risk of postoperative complications.

  • Shorter rehabilitation period (discharge possible in 1–3 days).

  • No large scars.

Disadvantages:

  • Not suitable for oncological processes.

  1. Vaginal hysterectomy – the uterus is removed through the vagina without external abdominal incisions.

When used:

  • Uterine prolapse or descent.

  • Small or medium-sized uterus.

  • No suspicion of oncological process.

Advantages:

  • No external scars.

  • Short rehabilitation period.

  • Lower risk of postoperative complications.

Disadvantages:

  • Not applicable for large uterine sizes.

  • Limited visibility for the surgeon.

  • Possible difficulties in the presence of adhesions.

How does the surgery proceed?

In most cases, the surgery is performed under general anesthesia. Main stages of intervention:

  1. Preparation and administration of anesthesia.

  2. Access to pelvic organs:

    • Abdominal method – through an abdominal incision.

    • Laparoscopy – through punctures.

    • Vaginal method – through the vagina.

  3. Removal of the uterus and adnexa (if necessary).

  4. Checking the condition of tissues, stopping bleeding, suturing.

  5. Patient’s awakening from anesthesia, transfer to the postoperative ward.

The duration of the operation depends on the complexity of the case – on average from 1 to 3 hours.

How to prepare for the surgery?

Preparation for extirpation of the uterus and adnexa is an important stage that helps minimize risks and promotes faster recovery. It includes examinations, consultations with doctors, and following certain recommendations before surgery.

Medical preparation

Before surgery, a comprehensive examination is required to assess general health and detect contraindications. Standard tests include:

  • Blood tests (general, biochemical, coagulation, blood type and Rh factor).

  • Urine analysis to assess kidney function.

  • Smears for flora and cytology to exclude infections and oncological processes.

  • Ultrasound of pelvic organs for detailed assessment of uterus size, condition of ovaries, and adjacent structures.

  • Electrocardiogram (ECG) for heart evaluation.

  • Chest X-ray or fluorography (if necessary).

  • Consultations with specialists (therapist, endocrinologist, cardiologist) in case of chronic diseases.

If cancer is suspected, additional studies such as CT may be required.

Dietary and behavioral recommendations before surgery

A few days before surgery, it is recommended to:

  • Limit heavy, fatty foods and products causing bloating (legumes, cabbage, carbonated drinks).

  • Eliminate alcohol and reduce caffeine intake.

  • Maintain hydration, drink enough water.

  • Use laxatives if prescribed by a doctor to cleanse the intestines.

  • Follow doctor’s instructions regarding medication intake or discontinuation.

Rehabilitation after removal of the uterus and adnexa

Recovery after surgery is an important stage affecting overall well-being and quality of life. The duration depends on the type of surgery, general health, and compliance with medical advice.

First days after surgery

Immediately after surgery, the patient is monitored in the hospital.

  • Physical activity. Getting out of bed is usually allowed 6–12 hours after surgery (even earlier with laparoscopy). This prevents venous stasis and thrombosis.

  • Pain. Moderate abdominal pain is possible in the first days, relieved by analgesics.

  • Wound care. The doctor monitors healing, prescribes antibiotics if necessary to prevent infection.

First month after surgery

Rehabilitation lasts 4–6 weeks.

Restrictions:

  • Avoid lifting more than 3–5 kg, intensive exercise, sharp movements. Light walks are beneficial.

  • Follow a light diet preventing constipation (adequate fluid, vegetables, fiber).

  • Proper hygiene and suture care according to doctor’s instructions.

  • Postpone sexual activity for 6–8 weeks.

Long-term recovery

If ovaries are removed, surgical menopause may occur with:

  • Hot flashes, sweating.

  • Mood swings, fatigue.

  • Dry skin and mucous membranes.

In such cases, hormone replacement therapy (HRT) may be prescribed.

Regular gynecological check-ups are recommended after rehabilitation.

Life after removal of the uterus and ovaries

This surgery changes the woman’s physiology, but modern medicine minimizes consequences and ensures good quality of life.

Possible emotional reactions:

  • Feeling of loss, especially if performed in reproductive age.

  • Decreased self-esteem regarding femininity and sexuality.

  • Anxiety about relationships and sexual life.

Psychological support, communication with relatives or women with similar experiences are important. Over time, most patients adapt and feel comfortable.

Intimate life after surgery

Removal of the uterus does not affect orgasm, as erogenous zones remain sensitive.

Possible changes:

  • Vaginal dryness, corrected with lubricants or estrogen creams.

  • Decreased libido, often linked to psychological rather than physiological factors.

  • Fear of pain during intercourse, which disappears after adaptation.

Frequently Asked Questions:

Can there be consequences after removal of the cervix and how to prevent them?

Weakness of pelvic floor muscles, vaginal dryness, changes in sexual sensations may occur. Kegel exercises, moisturizers for the intimate area, and regular gynecological check-ups are recommended.

What types of discharge may appear after uterine removal?

Light bloody or serous discharge for 2–4 weeks is normal. If discharge is heavy, foul-smelling, or painful, it may indicate infection or complications – see a doctor immediately.

What should be done to ease recovery after extirpation of the uterus?

Rest in the first weeks, gradually increase activity, avoid heavy loads. Eat properly to prevent constipation, drink enough water, wear comfortable clothing, avoid overheating. Follow doctor’s advice and regular check-ups.

Can there be discharge after uterine removal?

Yes, light or bloody discharge in the first weeks is normal. If prolonged, painful, or foul-smelling, it may indicate complications – consult a doctor.

What is prohibited after removal of the uterus and ovaries?

For the first 6–8 weeks: no physical strain, lifting heavy weights, intensive workouts, hot baths, sexual activity. Avoid alcohol, smoking, heavy foods causing constipation. Follow doctor’s recommendations for medications, wound care, and lifestyle during rehabilitation.