Hysterectomy (removal of the uterus)

The loyalty program applies to surgical interventions performed in the inpatient department, making treatment even more affordable.

The news that removal of the uterus may be necessary causes anxiety and many questions. This is indeed a difficult decision, but in some cases hysterectomy is the most effective and safe treatment method that helps improve quality of life.

At the «Oxford Medical» medical center, hysterectomy is performed by experienced gynecologic surgeons. The clinic’s equipment makes it possible to perform both minimally invasive and open gynecological operations, providing an individual approach to each patient. At the clinic, you can go through all stages of treatment — from consultation and diagnostics to surgery and subsequent rehabilitation. You can make an appointment for a consultation with a gynecologist by calling the contact center or through the online appointment form on the website.

Hysterectomy — is a surgical operation to remove the uterus. It is performed when the disease cannot be eliminated by conservative methods or with the help of organ-preserving surgery.

After hysterectomy, menstruation stops, and natural pregnancy becomes impossible. If the ovaries are not removed during the operation, they continue to function, so the production of female sex hormones is usually preserved, and menopause does not occur solely because of removal of the uterus.

There are several types of hysterectomy. They differ in the amount of tissue removed during the operation. The choice of method depends on the diagnosis, the extent of the disease, the woman’s age, and other clinical features.

According to the scope of the operation, the following are distinguished:

• subtotal hysterectomy — the body of the uterus is removed, while the cervix is left;

• total hysterectomy (extirpation of the uterus) — the uterus is removed together with the cervix;

• radical hysterectomy — the uterus, cervix, part of the vagina, and adjacent tissues are removed.

Radical hysterectomy is most often performed in the treatment of malignant neoplasms.

For some diseases, removal of the uterine appendages — the fallopian tubes and ovaries — may be required during hysterectomy.

Doctors at «Oxford Medical» explain: whenever possible, preference is always given to organ-preserving treatment methods. Hysterectomy is recommended only when it is the most appropriate treatment method.

Before a planned hysterectomy, a preoperative examination is performed, which makes it possible to assess the patient’s health condition and exclude factors that may increase the risk of surgery. If conditions requiring preliminary treatment or stabilization are detected, the surgical intervention is postponed.

The main contraindications include:

• acute infectious diseases;

• severe blood clotting disorders;

• decompensated diseases of the cardiovascular or respiratory system;

• a severe general condition in which the risk of surgery and anesthesia exceeds the expected benefit of treatment.

After temporary contraindications are eliminated or concomitant diseases are stabilized, the issue of performing the operation is considered again.

These restrictions apply only to planned hysterectomy. If an emergency condition arises that poses a threat to the woman’s life, the operation may be performed urgently.

Preparation for hysterectomy begins with a consultation with a gynecologist and a preoperative examination. Its purpose is to clarify the diagnosis, assess the patient’s general health condition, and choose the safest method of performing the operation.

Usually, before hysterectomy, the following are prescribed:

• gynecological examination;

• ultrasound examination of the pelvic organs;

• general and biochemical blood tests;

• general urine test;

• coagulogram;

• determination of blood group and Rh factor;

• tests for HIV, syphilis, viral hepatitis B and C;

• electrocardiogram;

• consultation with an anesthesiologist.

If necessary, the doctor may recommend additional examinations, in particular CT of the pelvic organs, magnetic resonance imaging, or biopsy, if this is necessary to clarify the diagnosis or plan the operation.

Since hysterectomy is performed under general anesthesia, it is necessary to follow the rules of preparation for anesthesia before the intervention. Usually, food intake is stopped 6–8 hours before the operation, and water can be drunk no later than 2 hours before it begins.

Doctors at «Oxford Medical» recommend: inform the doctor in advance about all medications that you take regularly. Some medications, in particular anticoagulants, antiplatelet agents, and certain medications for the treatment of diabetes mellitus, may require temporary discontinuation or adjustment of the regimen before surgery. It is also important to report allergic reactions to medications and previous surgeries.

Hysterectomy is performed using different surgical methods. The choice of access depends primarily on the disease for which the operation is performed and its planned scope.

The main methods are:

• Laparoscopic hysterectomy. The operation is performed through several small punctures in the abdominal wall. A laparoscope with a video camera and surgical instruments are inserted through them. In most cases, this method makes it possible to reduce the traumatic nature of the operation, postoperative pain, and shorten the recovery period.

• Vaginal hysterectomy. The uterus is removed through the vagina, without incisions in the anterior abdominal wall. This method is most often used for uterine descent or prolapse.

• Abdominal hysterectomy. The operation is performed through an incision in the anterior abdominal wall. This method is used when laparoscopic or vaginal access is impossible or does not make it possible to perform the intervention safely.

In modern gynecology, preference, whenever possible, is given to minimally invasive methods. At the same time, the final choice of the method of surgery is always determined by which access is the safest and most optimal in a particular clinical situation.

Hysterectomy is performed under general anesthesia. The duration of the operation depends on its scope, the chosen method, and the complexity of the clinical case.

The main stages of the intervention:

1. Preparation for the operation. After the patient is put under anesthesia, the surgical team prepares the surgical field and provides access to the pelvic organs in accordance with the chosen method.

2. Separation of the uterus. The doctor gradually separates the uterus from the ligaments, blood vessels, and surrounding tissues, controlling bleeding at each stage.

3. Removal of the uterus. The organ is removed laparoscopically, vaginally, or by an open method depending on the chosen surgical technique. If necessary, other planned interventions are performed at the same time.

4. Completion of the operation. After a final check of hemostasis, the surgeon sutures the surgical wound or punctures and applies sterile dressings.

If technical difficulties or circumstances arise during laparoscopic surgery that do not allow the intervention to be safely completed using a minimally invasive method, the surgeon may switch to open surgery through an incision in the abdominal wall. This decision is made to ensure maximum patient safety.

After hysterectomy, the patient stays in the hospital for some time under the supervision of medical staff. The duration of hospitalization depends on the method of performing the operation and the course of the postoperative period. After laparoscopic or vaginal hysterectomy, discharge is often possible after 1–2 days, while after open surgery, the hospital stay usually lasts longer.

In the first days after the operation, pain in the area of the postoperative wound, a feeling of fatigue, slight bloody discharge from the genital tract, and discomfort during movement may occur. Such manifestations gradually disappear as the tissues heal.

After discharge, it is important to follow the doctor’s recommendations:

• take prescribed medications;

• do not lift objects weighing more than 5 kg for 4–6 weeks;

• do not take a bath, visit a swimming pool, or sauna until the postoperative wound has completely healed;

• abstain from sexual intercourse for 6–8 weeks or until permitted by the gynecologist;

• take short walks regularly and gradually increase physical activity;

• attend follow-up examinations at the times determined by the doctor.

According to Royal College of Obstetricians and Gynaecologists, after minimally invasive hysterectomy, many women return to everyday activity in approximately 2–4 weeks, while after open surgery, full recovery usually takes 6–8 weeks.

Doctors at «Oxford Medical» emphasize: urgent medical attention is required if body temperature rises above 38 °C, there is heavy bleeding, a sharp increase in pain, discharge with an unpleasant odor, or redness and swelling of the postoperative wound. You should also not delay seeking help if shortness of breath, chest pain, or swelling of one leg occurs, since such symptoms may indicate the development of serious postoperative complications.

The consequences of hysterectomy depend on the scope of the operation. The most important changes after removal of the uterus are that menstruation stops and the ability to carry a pregnancy independently disappears.

If the ovaries are preserved during the operation, they continue to produce female sex hormones, so menopause usually occurs at the age usual for the woman. If both ovaries are removed at the same time, estrogen levels decrease sharply and surgical menopause develops.

It may be accompanied by:

• hot flashes;

• night sweats;

• dryness of the vaginal mucosa;

• sleep disturbances;

• mood swings.

According to The Menopause Society, women who have undergone bilateral ovary removal before natural menopause may, in the absence of contraindications, be recommended menopausal hormone therapy to relieve symptoms and prevent the long-term consequences of estrogen deficiency.

Doctors at «Oxford Medical» explain: if the ovaries are preserved during the operation, hysterectomy itself usually does not lead to a deterioration in the quality of sex life. After the recovery period is complete, most women return to their usual sexual activity. If the ovaries were removed at the same time and vaginal dryness or discomfort during sexual intercourse appeared, the doctor may recommend treatment that will help reduce these symptoms.

The cost of hysterectomy depends on the complexity of the operation and the method of surgical access (laparoscopic or open surgery). You can review the current prices for medical services here in advance. After the consultation and review of the examination results, the doctor will explain what scope of surgery is required specifically in your case and provide guidance on its cost. To make an appointment, call the contact center or use the online appointment form on the clinic’s website.

The information is for informational purposes and does not replace a consultation with a doctor.

Sources:

• US National Library of Medicine
• American College of Obstetricians and Gynecologists
• Royal College of Obstetricians and Gynaecologists