Let’s talk about hysterectomy.
Deciding whether to have your uterus removed is a personal choice, and it helps to understand your options before you make it. At Lively Wellness & Aesthetics in Odessa, TX, Dr. Charles Lively performs hysterectomies for patients across the Permian Basin who have not found relief from other treatments. He is board-certified by the American Board of Obstetrics and Gynecology and has been named a Texas Super Doctor by Texas Monthly. This page walks through when a hysterectomy makes sense, the surgical options available, what to expect from surgery and what recovery is like so you can talk through the decision with confidence.
A hysterectomy is a surgical procedure that removes the uterus, the organ in the body where pregnancy grows and where the menstrual lining builds up and sheds each month. Once we remove the uterus, you will no longer have periods and cannot become pregnant. Depending on your diagnosis, the surgery may also include removing your cervix, ovaries or fallopian tubes. The right procedure will depend on your symptoms, age and whether cancer or precancer is involved. Dr. Lively will review all of these factors with you before recommending a specific type of surgery.
The indication to do this surgery is when non-surgical remedies fail to take care of the problem.
Some of the indications for hysterectomy include:
There are different techniques of doing a hysterectomy, and each of them has its advantages and disadvantages. In each case, a circular incision is made around the cervix at the very top of the vagina so the uterus and/or cervix can be removed completely. With rare exception, they all have this incision.
A total hysterectomy removes the whole uterus along with the cervix, which is the lower opening of the uterus. This is the most common type. It does not automatically mean the ovaries are removed.
Also called a partial hysterectomy, this removes the upper part of the uterus and leaves the cervix in place. This type of procedure can be used to help preserve pelvic support and shorten recovery time. However, some patients are not candidates if the cervix itself is the source of the problem.
When the ovaries come out along with the uterus, the surgery is called a hysterectomy with bilateral salpingo-oophorectomy. Removing the ovaries stops your body’s main source of estrogen, which brings on menopause right away if you have not already gone through it. Dr. Lively weighs the benefits and drawbacks of this option and discusses them with you before recommending ovary removal.
This is a hysterectomy done when there is invasive cancer present. In this technique, lymph nodes are removed. Presently, this technique is not performed in the Permian Basin. Therefore, these cases are referred to gynecological cancer specialists.
During this procedure usually five 8mm incisions are made in the mid and upper abdomen. The incisions are all exposed and less cosmetically appealing. The operator is facing away from the patient across the room and sits with his head in a console with hand and foot controls moving the surgical instruments.
The advantage of this technique is it allows the operator three dimensional visualization and more adaptability if there are a lot of adhesions present. Further, it may reduce the likelihood of the operation finishing with a 20 cm incision and, therefore, saving the patient one extra day of hospitalization.
The right surgical approach will depend on the size of your uterus and your body type, along with whether you have had prior abdominal operations. Vaginal and laparoscopic methods usually mean smaller incisions and less pain, and you will likely be able to return home sooner. A large uterus, heavy scar tissue or cancer may call for an abdominal or robotic approach. You will have plenty of time with Dr. Lively to cover all your options and discuss the tradeoffs of each before you decide together.
Most hysterectomies are done under general anesthesia, meaning you are fully asleep and feel nothing during surgery. In some cases, a spinal or regional block numbs the lower body instead. Afterward, pain is managed with a combination of medications so you can move comfortably. Getting up and walking soon after surgery lowers your risk of blood clots and helps your bowels wake up. Dr. Lively’s team reviews your pain control plan before you go home.
Before your surgery, you will have bloodwork and possible imaging like an ultrasound to map out your anatomy. Depending on your age and health history, you may need an EKG or clearance from your primary care doctor to move forward. Pap smears and biopsies are also common steps to take before surgery to rule out or confirm cancer.
Blood thinners like aspirin, ibuprofen and certain prescriptions can raise your bleeding risk, and we usually have you stop them several days ahead of surgery unless there is a specific reason to keep taking them. You will also need to tell Dr. Lively about every supplement you are taking since some, like fish oil and vitamin E, can also thin your blood. If you smoke, you will need to stop before surgery to improve how well you heal.
You should work to make your recovery space at home comfortable so you can rest as soon as you are home from surgery. You will have a family member or friend drive you home and stay with you to help the first night. You can stock up on easy meals and make sure you have plenty of clean, loose clothing. Keep all of the supplies that you will need the first few days within arm’s reach. Set up a comfortable spot to rest where you will not have to climb stairs often during your initial recovery.
On the day of your surgery, you will check in and change into a gown before meeting your anesthesia team. An IV will deliver your fluids and medication. Once you are asleep or numbed, Dr. Lively will remove the uterus through the approach you discussed during your consultation and close the incision at the top of the vagina. You will be monitored closely throughout the entire surgery.
Most hysterectomies take one to three hours. Certain approaches will take longer than others, based on uterine size and other factors. Vaginal and laparoscopic methods are typically quick, but a large fibroid uterus or heavy scar tissue will add time.
Vaginal and laparoscopic hysterectomies often let you go home the same day or after one night. An abdominal hysterectomy may require a stay of one or two days. During your time in the hospital, nurses will watch your bleeding, your pain and your ability to pass urine before you are discharged.
Expect some vaginal bleeding or discharge for a few weeks as your internal stitches heal. You may also experience mild cramping, bloating and fatigue, which are all normal. You should begin walking short distances several times per day after your surgery to help with your recovery, with plenty of rest in between so your body can heal.
You will need to avoid lifting anything heavier than ten pounds, and do not put anything in the vagina until Dr. Lively clears you. This includes intercourse and the use of tampons. This healing process takes six to eight weeks, as the top of your vagina heals fully. Most patients will be able to shower, but you will need to avoid baths, pools and hot tubs during this time.
While hysterectomy is a common surgery, it, like all surgeries, comes with risks. This includes bleeding, infection, blood clots and reaction to anesthesia. In rare cases, nearby organs like the bladder, bowel or ureters can be injured. If the ovaries are removed, menopause will begin right away.
Some patients also feel a sense of loss after a hysterectomy, whether from the end of fertility or from a shift in how they think about their body. These feelings are normal and worth talking through with Dr. Lively or a counselor.
If your ovaries are left in place, they will keep making hormones, and you will reach menopause naturally at the usual age. However, you will not have periods to help keep track of this transition. If both ovaries are removed, menopause starts immediately, and symptoms such as hot flashes can appear within days. Dr. Lively can help with these symptoms and will discuss your options before surgery.
Those who enter menopause after ovary removal have the option of hormone replacement therapy at Lively Wellness & Aesthetics. This treatment replaces the estrogen that your ovaries are no longer making to ease hot flashes, night sweats, vaginal dryness and other symptoms. Dr. Lively offers bioidentical hormone replacement therapy, which uses hormones identical to those your body makes.
Once you are healed, most patients can enjoy sex as before, and many feel better without the pain or bleeding that led to surgery. Removing the uterus does not remove the clitoris or the sensitive tissue behind arousal and orgasm. If vaginal dryness or lower desire comes up, treatment options are available, including hormone therapy and other wellness services offered at the practice.
Call Dr. Lively’s office right away if you have a fever over 100.4 degrees, heavy bleeding that soaks a pad in an hour, foul-smelling discharge, worsening belly pain, trouble urinating or redness and drainage at an incision. Signs of a blood clot, such as swelling, redness or pain in the leg, or chest pain and shortness of breath, need emergency care.
Surgical options are often a last-resort choice when other methods have not provided relief. Nonsurgical conditions can be an option for certain conditions. Some of these treatments are available at Lively Wellness & Aesthetics, while others will need a referral to another medical professional. Non-surgical options may include hormonal medications, hormonal IUD, endometrial ablation, fibroid-directed medications and more.
The surgeon you choose will make all the difference in your comfort and peace of mind throughout the entire process. Look for these qualities in your surgeon:
Most patients feel soreness and cramping for the first week. The sensations often feel like menstrual cramps, which can be confusing and frustrating since your uterus is gone. Most causes are normal and may be due to hormonal fluctuations, scar tissue or general irritation in the pelvis as you recover from surgery. If the pain does not ease over the following weeks, be sure to reach out.
Cost depends on the surgical approach, the facility and your length of stay. Because a hysterectomy is medically necessary in most cases, insurance often covers it, though your plan’s deductible and copays still apply. We can help you understand your coverage and estimate your out-of-pocket cost before surgery.
If your cervix was removed and you have no history of cervical cancer or precancer, you likely will not need Pap smears. If the cervix was left in place, you will still need them. Either way, you should keep having regular pelvic exams to check for certain cancers and monitor vaginal and pelvic floor health.
Once the uterus is removed, there is nowhere for a pregnancy to grow, so pregnancy is not possible after any type of hysterectomy. If the ovaries were left in place, they would still release eggs, but the body would simply reabsorb them, and this cannot lead to pregnancy. A chance of ectopic pregnancy is possible, but extremely rare, with only 71 documented cases as of 2015, and it only happens when at least one ovary and fallopian tube have been retained. A hysterectomy is permanent and cannot be reversed, so if future fertility matters to you, discuss uterus-sparing options with Dr. Lively first.
You will be able to urinate and have bowel movements after surgery, though a catheter may drain your bladder for a short time right afterward. Constipation is common early on from anesthesia and pain medicine. Avoid straining while you heal. You can use fiber, fluids and gentle laxatives or stool softeners if necessary.
Hysterectomy can reduce pain from endometriosis, but it is not a cure because endometrial tissue also grows outside the uterus. Endometriosis tissue that is left behind can still cause pain and other symptoms. Hormone changes or treatments can also cause endometrial tissue to continue growing. Women with ovary-sparing hysterectomies are more likely to have a recurrence of endometriosis symptoms than those who have their ovaries completely removed, so Dr. Lively may recommend ovary removal for these women.
To find out whether a hysterectomy is right for you, schedule a consultation with Dr. Charles Lively at Lively Wellness & Aesthetics in Odessa, TX. Dr. Lively will review your symptoms, explain your options and answer your questions so you can decide with confidence. You can reach us at 432-580-9168 or online.