Surgical procedure in which the uterus is partially or completely removed. It can be performed via open, laparoscopic, or vaginal approaches; depending on the diagnosis, it may be combined with removal of the ovaries.
Indication
- Large or symptomatic fibroids (uterine leiomyomas) unresponsive to medical treatment
- Heavy, uncontrollable menstrual bleeding (abnormal uterine bleeding)
- Advanced adenomyosis and severe endometriosis
- Cancer of the uterus, cervix, or ovary, and certain premalignant conditions (such as high-risk endometrial hyperplasia)
- Significant pelvic organ prolapse (uterine prolapse)
- Treatment-resistant chronic pelvic infection or persistent pelvic pain (after careful evaluation)
Preparation
- Preoperative tests including complete blood count, biochemistry, coagulation panel, and ECG
- Review of pelvic ultrasound and, when needed, MRI and biopsy results
- Review of current medications; blood thinners are adjusted with physician approval
- Fasting (no food or drink) for 6-8 hours before the procedure
- If applicable, smoking cessation is recommended at least 2-4 weeks before surgery
How it's performed
- General or regional anesthesia is administered, with continuous monitoring of vital signs
- The abdominal area is sterilized and the surgical field is draped
- Depending on the surgeon and clinical situation, an open (laparotomy), laparoscopic, or vaginal approach is selected
- The ligaments and vascular structures of the uterus are divided in a controlled manner; if needed, the cervix and/or ovaries are also removed
- The uterus is surgically removed while protecting the bladder, bowel, and ureters
- Hemostasis is achieved, the tissues are closed, and a wound care plan is established
Post-procedure
- Hospital stay of 1-4 days depending on the approach and clinical situation
- Monitoring for pain and infection; intravenous fluids and antibiotic support if needed
- Avoidance of heavy lifting, sexual intercourse, and tampon use during the first weeks
- Contact a physician if there is vaginal bleeding or discharge
- Follow-up at week 6-8; further plan based on the histopathology result
Risks
- Bleeding, hematoma, and rarely the need for blood transfusion
- Wound or pelvic infection
- Injury to the bladder, ureter, or bowel (rare)
- Deep vein thrombosis, pulmonary embolism
- If the ovaries are also removed, early surgical menopause and related symptoms
FAQ
Will I continue to menstruate after a hysterectomy?
No. Because the uterus is removed, menstrual bleeding ends. Pregnancy is no longer possible. If the ovaries are left in place, hormonal cycle and ovulation-related symptoms may continue to be felt for some time.
If the ovaries are also removed, is hormone replacement therapy (HRT) needed?
If the ovaries are removed, surgical menopause occurs. The benefits and risks of hormone therapy are evaluated together with your physician based on your age, accompanying conditions, and cancer history. The decision is individual and is not given routinely to everyone.
Does hysterectomy negatively affect sexual life?
In most women, there is no significant long-term negative effect on sexual life; some women even report improvement because pain and bleeding decrease. Sexual intercourse is not recommended during the first 6-8 weeks. Vaginal dryness or changes in libido should be discussed with your physician.
Does hysterectomy always mean cancer?
No. A significant portion of hysterectomies are performed for benign conditions such as fibroids, heavy bleeding, endometriosis, or prolapse. The decision is made based on the diagnosis and on insufficient response to other treatments.
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