All You Need to Know About Hysterectomies (but were afraid to ask)

Real conversation with husband of my patient, after I had performed a hysterectomy:

Me: Your wife’s hysterectomy went well. She is in recovery and you will be able to see her in an hour or so.

Spouse: Great! Did you also take out her uterus?

Me: Um, yeah. That is what a hysterectomy is. Just curious, what did you think we were doing?

Spouse, looking perplexed: Uh, I guess I wasn’t sure what you were doing in there.

I would love to say that he was an outlier, that his male gender made him ignorant of female anatomy, but that is not the case. Hysterectomy is one of the most common major surgeries that is performed in this country and yet there is a lot of misinformation about what exactly it is, the types that are done, and the reasons for hysterectomy.

Did you know that the word “hysterical” comes from the Greek word for uterus, “hystera.” This is because for a long time, it was felt that hysteria was limited to females and the result of a defect in their wombs. I kid you not. And this is also the origin of the word hysterectomy.

What is a partial hysterectomy?

Oh, this is one of the greatest misunderstandings of human kind! First of all, “partial hysterectomy” is not really a medical term. But if it were to be a medical term, it would be the opposite of a total hysterectomy and would mean leaving the cervix behind (or Subtotal Hysterectomy or Supracervical Hysterectomy). So many people–even some non-gyn medical professionals– think that it means leaving the ovaries behind. This is incorrect. Unless you have ovarian cancer or a large cyst or something going on with your ovaries, we will usually leave your ovaries and yet you will still have had a total hysterectomy. Removing the ovaries and fallopian tubes is called a bilateral salpingo-oophorectomy. Say that ten times. Gynos shorten it to BSO.

Why would a woman want to keep her cervix?

Good question. Years ago, there was some data to support that it helped with post-hysterectomy sexual function. Most of that data has been debunked and I usually recommend taking the cervix, unless of course the reason for the hysterectomy is cancer or precancer of the cervix. But imagine, no more pap smears!

There are instances when it is physically very difficult to remove the cervix and safer to leave it in place. For example, if there is a large fibroid or scar tissue. Also sometimes with pelvic prolapse, the cervix is used to anchor the vagina and hold things up. Sorry, I am getting a little technical.

Will having a hysterectomy put me in menopause?

No. Since we are usually leaving your ovaries, which make the majority of sex hormones, you will not have instant menopause. However, there can be a decrease in blood flow to your ovaries and thus some alteration of hormones.

What types of hysterectomy are available?

When I was in residency in the 1990s, more than half of hysterectomies were Total Abdominal Hysterectomies (TAH). This meant a generous lower abdominal incision and long recovery time. Transvaginal Hysterectomies (TVH) were second most common, and these had much quicker recovery times but required more skill and had more limitations. For example, if you had multiple cesareans or a very large uterus, it usually meant you got a TAH. Sadly, TVH is a dying art and has been replaced by more high tech (expensive) methods.

Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) came along in the 1990s, followed by Total Laparoscopic Hysterectomy (TLH) and then Laparoscopic Supracervical Hysterectomy (LSH). I won’t go into the reasons to choose one over another, except to again mention that none of these includes removing your ovaries unless you specify that you want to remove your ovaries.

Finally, there is Robotic-Assisted Hysterectomy (RAH). It is marketed as being a superior method with quicker recovery. I am not convinced that it is any better than the other methods, with the exception of the abdominal hysterectomy which will truly put you out of commission for several weeks.

My mom and my grandmother had hysterectomies. Does that mean I will need one too?

Everyone’s mother and grandmother had hysterectomies! Mine included.

Quick story: when I was in medical school in anatomy lab, we had about 20 female cadavers. Most did not have a uterus and so when one did, all us clueless medical students would gather around in awe to see what a real uterus looked like. This is because hysterectomy used to be the answer for every female ailment. Pelvic pain? Hysterectomy. Infection? Hysterectomy. Bleeding? Hysterectomy. Fibroids? Hysterectomy. You get the idea.

Advances in medicine mean that we now know that less than 1% of fibroids will ever be cancerous. It means that we can do an IUD or an endometrial ablation or give effective medication for heavy bleeding.

Fortunately, hysterectomies are now more of a last resort, and any major surgery should be a last resort and taken seriously.

Now if only we still had Lydia Pinkham’s Vegetable Compound for hysteria.

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