Types of hysterectomy

A hysterectomy is an invasive, surgical procedure recommended for women who have problems with their uterus. These problems can include a prolapsed uterus, uncontrollable bleeding, fibroid development, and cancer of the uterus or ovaries.

But this procedure can cause changes in your hormone levels, so it's important to consider all of its pros and cons before deciding if it's right for you. 

Not all hysterectomies are the same. There are two main types of hysterectomy:

  • Total abdominal hysterectomy — in which the entire uterus, including the cervix, is removed
  • Subtotal hysterectomy — in which only the upper portion of the uterus, excluding the cervix, is removed

Sometimes, the ovaries and fallopian tubes may also be removed.

These different types of hysterectomy have their own advantages and disadvantages. Your doctor will help you decide which one is best for your condition.

Surgical techniques used for hysterectomy 

There are three main kinds of surgical techniques used to perform hysterectomies:

  • Vaginal hysterectomy — where the uterus is removed via incisions in the vagina, without leaving visible scars
  • Abdominal — where the uterus is removed through one long cut on the lower abdomen
  • Laparoscopic — where four small incisions are made around the abdomen to remove the upper uterus in pieces, and so, it is only used for subtotal hysterectomies 

Each of these can lead to different outcomes after the surgery.

Recovery and complications

All hysterectomies are invasive surgeries so be prepared for a long recovery. You can expect to be on your feet 2 to 3 days after the surgery, but you'll not be able to resume normal activities until at least 4 to 8 weeks have passed. You can resume having sex 6 to 8 weeks after the surgery.

You'll experience pain and discomfort during the recovery. The extent will vary between individuals and types of surgery. The abdominal method typically causes the most discomfort after surgery. Laparoscopic hysterectomies involve filling the abdomen with gas, so gas pain can be an additional side effect here.

You may also have typical complications from surgeries, including:

  • Poor reaction to anesthesia
  • Internal bleeding from surrounding organs
  • Infection at the incision site‌

 

Pros and cons of hysterectomy

A hysterectomy can have both positive and negative implications on your daily life — physically, mentally, and sexually.

Physical pros and cons  

The exact physical impact of a hysterectomy will depend on your symptoms before the operation.

Women most often report that they feel much better after their recovery because their original symptoms are gone. For example, the discomfort caused by fibroids or a prolapsed uterus is no longer present, and that's a great relief.

Researchers compared women who had undergone a hysterectomy with women who had chosen a myomectomy to treat their discomfort from fibroids. They found that a year after the surgeries, the symptoms had decreased the most in women who had chosen the hysterectomy. 

If you have a hysterectomy, you will no longer be able to get pregnant and will no longer get your period. This can be a great advantage if your periods are painful.

If your ovaries are removed as part of the surgery, you'll begin to enter menopause. Women who are close to — or are already in — menopause often have their ovaries removed to prevent future problems. Sometimes, however, younger women will also need to have their ovaries removed. If so, hormone replacement therapy can help keep your hormone levels normal. This will stop some of the symptoms of menopause from appearing.

Hysterectomies can also increase your risk of heart disease and osteoporosis if your ovaries are removed when you are premenopausal.

Mental pros and cons

Many women report improved mental health after a hysterectomy because their symptoms are finally gone.

A Swedish study measured levels of depression and anxiety in women before and 6 and 12 months after hysterectomy and found that all the women showed improved mental health after the surgery.

Many studies have, however, found that your age matters the most in terms of your post-surgical mental health. Younger women are much more likely to get depression and anxiety after their hysterectomies — even when the ovaries are not removed.

In general, women who still want to have children have a much more difficult time coping with the surgery and need to seek counseling more often than older women. If you still want to have children — and are in a position where you can consider other options — then a hysterectomy should be your last resort.  

Sexual pros and cons

In terms of sexual arousal and satisfaction after a hysterectomy, studies have reported contradicting results. While some have found that satisfaction increases after an appropriate recovery time, others have reported that it decreases or remains the same. If sex is difficult before the hysterectomy, the relief from your symptoms can greatly improve your sex life.

One common symptom is increased vaginal dryness — which can reduce both your arousal and your satisfaction over time.

Also, after a total hysterectomy, the loss of the cervix may cause changes to the shape of your vagina. Some women find this difficult to adjust to — the loss of the cervix may also change the intensity of the orgasm in women who enjoy the pressure their cervix provides during sex.

Other considerations

Have a detailed conversation with your doctor to decide what kind of hysterectomy you need and the alternatives available to you. They can also help you after your surgery by recommending exercises, mental health professionals, and other recovery services.

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Medically Reviewed on 9/27/2021
References
SOURCES:

BJOG: "A 1-year follow up of psychological well-being after subtotal and total hysterectomy - a randomized study."

ColumbiaAsia: "Hysterectomy: Advantages and disadvantages of removing uterus."

Fertility and Sterility: "Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids."

Journal of Affective Disorders: "Hysterectomy and subsequent psychological health: findings from a British birth cohort study."

MedicalArchives: "The Effect of Hysterectomy on Women’s Sexual Function: a Narrative Review."

Menopause: "Long term risk of de-novo mental health conditions after hysterectomy with ovarian conservation: a cohort study."

NYS Department of Health: "Should you have a hysterectomy? How to decide."

UCSF Health: "Hysterectomy."