Hysterectomy is one of the most commonly performed surgical procedures in the United States. It is estimated that 600,000 hysterectomies are performed in the U.S. each year. Following a hysterectomy, menstrual periods will stop and pregnancy will no longer be possible.
What Happens During Hysterectomy: The uterus and cervix are removed. For some conditions, the fallopian tubes and ovaries are removed as well.
Reasons for Hysterectomy: A hysterectomy may be performed to treat abnormal vaginal bleeding, severe endometriosis, pelvic pain that does not respond to other treatment, uterine prolapse or cervical or uterine cancer.
Types of Surgery
In an abdominal hysterectomy, a surgical incision that is about six to eight inches long is used to remove the uterus through the abdomen. This approach may be used if both the ovaries and fallopian tubes are being removed, if the uterus is enlarged, or if endometriosis, cancer or other disease has spread to the pelvic cavity.
Recovery Time: 1-2 days in the hospital; 6 weeks for total recovery
In a vaginal hysterectomy, no incisions are made. The uterus is removed through the vaginal opening. This procedure is most often used in cases of uterine prolapse, or when vaginal repairs are necessary for related conditions.
Recovery Time: 1-2 days in the hospital; 2 weeks for total recovery
Minimally Invasive Hysterectomy
Hysterectomies that are performed in a minimally invasive way avoid large abdominal incisions, with faster recovery and less pain.
Recovery Time: 1 day in the hospital; 2 weeks or less for total recovery
- Laparoscopic Supracervical Hysterectomy – Surgical removal of the uterus only
- Total Laparoscopic Hysterectomy – Surgical removal of the uterus and the cervix
- Hysterectomy – Robotic-assisted
During a laparoscopic hysterectomy, dime-sized incisions are made in the navel or abdomen. A small camera provides the surgeon with a view of the inside of the abdomen, allowing the surgeon to operate with small, laparoscopic instruments, removing tissue through the tiny incisions.
As with vaginal hysterectomy, there is no large abdominal incision. This type of surgery leaves tiny abdominal scars that are about one-half inch each in length.
Although hysterectomy can treat excessive bleeding or fibroids, other treatment options may be appropriate for women without cancerous conditions. These options preserve your ability to have children in the future and can help you to avoid unnecessary surgery.
The method of treatment that is best for you will depend on the severity of your symptoms and your personal history. Speak to your doctor about alternatives to hysterectomy, or seek a second opinion.
What They Are: Nonsteroidal anti-inflammatory medications (NSAID) include mefenamic acid, naproxen and ibuprofen. You can buy some NSAIDs (including ibuprofen) without a prescription. These medications reduce menstrual cramps and blood loss.
How They Work: They are taken in tablet form when you have your period. If you do not experience relief with non-prescription NSAIDs, your doctor may prescribe a similar prescription medication.
Length of Treatment: Daily during your period
Oral Progesterone or Birth Control Pills
What They Are: Oral progesterones come in the form of high-dose progestin pills or as birth control pills.
How They Work: Progesterones can correct hormonal imbalance and reduce bleeding by preventing an overgrowth of the endometrium (the lining of the uterus). It might take three months for bleeding to improve after you start taking hormonal birth control.
Length of Treatment: Oral progesterones are often taken for 12 continuous days per 28-day cycle. Birth control is taken daily.
Hormonal IUD (i.e. Mirena)
What It Is: An IUD is a small, t-shaped device that is inserted into the uterus and releases a form of a progesterone-like hormone called a progestin. There are two types of IUDs – one works for five years and the other works for three.
How It Works: Your doctor will insert the IUD into your uterus in his or her office – this is not a surgical procedure. You may be given a local anesthetic, although this is not always needed. The procedure takes only a few minutes, and most women can usually resume their daily activities immediately after.
Length of Treatment: A new IUD should be inserted every three to five years, depending on your IUD.
GNRH Injections or Nasal Sprays
What It Is: GnRH agonists are modified versions of a naturally occurring hormone known as gonadotropin releasing hormone, which helps to control the menstrual cycle.
How It Works: GnRH can be delivered by injection or with a nasal spray. All are equally effective. Most women stop bleeding within two months of treatment.
Length of Treatment: The usual length of treatment is 3-6 months. Women who have a 6-month treatment generally experience a longer delay before their symptoms return.