Hysterectomy: What You Need to Know
I see patients with hysterectomies almost every day. It’s not a big deal right? Very common surgery, people are so glad they don’t have to deal with a pesky uterus anymore, you know the deal. But, some people don’t know the deal. So let’s talk about some considerations or misconceptions people have about hysterectomies.
An important disclaimer: I AM NOT your surgeon. I am in fact, not a surgeon at all. I am a nurse practitioner who treats many patients across the lifespan, including women in menopause and women who have had hysterectomies. So I cannot tell you if you are a good surgical candidate. I will not be able to tell you exactly what type of procedure you will have. But, we can cover some common misconceptions and talk about considerations most people forget about related to hysterectomy.
First and foremost, this is a MAJOR surgery. If you’ve struggled with painful periods or other women’s health issues your whole life it’s easy to say, “Just take it all out!” But it’s not that simple. Even if your surgery only requires very small incisions and all goes well, you will still require sedation. You will still need to take a few weeks off work. And you may be surprised at how long it takes to feel like you again. While hysterectomies are the right choice for many, we never want a patient to rush into a procedure and be surprised about the outcomes or recovery afterward.
An important thing to ask about and remember for later is what EXACTLY will be removed. It may sound silly, but many patients are unsure if they still have ovaries, tubes, or their cervix. This makes sense when you understand that in the past it was common to leave the cervix in place, and now that is not the standard of care. It’s also important to know if you have a cervix, since this would require you to continue cervical cancer screening. And it’s important to know if you have ovaries so we can complete the right workup/testing/imaging in case of pelvic or abdominal pain. Knowing what was removed, and what is still in place gives your provider a better picture if you are experiencing problems, and helps ensure you are completing the appropriate routine screening.
In medicine we say, “you can’t fix one thing without breaking another.” When it comes to hysterectomies, we are removing key structures in the pelvis that have been holding up your bladder for your lifetime. Now, that doesn’t mean your bladder instantly falls after surgery and you are automatically incontinent. But it does mean that we are making changes that could require attention later. I recommend talking to your provider about pelvic floor physical therapy. You may need a referral, and there could be a wait time, so this would be a good question to ask at your pre-op appointment. A pelvic floor physical therapist can identify weaknesses that you can work on together to fix and prevent incontinence and pelvic pain in the future.
Another question to ask your provider about is hormone replacement therapy. Before you get scared about hormones, it’s not necessary for everyone, and it’s not a HAVE TO. But many people are great candidates to use hormones very safely. This is something you can have an informed and thorough conversation about with your provider and discuss the benefits vs the risks. They can also discuss non-hormonal or alternative options. The biggest example of this problem is vaginal dryness. The majority of women in menopause struggle with vaginal dryness due to the lack of estrogen. This can be greatly improved with prescription creams, while other people find over-the-counter options suffice. This problem can greatly impact the life of women by making them so uncomfortable they cannot exercise the way they want, have generalized discomfort/pain throughout the day, and have painful intercourse. So if you are struggling with any symptoms of menopause, please talk to your healthcare provider.
Lastly, a hysterectomy might not solve all your problems. Many people will list a hysterectomy as one of the best decisions they ever made. But there is still the possibility you could have a complication, have pelvic pain related to scar tissue, or struggle with menopausal symptoms. It’s not a silver bullet, but it is worth talking about in a well-informed, evidence-based, and thoughtful setting.
I hope this was helpful for some of you, or at least food for thought. Please share with others who you think may find this helpful and stay tuned for more!
