The uterus is an important structure in the woman’s body. Anatomically it lies in the lower abdomen near the umbilicus. It is also called the womb where the embryo is conceived, and the fetus grows during pregnancy. The luminal surface of the uterine cavity is also responsible for menstrual periods. The uterus is a dynamic organ in the female body. It is supported by the ligaments and musculature. It is also induced and produces various hormones that derive and maintain sexual activity. The uterus is susceptible to various infectious diseases, trauma, injuries, and malignant conditions. Medically only a few conditions are treatable. Advanced stage diseases are to be treated with surgical procedures. Hysterectomy is one of such option available to cure chronic and advanced uterine conditions. Hysterectomy depends on various factors such as disease condition of the uterus, age of the patients, and fertility issues. Hysterectomy is the removal of the uterus from the female body. It can involve complete removal of the uterus, or its malfunctioning/diseased part, along with ovaries, fallopian tubes, and cervix as well. In some cases, only the uterus is removed and other reproductive parts are kept intact. It all varies from patient to patient and on the disease condition of a person.
Hysterectomy is a major surgical procedure that involves an expert surgeon and an anesthesiologist and their supporting team. Once a hysterectomy is carried out, the female permanent progress into menopause. She becomes infertile and is unable to become pregnant again. It is one of the safe and low-risk surgery.
Why is that Hysterectomy performed?
Hysterectomy is performed usually in post-menopausal women due to various underlying chronic conditions. But there are few reasons that augment the need for removal of uterus from female patients.
- When there is chronic pelvic pain for many months.
- Uncontrolled vaginal bleeding that is persistent for many days and weeks.
- Malignancy in any reproductive organs such as ovaries, cervix, or uterus also necessitates hysterectomy.
- Fibroid uterus: it is benign conditions of the uterus when small cysts develop on the inner luminal surface of the uterus. These are small tumors that can turn into malignant ones if not treated with surgery. Then in this condition hysterectomy is best to prevent malignancy.
- Pelvic Inflammatory disease (PID) is a chronic disease condition in the lower abdomen and uterine cavity that if not treated can lead to cancerous conditions.
- With age, supporting structures of the uterus get loosen and uterine prolapse starts. With advanced conditions, the uterus sometimes prolapses through the vaginal canal. This is common in old age associated with surgeries and trauma.
- There is a condition of the uterus in which uterine tissues get impregnated at places other than the uterus, this is called endometriosis. Endometriosis is usually associated with abnormal bleeding tendencies. Medical treatment only treats benign conditions. Advanced and untreated endometriosis always necessitates the surgical removal of the uterus.
- Another condition in which uterine layers are impregnated in nearby muscles is called adenomyosis.
Types of Hysterectomy
In partial hysterectomy, only a part of the uterus or uterus only is removed from the body. This can leave the cervix intact in the body. Usually, this type of hysterectomy is performed through an abdominal hysterectomy procedure. Pap smear will be still needed for cervical cancer screening in partial types of hysterectomy.
Total Hysterectomy involves the complete removal of the uterus, its ligaments, and cervix from the body. It can be carried out via abdominal, vaginal, or even laparoscopic surgical methods. Once a person is operated with this kind of procedure, then there is no need for the screening of uterine or cervical cancer.
Hysterectomy and Salpingo-Oophorectomy
In this type of hysterectomy, surgeons operate the patients for the complete removal of all internal reproductive structures from the body. Women after menopause usually opt for removal of one or both ovaries, fallopian tubes along with the uterus cervix, such surgeries are called hysterectomy with Salpingo-Oophorectomy. Women after this surgery need hormones such as estrogen replacement therapy for the rest of their life.
How is the procedure perfect?
Hysterectomy is a major surgical procedure that involves the removal of the uterus, its ligament, and other supporting structures from the body. In order to carry out such major surgery, surgeons always involve one anesthesiologist with them. General anesthesia makes patients fully sleep during surgical procedures. While in the local anesthesia, the lower part of the body below the waistline is sedated, and the person is awake during surgeries such as hysterectomy.
Following are the techniques that are used to remove the uterus from the body.
This is the most commonly used route by surgeons to remove the uterus from the body. Here surgeons usually give either a vertical or horizontal incision in the lower abdomen to cut the skin, fascia, and other layers during hysterectomy and remove the uterus under general or local anesthesia. This is also called total abdominal hysterectomy. Incisions are healed later on leaving no scar.
This is another way to remove the uterus via the vaginal canal. Again this can be done via local or general anesthesia. A small cut is given deep inside the vaginal canal and this allows out pocketing of the uterus. Once its ligaments are cut, the uterus can be pulled out through the vaginal canal. Again, this procedure is very safe and effective as it leaves no external scar marks.
Abdominal hysterectomy comes with an open and large cut, hence it has cosmetic effects on the skin. There is an alternative to trans-abdominal surgery i.e laparoscopic hysterectomy. Laparoscopic surgical procedures have gained a lot of fame and attention in recent times due to the less time taking procedures, less bleeding, and few but very small incisions. A laparoscope is a small tube-like instrument with a high-resolution camera and light at its end. Three to four small incisions are made in the different regions of the abdomen. This is followed by the insertion of probes into the abdomen cavity. One probe cuts ligaments and uterus into small pieces and these pieces are then removed by another probe one by one. Laparoscopic hysterectomy takes less time and is more effective in healing wounds very rapidly.
Risks with Hysterectomy
It is one the safe, low risk and prophylactic procedure. But still, it carries few risks especially in case of abdominal hysterectomy.
Followings are the risks associated with any type of surgical procedure that involves removal of uterus:
- Excessive bleeding during surgery
- Blood clot formation due to faulty incisions and poor surgical skills.
- There is a chance of a patient getting infected due to poor aseptic measures in the operation theater.
- Earlier menopause if both ovaries aren’t removed during surgery.
- During hysterectomy, there is a risk of bladder rupture, injury to the ureter and other pelvic organs.
Recovery from hysterectomy
Hysterectomy is a major surgical procedure that is why it requires hospitalization of a patient for a few more days after surgery. At this time, doctors and nurses will keep checking for vital and post-surgical complications. Patients who undergo a hysterectomy are allowed to walk inwards and in hospitals. This helps in preventing the clotting of blood in the legs.
In the case of vaginal hysterectomy, surgeons usually place sterile gauze in the vaginal canal in order to prevent bleeding diathesis. These pads are removed after a few days once the bleeding stops. Since this is major surgery, so in the case of vaginal hysterectomy, one should expect bleeding to last for more than a week normally. Blessing is usually coupled with brownish discharge from the vagina. Menstrual pads are recommended during this time as these prevent staining of clothes. Most surgeons recommend mobility and walking habits to their patients once they are being discharged from the hospital. Patients are encouraged to walk in their homes or around the neighborhood. But there are certain cautionary measures that are suggested to patients after hysterectomy to prevent post-surgical complications. These prohibitions include staying away from heavy exercises, swimming or attending gym after hysterectomy.
Patients return to their normal life after four weeks in case of vaginal hysterectomy and in six weeks if they opt to go for abdominal hysterectomy.
Side Effects of Hysterectomy
Apart from the relationship of hysterectomy with weight gain, there are other minor and major side effects that a patient may experience. Major side effects are:
- A woman lose ability to get pregnant.
- After hysterectomy, women permanently enter into the menopause where they no longer go through typical menstrual periods.
- Insomnia is another common side effect after hysterectomy.
- Mood changes and hot flashes are also experienced by the patients after the removal of the uterus.
- Vaginal dryness and decreased sexual drive.
- Pain and swelling at the site of incision.
- Redness and bruising.
- Itching and burning sensation or a numb feeling near the incision on abdomen or down the leg.
Life after a hysterectomy
After a hysterectomy, a woman’s body undergoes immense physiological and hormonal changes. Following are the changes that a woman experiences after the removal of her uterus.
- A woman will never be able to conceive after a hysterectomy.
- Permanently end to menses and bleeding due to menstrual periods.
- Post hysterectomy there will be permanent menopause.
- Getting ovaries removed along with hysterectomy results in permanent menopause irrespective of the age of a person.
- In partial hysterectomy, the cervix remains intact in the body, so a person still carries a chance of developing cervical cancer later in her life.
- A woman after a hysterectomy can never get pregnant.
- There are some positive and good outcomes with hysterectomy such as
- A person still continues to enjoy a good sexual life even after getting her uterus removed. The reason is that people feel more ease during sexual activities due to less pain and bleeding tendency that was due to Inflammatory uterus.
- A person usually gets relief from the chronic symptoms after a successful hysterectomy. This can result in a good and healthy lifestyle.
- Hysterectomy is also related to some bad psychological outcomes such as some patients were observed to have depression and sadness with the feeling of getting their uterus removed.
Weight loss and Hysterectomy
There has been a lot of discussion and questioning about hysterectomy and its relation on weight loss or weight gain. Until now there has been no clue about weight loss after a successful Hysterectomy. But there is another interesting fact here worth mentioning. Many people tend to gain weight after hysterectomy. After surgery, maximum bed rest is recommended to the patients, as a result weight is gained during this period.
In a second case scenario, ovaries produce estrogen hormones that keep burning the fat in the body. Most of the women also tend to get their ovaries removed along with the uterus, so in these circumstances, no estrogen is produced. This leads to weight gain.
But this can be managed by taking following measures:
- Cutting down the number of total calories per day by the person after hysterectomy. Remember that don’t cut down nutrients but the total amount of diet per day. Only then you can maintain your weight in desired limits.
- Post hysterectomy, eating soy may help in replacing the depleted estrogen in the body. Soy has estrogen like effects in the body.
- Get your diet plan by a dedicated nutritionist and doctor.
- Replace high caloric content diets with less caloric but balanced diets.
- Stay in control while waiting out.
How to lose weight after this hysterectomy?
Most common complaint post hysterectomy is about weight gain. This happens if a patient opts for ovarian removal as well along with the uterus. Reason is that women enter into the menopause after such pelvic surgeries. And in menopause, the key hormone responsible for the fat metabolism estrogen is reduced markedly resulting in weight gain. That is why in order to maintain a healthy life after hysterectomy it is necessary for women to take steps that can help them in maintaining normal weight. This can be done by either doing exercises or making a diet plan. Since hysterectomy is a major surgical procedure that is why a patient is never allowed to go for full and heavy exercises in the first three months after surgery. But there are a lot of other options available if a person is interested in losing her weight after a successful Hysterectomy. Below are the best options to reduce the weight after a hysterectomy:
Indulging into aerobic and low impactful exercises can actually reduce weight.
But there is condition to these physical activities, as women need permission from their respective surgeons. These exercises can be taken 3 months after surgery.
Following are the exercises that can be opted
- Breaststroke swimming
- Road cycling
- Spin class
- Stair machine
- Stationary bike (low to moderate efforts)
- Freestyle swimming (low to moderate)
- Water aerobics
- Skiing (cross country skiing)
- Low impactful aerobic exercises (but without running and jumping)
- Taking a cross country hike
- Indulging into a folk or traditional dance practice (avoid belly dance though)
- Stationary rowing
- Walking at moderate speed
- Elliptical machine
Key points for the exercise mediated weight loss in women after hysterectomy:
- In exercises, choose low impactful exercises only as these will have little effect on the pelvic floor.
- Multiple exercises can be chosen such as walking, hike, swimming, cycling and other light indoor sports activities. Consult your physiotherapist or doctor for more such exercises.
- If you are obese and carry too much fat on the abdomen, then avoid high impact exercises as these effects pelvic floor and pelvic muscles that hold uterine cavity.
- Get yourself adopted to a variety of exercises.
Post hysterectomy weight can be cut down with some diet plan. If a person is able to balance the number of calories consumed vs the number of calories required in a day then weight can be adequately reduced. So, there must be a strict diet plan to achieve ideal weight conditions.
Here are few tips in this regard:
- No to carbohydrates:
Carbohydrates are a rich source of energy ultimately resulting in fat deposition and weight gain in the long run. So one should stop taking carbohydrates such as pizza, pasta or pieces of bread and rice.
- No to energy drinks:
High energy drinks such as fizzy drinks, blended coffee, sodas or smoothies are strictly prohibited because after consuming such drinks weight is rapidly increased. So one should stop drinking these drinks.
- Stop eating syrups and sauces:
Sauces, syrups and salad dressing that make a large part of these days food are richly supplied with sugar and fat, so these also cause weight gain. Hence one should avoid such foods.
Now there are few tips on what foods to eat, so that one can lose weight after consuming these foods.
- Eat safe carbohydrates:
Not all carbohydrates contain richly supplied fat and sugar. Foods such as vegetables, legumes, some potatoes and right kinds of fruits can help in ensuring normal metabolism as well as maintaining weight in optimal ranges.
- Take nutritive proteins:
Fish, chicken and lean meat are what we call safe proteins for patients who are on a diet plan.
One should prefer drinks that are neither rich in sugar nor rich in fats should be preferred over tea, coffee or energy drinks. Lemon juice and green tea are most effective in reducing weight.