Hysterectomy: A physical and emotional procedure

Understanding the emotional and physical impacts of surgical removal of the womb.

“When my doctor recommended a hysterectomy, I was taken aback,” says Jacqueline*. “I’d suffered from a huge fibroid for years, but after my third child was born, it was time to make some decisions. The fibroid was growing and causing pain, and the heavy bleeding I experienced was a concern. My doctor thought it might be cancerous.”

What is a hysterectomy?

A hysterectomy is a surgical operation performed to remove the uterus or womb. Dr Tom Mokaya, an obstetrician and gynaecologist at Mediclinic Sandton, says a hysterectomy can be performed for different reasons, including:

• Severe fibroids
• Uterine prolapse
• Cancer in the uterus, cervix or ovaries
• Severe endometriosis
• Severe pelvic pain
• Severe and abnormal vaginal bleeding
• Adenomyosis (when the lining tissue of the uterus grows inside the walls of the uterus)

Types of hysterectomy

Dr Mokaya explains there are several types of hysterectomy. These include:

1. Supracervical / subtotal hysterectomy

This is the surgical removal of the upper part of the uterus and the cervix is left in place. The ovaries may or may not be removed, depending on the condition.

2. Total hysterectomy

This is the most common type of hysterectomy, which involves the removal of the entire uterus and cervix. The ovaries and the fallopian tubes may also be removed depending on your condition.

3. Radical hysterectomy

This is a type of hysterectomy where the entire uterus is removed, as well as the tissue on the sides of the uterus, the cervix and the top section of the vagina. Radical hysterectomy is normally indicated to treat certain types of cancer, such as cervical cancer.

Hysterectomy techniques

There are two main techniques used to perform this procedure, he says. They are:

1. Open surgery

The surgeon makes an incision in the lower abdomen and removes the uterus.

2. Minimally invasive surgery

This includes the following options:

• Vaginal hysterectomy: The surgeon makes an incision in the vagina and removes the uterus through this incision.
• Laparoscopic hysterectomy: The surgeon uses a laparoscope to remove the uterus through a small incision in the belly button.

Emotional impact of hysterectomy

During surgery, Jacqueline’s cervix, uterus and fallopian tubes were removed. “I knew it was going to be a serious operation, but I didn’t anticipate the emotional loss I felt afterwards. It was official – my days of falling pregnant were over,” Jacqueline says. “I still have my (now) useless ovaries but needed medication to treat the depression I experienced afterwards.”

Liezl van Rooyen, a clinical psychologist at Mediclinic Stellenbosch, says the impact of a hysterectomy is not only physical but can be emotional too. “A hysterectomy represents an end to your childbearing years, which can feel like a huge loss,” she says. “Midlife often brings many difficult changes when it comes to career and family life. A hysterectomy, especially one that triggers menopause, may add to these feelings of stress.”  In many cases the emotional after-effects of the procedure can be minimised with counselling, a good support system, and the help of your doctor.

Side effects of hysterectomy

“The most common side effects of a hysterectomy are irritation at the incision sites and vaginal drainage (which may occur six weeks after surgery),” says Dr Mokaya. “If the ovaries were taken out during a hysterectomy, you might experience menopausal symptoms such as hot flashes, loss of libido, difficulty sleeping and vaginal dryness.”

Undergoing a hysterectomy may help you live a more enjoyable life, especially if you are suffering from constant pelvic pain or heavy and irregular bleeding. It also may lower your risk of uterine cancer and potentially be lifesaving.”

* Not her real name