Hysterectomy: Recommendations, Alternatives, and Recovery

Why is a hysterectomy recommended for some women?

A hysterectomy is recommended for some women seeking definitive treatment in overcoming their problems of abnormal uterine bleeding, uterine fibroids, endometriosis / adenomyosis and gynaecological cancers.

Are there any alternatives to a hysterectomy that women should explore before making a decision?

Yes, there are several alternatives to a hysterectomy that women should consider.

Medical therapy can be effective in managing problematic and abnormal uterine bleeding. This can include:

• Oral medications
• Injectable treatments
• Intrauterine devices (IUDs) that release hormones to control bleeding

For women with uterine fibroids, alternative treatments include:

• Myomectomy, which is the surgical removal of fibroids while preserving the uterus
• Uterine artery embolisation (UAE), which blocks the blood supply to the fibroids causing them to shrink
• High-intensity focused ultrasound (HIFU), which uses focused ultrasound waves to destroy fibroid tissue

Exploring these options with a healthcare provider can help women make an informed decision that aligns with their health goals and personal circumstances.

If a surgical procedure is needed, what are the available options?

The choice of surgical method depends on several factors, including the size and position of the uterus, the presence of any underlying conditions, the surgeon's experience and expertise, availability of advance technologies, and the patient's overall health and preferences. Your healthcare provider will discuss the most appropriate surgical approach for your specific case.

1) Abdominal hysterectomy:

The uterus is removed through an incision in the lower belly, which can either be horizontal along the bikini line or vertical from the belly button to the bikini line. After the removal, the incision is closed with stitches. This method is most recommended when cancer is present or when the uterus is enlarged.

2) Vaginal hysterectomy:

The uterus is removed through an incision made at the top of the vagina. After the removal, the inside of the vagina is stitched up with dissolvable stitches. This method is often chosen for cases where the uterus has prolapsed either partially or totally through the vagina.

3) Minimal Access Surgery (MAS) - Laparoscopic or Robotic

a) Laparoscopic:

Also known as a keyhole surgery, this procedure uses a laparoscope — a thin tube with a telescope and video camera. The tube is inserted through a small incision in the abdomen, allowing the surgeon to see inside. The uterus is then removed through the small incision or the vagina.

b) Robotic:

Where robotic surgery is performed, a more specialised device is used to operate through similar small incisions but with better precision and accuracy.

Will there be an impact on woman’s intimate life? What changes should one anticipate after a hysterectomy?

Following hysterectomy, there is very little, if any, impact on your intimate life as it does not remove your ovaries where your female hormones are produced. However, women will no longer menstruate and will not be able to bear children after the procedure.

Some women may experience some degree of vaginal dryness, which can be easily managed with appropriate lubricants or creams.

What is the expected recovery time and the do’s and don’ts after surgery?

The recovery time for a hysterectomy generally ranges from 4 to 6 weeks. However, this duration can be shorter if the surgery is performed using minimal access surgery (MAS), such as laparoscopy or robotic surgery. Recovery also depends on the individual's overall health and the presence of any existing medical conditions.

During the recovery period, it is advised to consume adequate amounts of fluid and a well-balanced diet to support healing. Remain active and ambulate adequately. Light exercises are encourage but avoid carrying heavy objects or any sexual relation for about 4 weeks to allow proper healing.

Dr. Teh Beng Hock

Obstetrician and Gynaecologist, Gynaecological Oncologist

Gleneagles Hospital Kuala Lumpur