In Australia, one in six women will have undergone a hysterectomy in their lifetime. The removal of any organ is a major surgery and will impact your life, so understanding what is involved is vital, so you are able to make an informed decision. Find out how you can prepare for surgery and post-op convalescence so you can have the best chance of a healthy recovery.
What is a Hysterectomy?
A hysterectomy is the removal of the uterus can can be performed through an abdominal incision, or through the vagina. The uterus is removed – either completely, including the cervix (a total hysterectomy), or partially, where the cervix is left behind (a subtotal hysterectomy). In addition to the uterus, removal of the fallopian tubes is recommended since this may reduce the risk of future ovarian cancer, without causing menopause or other side effect. It is sometimes recommended to have the ovaries removed as well.
When the uterus, tubes and ovaries are removed, the procedure is called a hysterectomy and bilateral salpingo-oopherectomy. A hysterectomy where the ovaries are left in situ is used for conditions like excessive menstrual loss, fibroids, prolapses and when women have severe pain and bleeding associated with adenomyoisis.
If there are oestrogen-dependent conditions present, such as severe and none-responsive endometriosis and some types of cancer, a hysterectomy and uni/bilateral salpingo-oopherectomy is recommended. Removing the ovaries can prevent or slow down the growth of these oestrogen sensitive tissues.
It is important to note that hysterectomy is not a "cure" for endometriosis as the endometrial tissue grows outside the uterus, but it does remove the symptoms of heavy, painful bleeding. Pain at ovulation and endometrial lesions may still occur in some women.
It is a total cure for uterine fibroids and adenyomyosis as both these conditions are located inside the uterus and the uterine muscle. Removal of the uterus removes these tumours and cysts.
It is very important to discuss with your health professional, gynaecologist/surgeon all the risks that could occur with this major surgery.
Preparing for Surgery
Recovery from any abdominal surgery can be improved by following a few strategies to improve wound healing, reduce wound infections, assist with early post-operative mobility; and reduce any bowel discomfort. This preparation is not only for hysterectomy, but myomectomy, laser surgery, laparaoscopy, or laparotomy.
Here are some tips for pre-surgery care. Start a few months prior to surgery but I alway recommend you stop all supplements and herbs at least 2 weeks prior to surgery. This lessens the risk of any increased bleeding or interactions.
Vitamin C promotes collagen formation and has been shown to improve wound healing time.
Zinc supplements have beneficial effects on wound healing and has been used topically as far back as 100 BC. More than half of all Australian women consume less than the RDI for zinc and many vegetables are zinc deficient. Surgery increases zinc requirements because zinc is needed to enhance cell proliferation during wound healing.
Vitamin A plays an important role in would healing by increasing cellular activity required for repair. A post operative supplement of vitamin A can also increase collagen synthesis and improve the bursting strength of the scar. Vitamin A applied topically improves healing and the appearance of scars. Dietary sources of Vitamin A include full cream dairy products, egg yolk, yellow and green vegetables and yellow or orange fruit.
Vitamin E prevents internal scar tissue formation (adhesions). Care must be taken as there is a very slight risk of increased bleeding during surgery. Small doses of 100-250 IU can be taken preoperatively. Once food is resumed after surgery, doses can be increased to around 400-500 IU. Vitamin E can also be applied topically to the wound to hasten healing and reduce scarring. Oral Vitamin E reduces the risk of post-operative blood clots.
Poor muscle strength and agility can hamper recovery time post-operatively because getting out of bed and walking around is much more difficult. Weak leg and abdominal muscles can be improved post-operatively by specific exercises such as yoga, squats, walking, abdominal and body weight exercises. Being physically active post recovery improves recovery time an stamina, and reduces the risk of blood clots and respiratory infections.
Bowel issues is one of those justified fears that occurs after any kind of surgery but more so when the surgery involves the reproductive organs. Fortunately there are a few dietary changes you can make in the weeks prior to surgery to help prevent or reduce any symptoms.
Seed Breakfast - This should be started about one week before your operation and continued as soon as solid foods can be eaten after surgery. This breakfast consists of a combination of seeds, pectin containing fruit and yoghurt. In Winter the seed mix can be added to cooked oatmeal or rice and eaten with warmed stewed fruit and yoghurt.
Seeds & Rice Bran
Ground pumpkin seeds
Ground sesame seeds
Combine together in equal quantities by weight. These can be kept in the fridge for a week.
Grated raw apple
Stewed apple, pear or plums
Plain unsweetened full fat greek yoghurt
Pot set unsweetened full fat yoghurt
Daily salads of grated raw carrot and beetroot or a medium sized cooked beetroot to help prevent post-operative constipation.
Yoghurt or cultured milk drinks colonise the bowel with healthy bacteria and minimise flatulence. Drink or eat about one cup per day
Avoid refined sugars which tend to increase fermentation and flatulence
Avoid foods known to cause flatulence, constipation or diarrhoea.
Herbal tea can be taken pre and post-operatively, 3 to 6 cups per day. A mix of Lemon balm, chamomile and peppermint is the best brew for digestive help. Mix an equal quantity of all 3 herbs in a jar, use 2 tsp per cup. This brew can be taken into hospital.
Nausea can be relieved by ginger root. You can grate some into your herbal tea, take it in table form (0.5-1g every four hours) or 10-20 drops of herbal fluid extract.
Convalescence is something people have forgotten to do! Laser surgery and shorter hospital stays have pushed many women to forgo their recuperation time and go back to work, start housework or look after children far too soon that is advised. The financial strains on households also mean a shortened convalescence time for many people.
The general recommendation after hysterectomy is 6 weeks rest. This does not mean total bed rest for the entire 6 weeks, but the first 2 weeks should be! There should be no vacuuming, mopping or any motion that twists your body. No lifting anything above 5kg. You should ease yourself out of bed by first rolling to your side, curling your knees up to hang over the bed, then sitting up using your arms to push you up. No abdominal muscles should be used.
You should plan to have a good support system around you. Your family and friends may be able to come around to make sure you are resting, look after children, cook meals and do housework. A good pre-op plan is important so everyone know the tasks expected of them.
Warming soups and stews are a great way to get nourishment without placing strain on the digestive system. This gives your body the chance to focus it's energy on healing. During summer months (especially here in Queensland), you can use juices instead.
Getting up everyday to do some gentle walking is a good idea. You can increase the time and distance slowly. Even just 2 minutes the second day after surgery, 3 minutes the next etc.
Rest as much as you can! The exhaustion is real and you need time to heal from a major organ being removed from your body. Just because this is a common surgery, does not make it any less risky or faster to recover from. If you had a lung, kidney, or other organ removed, you would not be expected to jump out of bed and cook dinner for the family so take the rest you need.
Hormones after Hysterectomy
There is no reason you can't thrive after hysterectomy! Your hormones be erratic after surgery, especially if you were unable to keep your ovaries. Your adrenals will be key in making sure your surgically induced menopause is not any more difficult than it should be. If you kept your ovaries, then your hormones will still take time to settle down. Allow at least 6 months for this to occur.
I have worked with a lot of women in clinic that have needed help post-op (including myself), so I understand how complex recovery can be. As part of my 8 Week Skin & Hormone Essentials Program, I delve deep into the underlying causes of hormonal issues and how to support our bodies, including life after hysterectomy.