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Fibroids and adenomyosis are two gynecologic conditions that can be treated in many different ways. Treatment options include medical management, interventional procedures, or surgery. There are options for those who want to preserve their uterus and fertility, but these options are not always successful for everyone.

A hysterectomy may be recommended if your fibroids or adenomyosis have not improved with other treatments. This is a definitive procedure, which means that it cannot be reversed or undone. It also means that it permanently eliminates all fibroids and adenomyosis symptoms.

At Weill Cornell Medicine, our standard of care is to perform hysterectomies using a minimally invasive approach. This can be done in one of three ways; vaginally or utilizing laparoscopic or robotic-assisted technology. A minimally invasive approach causes less pain, fewer adhesions, and a quicker recovery than a traditional, "open" abdominal hysterectomy.

Who is an Ideal Candidate for a Hysterectomy?

The ideal candidate for a hysterectomy is someone who desires a permanent solution for fibroid or adenomyosis symptoms. The central benefit of this procedure is that it provides relief for the rest of your life.

Undergoing a hysterectomy means that you will no longer have menstrual bleeding or be able to become pregnant, so it is not the right choice for someone wanting to have children in the future.

At the Weill Cornell Medicine Fibroid and Adenomyosis Program, you will receive an extensive evaluation by a team of fibroid specialists to determine if you are a suitable candidate for a hysterectomy.

Considerations

Robotic and laparoscopic hysterectomies are safe procedures, but all surgeries carry some risk. Some potential risks of hysterectomy, though uncommon, include:

  • Reaction to the anesthesia
  • Infection that can be treated with antibiotics
  • Bleeding requiring blood transfusion
  • Damage to other organs inside the abdomen
  • Blood clots after surgery
  • Dehiscence (when the stitches in the vagina come undone)

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

Misperceptions About Hysterectomy

Hysterectomy and menopause: One of the most common misconceptions about hysterectomy is that the surgery will cause you to go into menopause. This is not true.

Your menopausal status is related to the function of your ovaries. During a hysterectomy, your uterus, and, in some cases, your cervix is removed. The procedure will not cause menopause because the ovaries will continue to produce hormones up until the time when menopause would normally occur.

However, the decision to retain or remove your ovaries is a separate procedure based on your medical condition and discussion between you and your surgeon. If one or both ovaries need to be removed, this can be done at the same time as the hysterectomy.

Hysterectomy and sexual function: Some patients may be concerned about sexual function or desire after hysterectomy, believing that a hysterectomy will impact their sexual function negatively. Typically, women do not experience a change in sensation during sex or a change in the ability to have an orgasm after the surgery. In fact, it is more common for patients to enjoy sex more after hysterectomy since they are no longer suffering from the symptoms of fibroids or adenomyosis.

Hysterectomy Procedure Options

A hysterectomy is the surgical removal of the uterus. There are two types of hysterectomy:

  • A supracervical (or partial) hysterectomy is the removal of the uterus, but not the cervix
  • A total hysterectomy is the removal of the uterus and cervix

The decision to keep or remove the cervix along with the uterus will be a discussion between you and your doctor. The cervix is typically removed in cases of pelvic pain, abnormal uterine bleeding, and abnormal pap smears. To decrease the risk of certain cancers in the future, the fallopian tubes are removed during the time of surgery.

Laparoscopic hysterectomy: A laparoscopic hysterectomy is a minimally invasive hysterectomy. During this procedure, the uterus is visualized using a thin, lighted scope with a camera on the end called a laparoscope. Small instruments are then inserted through the incisions into your pelvis to perform the surgery to remove the uterus.

Robotic hysterectomy: A robotic hysterectomy is similar to a laparoscopic hysterectomy, except that the surgeon sits at a console away from the patient to control robotic surgical instruments. The surgeon controls the robot's movements steadily and precisely. This lets the surgeon get into tiny spaces more easily and have a better view of the operation than with conventional laparoscopic surgery.

Vaginal hysterectomy: A vaginal hysterectomy is another minimally invasive surgical approach to removing the uterus. This surgery can be done in certain patients depending on the size of the uterus and fibroid size and location. It is typically not recommended for patients with pelvic pain, painful periods, or suspected of having endometriosis.

The decision to perform a robotic, laparoscopic or vaginal hysterectomy depends on what the patient prefers and the experience of the surgeon. All the gynecologic surgeons of the Weill Cornell Fibroid and Adenomyosis Program are experts in all three procedures.

What to Expect During a Laparoscopic or Robotic Hysterectomy

Before the procedure, you will be given general anesthesia so that you will be asleep. The surgery may range from three to four hours.

Three or four small incisions are made near your belly button. The laparoscope is inserted into your abdomen. Other surgical instruments are inserted through the other incisions. Your uterus may be removed through the vagina or may need to be cut into small pieces, protected within a bag that can be removed through one of the small abdominal incisions. After surgery, the incisions are closed with a few stitches and covered with dressings.

The minimally invasive surgery is typically performed as an outpatient procedure and you can expect to leave the hospital after several hours of observation.

What to Expect During Recovery

For the first few weeks after surgery, some women experience cramps and pain, but this should not be severe. There can be light vaginal bleeding for one to two weeks. You are encouraged to start walking the day after surgery and can expect to return to normal activities and work within three to four weeks.

It is important to not put anything in your vagina for six to eight weeks and until you have been cleared by your doctor. This includes sexual intercourse and tampons. You can resume intercourse only after you have been cleared by your surgeon to avoid the risk of dehiscence (separation of stitches in the vagina).

Recovery complications to monitor: Be sure to call your doctor if your pain is not controlled by the pain medication, as well as if you experience heavy vaginal bleeding, nausea or vomiting, diarrhea, or difficulty or pain with urination for several days after the procedure.

Follow-up care: You will be scheduled for a postoperative visit for two weeks following your surgery. Four to six weeks after the surgery, your surgeon will perform a speculum exam to check for healing. There will be additional follow-up visits based on your recovery.

The staff and doctors at the Weill Cornell Medicine Fibroid and Adenomyosis Program are always available to answer any questions and concerns you may have.

Why Choose Weill Cornell Medicine for a Hysterectomy?

There are many treatment options available to women who suffer from fibroids or adenomyosis. Treatment options range from medical therapy to surgery, with many other options in between.

The team at the Weill Cornell Medicine Fibroid and Adenomyosis Program is proud to offer the latest treatment options and provide personalized care for our patients. By getting to know and listening to our patients, we understand their needs, as well as their most difficult symptoms.

Our team includes highly trained surgeons who specialize in hysterectomy. We discuss the risks and benefits of this procedure extensively with interested patients. Our specialists carefully evaluate each patient to determine if they are suitable candidates for laparoscopic and robotic hysterectomy.

Our team of minimally invasive gynecologic surgeons and interventional radiologists collaborates with other specialists in reproductive health, integrative medicine, and nutrition to help patients receive high-quality, personalized care.