Womens Health, Fitness, Weight Loss, Beauty and More

Hysterectomy

Topic Overview
From Healthwise
What is a hysterectomy?

A hysterectomy is surgery to take out a woman’s uterus, the organ in a woman’s belly where a baby grows during pregnancy. After a hysterectomy, you will not be able to get pregnant.

Other organs might also be removed if you have severe problems such as endometriosis or cancer. These organs include the cervix (the lower part of the uterus that opens into the vagina), the ovaries (glands on both sides of the uterus that release eggs for pregnancy), and the fallopian tubes (the passageway between the uterus and the ovaries).

Whether or not the ovaries are removed will depend on your age and risk for certain types of cancer. For example, removing the ovaries lowers the risk of ovarian cancer and some types of breast cancer. But, if you have your ovaries removed before the age of menopause, you will go into early menopause, and you may be more likely to get heart disease or osteoporosis. Be sure to discuss all the benefits and risks of removing your ovaries with your doctor.

See an illustration of the female reproductive system.

What problems does this surgery treat?
Most often, hysterectomy is done to treat problems with the uterus, such as pain and heavy bleeding caused by endometriosis or fibroid tumors. The surgery may also be needed if there is cancer in the uterus, cervix, or ovaries. Some women may have the surgery during childbirth to save their lives if there is heavy bleeding that cannot be stopped.

Before you choose to have a hysterectomy, consider all of your treatment options. In many cases, this surgery is a last resort after trying other treatments for the problem.

How is the surgery done?
There are many different ways to do hysterectomy surgery. The type of surgery you have depends on three main things: the reason for the surgery, the size of the uterus and its position in the belly, and your overall health. The most common types are:

Abdominal hysterectomy. In this type, the doctor makes a cut in the belly, either across the bikini line or straight up and down. The doctor takes out the uterus and the cervix. This type is most often done when cancer might be present or when severe endometriosis, a lot of scar tissue (adhesions), or a very large uterus makes the uterus hard to remove.
Vaginal hysterectomy. With this type, the doctor takes out the uterus through the vagina. He or she makes a small cut in the vagina instead of the belly. Your doctor will not use this method when there is a chance that cancer may be in the uterus, cervix, or ovaries. Doctors use this type of surgery only in cases where the uterus is small and easy to remove.
Laparoscopically assisted vaginal hysterectomy (LAVH). To do this surgery, the doctor puts a lighted tube (laparoscope) through small cuts in your belly. The doctor can see your organs with the scope and can insert surgical tools to cut the tissue that holds your uterus in place. Then he or she can remove the uterus through your vagina.
Laparoscopic supracervical hysterectomy (LSH). With LSH, the doctor inserts the scope and tools through small cuts in your belly. He or she takes out the uterus in small pieces and leaves the cervix in place. This surgery is done only if you don’t have cervical cancer.1,
Total laparoscopic hysterectomy (TLH). In this type, the doctor inserts a scope and tools through several small cuts in the belly. The doctor takes out the uterus and the cervix in small pieces through one of the cuts.
How long will it take to recover from surgery?
Feeling better after surgery takes time. Most women are in the hospital 1 or 2 days after the surgery. Some women stay in the hospital up to 4 days.

When you get home, make sure you move around, but also be sure you don’t do too much. You can walk around the house and up and down stairs, but take it slow. During the first 2 weeks, it’s important to get plenty of rest. Even after you start to feel stronger, you should not lift heavy things (anything over 20 pounds). Also, you should not have sex until your doctor says it’s okay. It usually takes 4 to 8 weeks to get back to a normal routine.

Fatigue: When to rest, when to worry

Some days you’re so low on energy that you’re drowsy by lunchtime and in need of a nap by midafternoon. What’s making you so tired all the time? Stress, poor eating habits, overwork, even medical treatments can wear you down.

Most of the time, fatigue can be traced to one or more of your habits or routines. You have the power to put the vitality back in your life.

Why so weary?

Taking a quick inventory of the things that might be responsible for your fatigue is the first step toward relief. Fatigue can have a variety of lifestyle causes, including:

Lack of sleep. Getting even an hour less than the sound slumber you need each night can leave you drowsy and unable to manage your daily routine. You may not go to bed early enough. Or more likely, you go to bed but can’t sleep well. As you get older, it becomes harder to get uninterrupted sleep. You sleep less soundly. You awaken earlier.
Stress and anxiety. If you’re running from one task to the next without a break, it’s eventually going to wear you down. Going through life anxious and on edge can keep you from relaxing and getting the rest you need.
Inactivity. You’re too tired to exercise, so you don’t. But then when you do exert yourself, you tire easily because you’re out of shape. Engaging in moderate physical activity for a half-hour or longer most days of the week may decrease stress, improve mood and leave you feeling energized. Don’t schedule your activity too close to bedtime, though, or you might have trouble falling asleep.
Eating habits. If you’re not eating properly or drinking enough fluids, your body isn’t getting the fuel and fluid it needs. Trying to remedy this with caffeine can backfire, especially if you consume it late in the day. Caffeine not only makes it harder to fall asleep, it also interferes with sound sleep and may keep you tossing and turning throughout the night.
Certain medications. Some medications, including many beta blockers and antihistamines, can cause fatigue. In addition, some cold medications and pain relievers contain caffeine and other stimulants that can keep you up at night.

Battling fatigue

To beat fatigue, try these tips:

Reduce stress
Take some of the pressure out of your day. Learn to say no. Set priorities. Then organize your activities so that you avoid confusion. Pace yourself. Put aside time each day to do something you enjoy. Take a midday stroll around the block, or get up 15 minutes earlier to give yourself more time to start your day.

Manage workplace tension
On-the-job aggravation can add to work-related fatigue. Sit down and try to resolve conflicts with co-workers. Become better acquainted with your boss and clarify what he or she needs from you. Be realistic about your limitations. Take time out to get up from your desk and stretch for a few moments several times a day.

Be active
Try to include at least 30 minutes of moderate physical activity in your day. Don’t worry about doing a full workout all at once — start with 10 minutes of activity at a time. Whether you walk, garden or swim, once you get moving, you’ll likely notice you have more stamina. While 30 minutes is the minimum recommendation, you may need up to an hour of moderate activity daily to maintain fitness and a healthy weight.

Eat well
Start your day with a low-fat, high-fiber breakfast that includes plenty of complex carbohydrates, such as whole grains and fruits for lasting energy. Stay away from sugary cereals and juices and caffeinated drinks. They can make you feel sluggish later in the day. Don’t skip meals; refuel every three or four hours. Very low calorie diets are guaranteed to increase fatigue.

Avoid alcohol
Alcohol depresses your central nervous system and acts as a sedative, making you tired for hours after consuming no more than only a drink or two. It may also disrupt your sleep, if you drink just before bed.

Practice good sleep habits
Avoid eating, reading or watching TV in bed. Keep your bedroom cool, dark and quiet. And set your alarm for the same time each day — the routine can help you establish a regular sleep schedule. Naps are OK, but keep them short and early in the day. Schedule workouts at least six hours before bedtime. Small snacks may help you drift off, but large late-night meals can keep you up. If you can’t sleep, don’t toss and turn, go into another part of the house and read or relax until you feel drowsy.

When to see your doctor

Sudden or persistent fatigue, despite adequate rest, may mean it’s time for you to consult your doctor. Unrelenting exhaustion may be a sign of an underlying medical problem. In general, talk to your doctor if you’re extremely tired or unable to regain your energy after several weeks of increased rest. Medical causes of fatigue can include:

Anemia
This blood disorder results from a number of problems that affect your blood’s ability to transport oxygen, causing fatigue.

Cancer
Fatigue can be a symptom of cancer. A thorough checkup, including routine cancer screenings, can help rule out malignancy as a cause of your fatigue.

Depression
A loss of energy that’s accompanied by any number of symptoms, including sadness, loss of appetite, difficulty sleeping or oversleeping, a lack of interest in pleasurable activities, and difficulty concentrating may be a part of depression.

Diabetes
Extreme fatigue can be a warning sign of diabetes. Signs and symptoms of diabetes, in addition to fatigue, include excessive thirst, frequent urination, blurred vision and recurring infections.

Medications
Prescription or over-the-counter medications may cause fatigue or make you too restless to sleep well. Antihistamines, cough and cold remedies, some antidepressants, and many other drugs may make you tired. Talk to your doctor if you suspect your medications are making you tired.

Restless legs syndrome (RLS)
This condition is characterized by an inability to keep your legs still and by tingling or aching sensations in your legs, feet or arms. The symptoms generally occur at night, preventing sound sleep.

Sleep apnea
Signs of this disorder include loud snoring, pauses between breaths and awakening frequently while gasping for air. It’s a common source of fatigue because it interferes with sound sleep. Losing weight and quitting smoking may help, as well as an adjustment in sleeping position. Lying on your side or facedown may reduce snoring.

Thyroid problems
Hypothyroidism is a condition in which your thyroid gland fails to make or release enough thyroid hormone. Signs and symptoms include sluggishness, chronically cold hands and feet, constipation, dry skin and a hoarse voice. Hyperthyroidism is a condition in which your thyroid produces excessive amounts of hormone. Too much hormone also can cause fatigue, muscle weakness, weight loss, increased heart rate, nervousness and irritability.

A diagnosis of exclusion: Chronic fatigue syndrome
Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that doesn’t improve with bed rest and may worsen with physical or mental activity. Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious.

Severe and debilitating fatigue, muscle aches and difficulty concentrating are the most commonly reported symptoms of chronic fatigue syndrome. In some cases, low-grade fevers and swollen lymph nodes also may develop.

A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.

Don’t let fatigue keep you from getting help

Once you face your fatigue head-on, you’ll find that making small lifestyle changes or treating an underlying medical condition will go a long way toward giving you back your get-up-and-go.

Help for Intimate Pain

As a hypnotherapist in Franklinville, NJ, who works with women with chronic pelvic pain, Loretta Sernekos, PhD, is intimately familiar with her clients’ symptoms. She has CPP, too. So she’s aware of how, in addition to all the ways they hurt, their distress is compounded by one terrible, frustrating fact: Even after extensive consultations, many still haven’t found the root cause of their problem or a treatment that works.

Their doctors, of course, haven’t either. What that means for Sernekos’s clients and the 15% of American women who suffer from CPP is that nothing can be taken for granted: not walking, sitting, having sex, going to the bathroom, even wearing a favorite pair of tight-fitting jeans, which can press in all the wrong places. “Thank God I love hippie skirts,” says Sernekos.

But unlike 1960s-inspired fashion, chronic pelvic pain is ready to be resigned to the past. “Women no longer have to settle for being debilitated,” says C. Paul Perry, MD, chairman of the International Pelvic Pain Society and an assistant clinical professor of obstetrics and gynecology at the University of Alabama at Birmingham. “We’ve made a lot of progress in the past decade in educating physicians about chronic pain.”

What doctors now know is that CPP is rarely due to just one problem. “Most women have three or more conditions, each of which adds to their overall discomfort,” says Richard Marvel, MD, director of the Center for Pelvic Pain at the Greater Baltimore Medical Center and an assistant professor of gynecology and obstetrics at Johns Hopkins School of Medicine. “If you treat just one cause, the patient won’t get much better.”

After finally seeking help at a pelvic pain center, Sernekos, for instance, learned she had several underlying conditions: generalized vulvar dysesthesia (pain anywhere in the vulva), vulvar vestibulitis (excruciating tenderness at the entry to the vagina), and a pelvic joint problem that pulls her pelvic floor muscles taut as a drumhead. A carefully tailored treatment regimen has made her 90% better: “I’m no longer in hell,” she says.

Still, to find relief, you’ll need to be your own educator and advocate. It’s essential that you understand some of the more common components of CPP, the subtle differences between them that even doctors miss, and how the various conditions interact with one another and exacerbate your symptoms. Familiarize yourself with the tests you’ll need, as well as the menu of conventional and natural therapies available to you. Most important, learn how to find a specialist who knows how to untangle the myriad, mysterious causes of your pain. Your first challenge: Learn why you hurt.

Five common conditions for which your doctor will test are:

1. Endometriosis

5 million women have it

Cells similar to the tissue lining the uterus migrate elsewhere and break down each month in sync with your period.

Telltale signs

Severe cramps, often coinciding with your menstrual cycle, that radiate to the lower back and leg.

How it’s diagnosed

Laparoscopy (a minimally invasive surgical procedure) to perform biopsies (removal of tissue samples for examination under a microscope).

Treatments

Frontline remedies include nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen sodium, along with birth control pills and other hormones to shrink endometrial tissue. Your doctor may recommend minimally invasive surgery to remove or destroy endometrial growths or, in severe cases, a hysterectomy.