Since, the procedure of hysterectomy is irreversible, the doctors take thorough medical examination of the patient and then decide if and what kind of surgery should be performed. From a minor preparation like quitting smoking; prohibition from consuming certain drugs like aspirin, ibuprofen, clopidogrel, warfarin and the like; to major physical tests are done.
The physical tests include a diagnostic pelvic examination and Pap smear (smear of vaginal or cervical cells obtained for cytological study). Before going in for a hysterectomy, for pelvic pain, the patient usually undergoes minor exploratory surgery procedures, namely, laparoscopy so as to eradicate other causes of pain. Similarly, prior to hysterectomy due to abnormal uterine bleeding, a sampling of the uterus lining is done to ensure the presence of any kind of cancer or pre-cancer of the uterus. This test is known as endometrial sampling. A trial medication may also be given to ease out the pain or bleeding. In addition to this, in order to make a more perfect diagnosis, an ultrasound of the pelvis or a computerized tomography (CT) of the pelvis may be done.
A woman having her regular menstrual cycle but suffering from irregular uterine bleeding, is first given a hormonal treatment. Non-hormonal or minor surgical processes such as tranexamic acid and ablations (removal of the uterine lining) respectively are also administered to the patient. If in spite of these tests, the bleeding does not subside and/or causes anemic conditions for the patient and there are no abnormalities in her endometrial sampling, the doctor resorts to hysterectomy.
Similarly, a woman who is in the menopausal stage of her life will be initially treated with the hormonal tests, failing which she can undergo hysterectomy. Of course, there is a big difference in the dosage of optimal medication after the surgery for either category of women.
Though the patient is advised not to eat or drink anything for at least 8 hours before surgery, postsurgery the patient is allowed to take medicines to reduce pain. This is given through IV intravenous tubes. The doctor advises the patient on the duration of hospital stay. A tube or catheter is inserted in the urinary bladder to drain out the urine, as immediate movement will not be possible. However, the earlier the patient is able to use the toilet and move about, the better it is for her. Movement only after a few days after the surgery is recommended, because, this will ease out the blood flow in the patient’s leg and prevent any kind of blood clotting. A normal diet is also recommended as soon as possible.
A gauze pack that had been placed in the vagina just after the surgery will be removed after a few days. Sanitary pads have to be used for some days as it is normal to have bleeding and brownish discharge post surgery.
Depending on the condition of the patient, the doctor suggests on the time when she will be able to get back to normalcy and also advises her not to lift heavy objects or bend too much.
Intimate relations can be resumed after about 6 weeks. In fact, in some cases, the relief from the thought of getting pregnant (if the ovaries have been removed) increases pleasure.
The patient who has experienced menopause will be relieved from chronic pain due to uterine problem. On the other hand, if a woman’s ovaries (both) have not been removed and she has not yet reached menopause, the surgeon recommends certain hormone replacements. Premenstrual symptoms are not affected by this surgery.