What to Expect After Hysterectomy

I had trouble finding straightforward advice on hysterectomy recovery, so I decided to share my experience. Granted, no two surgeries are the same, but I think we can make some useful generalizations. 

On the day I write this (January 28, 2024), I am 10 days post-surgery.

I had Stage 4 endometriosis. My endometriosis was affecting my day-to-day quality of life. There were days I couldn’t get off the couch, either due to fatigue or pain, or both. The flare-ups would feel like child labor. My bleeding was… out of control. There were days (and nights) I could fill an entire menstrual cup in about 45 minutes. By Christmas of last year, I was just trying to make it through each day. My local OB/GYN was urging me to “manage my symptoms” rather than having surgery. I don’t think she understood how much agony I was in. I did not feel heard or seen. I also couldn’t live on heavy-duty painkillers the rest of my life. I could write a whole article on endometriosis, but that’s a separate topic.

A friend referred me to Seckin Endometriosis Center in NYC, after having 4 unsuccessful surgeries herself, and I never looked back. (Beware of specialized surgeries in a small town, or non-major city!).

My surgery involved the removal of my uterus (hysterectomy), removal of one (and a half) diseased ovaries (partial oophorectomy), and a cystectomy, which is the excision of multiple cysts and endometriomas.

*Prior to going into surgery, you will be asked, probably multiple times, “what surgery are you having today?”, so it’s important to know the technical terms. They want to make sure you fully understand – and consent to – the organs they are about to remove. 

**My surgery was fairly complicated. If you are going in for a simple hysterectomy – or even a simple oophorectomy, I would expect your recovery to be faster and easier than mine.

In the process, they also removed my appendix, my fallopian tubes, my cervix and a whole bunch of endometrial tissue that was errantly growing inside my abdominal cavity. 

Endometrial tissue looks like dried glue and had adhered to many of my organs, including my bladder, bowel and ureters. In fact, the tissue had wrapped around my right ureter so badly, it was almost completely obstructed. Of course, no one knew any of this until they got in there to see what was actually going on.

This is one of the biggest challenges of endometriosis: you can’t see it from the outside.

When my surgeon came around the next day, she took my hand and said, “it was pretty bad in there, how have you been living like this?”. 

I could have cried (but I knew it would hurt too much, LOL). 

At that moment, I felt so unbelievably vindicated.

Getting Ready for Hysterectomy

In the weeks leading up to your surgery, it will behoove you to get your body into good shape. If you go in strong, it will make your recovery quicker and easier. If you are a caffeine fiend, you may want to consider weaning yourself of caffeine leading up to your surgery. There will be about 3 days (at least) where you cannot have coffee (you won’t want it, either), and the withdrawal will not help.

Day Before Surgery

The day before your surgery, you will most likely have to do a “bowel prep” to empty your bowel so the surgeons have more space to work. 

I was dreading this part, as I’d never done it before, but it really wasn’t that bad. The harder part was not being able to eat solid food for about 36 hours prior to surgery. A hearty broth is your best friend the day before surgery; you don’t want to become weak and hangry.

The day of your surgery, you won’t be able to eat at all. This sucks if your surgery is in the afternoon like mine was. Note that you might not know the time your surgery is scheduled for until the day before. Note also you will likely lose several pounds this week and the next. 

Surgery Day

The morning of your surgery, you’ll be asked to shower and clean your body really well with a potent antibacterial soap. Make sure you stay as clean as possible before your surgery; this will reduce your infection risk. 

Try to stay as calm as possible – find your happy, calm place. Turn off your phone so you aren’t too overwhelmed by texts and… people. 

Think positively – it’s going to be okay! You’ll be so relieved when it’s all over.

If you are prone to nausea, especially from anesthesia, make sure to tell the doctors and nurses beforehand!! I will talk a lot about managing nausea because I think it’s commonly overlooked.

Waking Up

Waking up from surgery can take a while, depending on how long you were under. I was under for 4.5 hours, so I was very groggy for days, especially the first 2 days. If you are only under for an hour or two, you won’t feel groggy for as long. 

My surgery was late in the day, so I stayed that night at the hospital, though some of you will probably go home the same day. There’s no shame in staying a night – or even two. Looking back, there is NO way I could have gone home that night. Absolutely no way.

When you come to, the first thing you will notice is that your throat is very sore from the breathing tube, like you have a frog that you can’t clear. In fact, you may not get your voice back to normal for a few days. 

It will be extremely painful to cough, sneeze, laugh, cry, clear your throat (learned all this the hard way), and it’s doubly painful to vomit, so do whatever you can to prevent those things. You won’t have a lot of energy to talk, so just whisper until you get your voice back .

You will probably wake up with pressers on your lower legs. These are leg massagers that cycle through inflation to keep the blood moving in your lower legs to prevent blood clots. I rather liked that part.

Depending on the time of day, you may be offered food, though I will tell you, you won’t have much of an appetite. But try to eat something, even if it’s just a few bites, and drink, drink, drink because they won’t discharge you until you pee a certain amount. You will likely still have a catheter during the first few hours/night of recovery, so you don’t have to worry about getting up to use the bathroom… yet. 

Gas Pain After Hysterectomy

The pain will be pretty intense when you wake up – and most of it is from gas. When they operate on you, they fill your abdomen with CO2 to create space to maneuver their tools and cameras, and this gas gets trapped inside you after surgery. 

I’m not kidding when I say the gas pain is the worst part of all of this. The pain from the gas is dynamic; sometimes it feels like stabbing pain and sometimes it’s more of a dull ache. It even hurts in your shoulders and your neck (what?). Bottom line: the gas pain is rough. 

I was given Tylenol and Torodol (a strong ibuprofen) after surgery – and was sent home with it. I’ll be the first to tell you it wasn’t enough, so I requested narcotics in the hospital after a night of no sleep. I still don’t know what the big effing deal is about receiving narcotics for a couple of days after a major surgery. They make you feel like an addict for asking for it. I wish it weren’t this way. 

That said, you don’t want to stay on the narcotics longer than you have to. For me, it was about  2 days. Narcotics will contribute to constipation, which is an inevitably of surgery, but you don’t want to make it worse. 

Basically, pain control is all a balance between pain relief and side effects. 

You won’t be able to start passing the gas for about 24 hours after surgery (or more), which is why that first day is so brutal. By about 36 hours, you should start passing the gas, both out your rear and through burping it up and believe me, you will feel a great sense of relief once the gas starts dissipating. 

Nausea after Hysterectomy 

Speaking of the gas, the pain and the fullness of the gas – alone – can cause nausea. Add onto that the anesthesia and, if you are taking narcotics (like Oxy or Norco), these can all contribute to nausea. Nausea after hysterectomy can be sheer misery, so it’s very important to control it for the first 3 days after surgery. You do NOT want to be vomiting after abdominal surgery — I can’t think of anything worse. 

In my experience, this is something you have to be very proactive about. I was sent home with Zofran, and I’m so glad I had it. But I had to push for it!

Again, once the gas starts to dissipate, the nausea will also subside — and you’ll start feeling much better.

Walking

They want you to get up and walk in the first 24 hours after surgery, depending on time of day, and once they remove your catheter. 

This will seem like a daunting task. The act of even sitting upright is a challenge, and then figuring out how to swing your legs over so you can stand. Eesh. 

But don’t worry, it gets easier. 

It’s tough the first time you stand to walk. Even getting your body vertical can be a challenge. You may feel very dizzy or nauseous, so take it slow. If you have an abdominal binder, use it. You might feel like your innards are about to spill out of you, so having something to compress the tummy can help you feel more comfortable. 

The thing is walking helps expel the gas, so as uncomfortable as it can be, you need to do it; if you lie in bed all day, the gas won’t come out as readily. 

Going Home

Getting home from the hospital was no picnic. I was in NYC, so we took an Uber. Do yourself a favor and get the Luxury Uber – you will feel every little pothole and bump, not unlike after childbirth.  

Once you get home, just go to bed. I feel like I slept for 2-3 days afterward. 

Two very important things: stay on top of your meds and don’t forget to walk. Hopefully, you’ll have someone taking care of you that can keep a med schedule – and even wake you up in the night to take your meds – and to take you to pee. *Don’t worry, you won’t be pooping for several days or more.

Just rest as much as you can, but don’t neglect to get up and walk every so often, even if it’s just a short distance. 

Leg and Back Pain After Hysterectomy

I had major pain in my lower-right back for the first week after surgery. Apparently, this is common. The back pain will go away in about a week, only to make room for…. the leg pain. 

I still have no idea why my legs hurt so badly – it felt like I had run a marathon, mostly in my upper legs. It may be because of how my legs were positioned during surgery, or perhaps because of sudden underuse. This pain occurred starting about a week after surgery and lasted about a week. 

Hot flashes and Headaches after Hysterectomy

Because they took 1.5 of my ovaries, my estrogen had plummeted and left me with crazy hot flashes and later, headaches. The hot flashes make you feel like you’re running a fever, and actually had me a bit worried that I was (I wasn’t).  

We’ve all heard of hot flashes, but I was not prepared for “hysterectomy headaches”. These actually got worse the 2nd week after surgery, as I still hadn’t received my estrogen that was being sent in the mail (big mistake!).

I’ve read that even the removal of the uterus (alone) can cause these symptoms as well. 

Be sure you have the hormone convo before surgery so you aren’t caught off guard by this. Hysterectomy recovery is miserable enough without dealing with sudden hormone deprivation. *Please see note at bottom regarding hormone replacement!

My appetite came back on the 2nd day, but I was only hungry for very simple things, like toast. Eat whatever appeals to you, you can worry about nutrition later.

By day 3, you should be starting to feel better and by day 5… you might even feel pretty ok. You’ll probably have a post-op appointment on day 5 or 6. This is when they’ll remove the tape from your incisions and make sure all your major systems are back online. 

They’ll also want to make sure you can poop – and might send you home with a laxative which you can (and should) use. The postoperative constipation is real – and your belly might start to get bloated. This will only add to your discomfort. 

On Day 5, I flew home from NYC after my appointment. This was not ideal, but I really wanted to get home. I had lots of help, including wheelchair assistance. *Do yourself a favor and buy a 1st class ticket if you are flying home. 

About a week after your surgery (by day 7 or 8, give or take), you should have turned a corner. 

You might be wondering when you can lay on your side after hysterectomy. For the first few days after the surgery, you’ll be confined to sleeping on your back because of the incisions on your right and left side (for laparoscopic surgery). After about a week, you may be able to start lying and sleeping on your side, if it feels ok. Your body will tell you. 

By Day 8, I was able to have (kind of) a normal day, which felt so good. By Day 10 (today), I feel like I’m getting back into the swing of things. I can drive and walk longer distances, go to the store (although twisting a lot in driving doesn’t feel great). Bending over is not my favorite, but I can do it. I’m relying heavily on my legs vs. bending over.

I can’t lift heavy things (for several weeks) and I don’t have a lot of endurance, but I think it will get better every day. Right now, I can “do” laundry… but I can’t carry the laundry basket. I can cook food and do light cleaning… but I can’t take out the trash because it’s too heavy. Things like that. 

I am told it will take 4 weeks to feel fairly normal, so I’m looking forward to that. Update: I am 4 weeks post-surgery and they were right! Four weeks is about the magic number when you can start easing back into your normal everyday activities. Notice is said EASE. 

I can already feel relief in my body. My hip pain has subsided. My tailbone pain is gone. I can stand after being seated a while for dinner, for example, and not have to brace myself to stand and walk. I had been suffering greatly from Stage 4 endometriosis.

I ceremoniously threw away all my tampons, cups, pads, and period underwear. I’m just so grateful to have ridded myself of endometriosis. I’m so grateful to my surgeons, Drs. Tamer Seckin and Amanda Chu, at  Seckin Endometriosis Center in NYC.

What to Wear After Hysterectomy

In the first few days after your surgery, it’s best to stick to dresses and nightgowns. You don’t want anything against your waist, though I found it was ok to wear regular underwear, as long as it’s not too tight. It’s a little bit more forgiving than after a c-section because your incisions are smaller and less… gruesome. The incisions with a hysterectomy are surprisingly small and dainty, only a couple of centimeters each (I had 4).

I was able to start wearing loose pants, like sweatpants, after a few days. You can also ease back into yoga pants, as long as the panel around the tummy isn’t too tight. I found that I could wear them for a couple of hours, but then the pressure got too uncomfortable, and I’d switch back to loose sweatpants. 

Maternity pants/jeans would work too, as long as they have a full panel, but honestly, I was most comfortable in dresses and maxi skirts.

Hormone Replacement

Please, please be advised that many OB/Gyns in this country do NOT have proper/current training on menopause care and hormone replacement. Facts. It’s hardly taught in medical school and many (most) practicing Ob/Gyns are using data from a 20 year old WHI study (that has since been debunked) regarding cancer risk and hormone replacement. 

I feel like I could write a 10-page diatribe about this, but please protect yourself from the bad/outdated advice that may be doled out by your well-meaning OB/GYN regarding HRT (hormone replacement treatment), which is now called MHT (menopausal hormone therapy).

Please refer to modern standards for HRT/MHT, as issued by OB/Gyns who are menopause specialists, such as Dr. Corinne Menn and Dr. Mary Claire Haver. Bottom line: estrogen replacement is the gold standard for women undergoing full or partial hysterectomy, unless you have a reason you can’t take it. Discuss your situation with a qualified menopause care specialist. If your OB/Gyn is giving you the runaround, seek another opinion!

Life without hormones is miserable. Fight me on this.

Update:

Hi! I’m 6 weeks post-surgery. Some have asked me when they can go back to work after hysterectomy. They say 6 weeks. If you have a desk/office job, I would think you’d be able to go back around 3-4 weeks, if you had to. If you have a physical job, discuss it with your surgeon. Honestly, hanging out at home can get pretty boring and a little depressing, so maybe easing back into to work isn’t a bad thing. 

My muscles feel weak and it’s been annoying to not be able to use them. I feel like I’ve lost muscle mass and gained fat, but I guess that’s just how it goes after surgery. The situation is temporary (I hope). I’m really looking forward to getting back to the gym and being able to take a bath again!

In conclusion, you’ll need a solid 4 weeks before you can resume activities after hysterectomy, like lifting heavier things, but you should start to fee better after about a week. Be patient. Replace our hormones, if you’re able. Ask for help with kids. Don’t push it too hard. You can do this!