Hysterectomy (from Greek ὑστέρα, hystera, “uterus” + ἐκτομή, ektomḗ, “a cutting out of”) is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.
Usually performed by a gynecologist, hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called “complete”) or partial (removal of the uterine body while leaving the cervix intact; also called “supracervical”). It is the most commonly performed gynecological surgical procedure. In 2003, over 600,000 hysterectomies were performed in the United States alone, of which over 90% were performed for benign conditions. Such rates being highest in the industrialized world has led to the major controversy that hysterectomies are being largely performed for unwarranted and unnecessary reasons.
Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases.
Oophorectomy (removal of ovaries) is frequently done together with hysterectomy to decrease the risk of ovarian cancer. However, recent studies have shown that prophylactic oophorectomy without an urgent medical indication decreases a woman’s long-term survival rates substantially and has other serious adverse effects. This effect is not limited to pre-menopausal women; even women who have already entered menopause were shown to have experienced a decrease in long-term survivability post-oophorectomy.
Why Is a Hysterectomy Performed?
Your doctor may suggest a hysterectomy if you have any of the following:
- chronic pelvic pain
- uncontrollable vaginal bleeding
- cancer of the uterus, cervix, or ovaries
- fibroids, which are benign tumors that grow in the uterus
- pelvic inflammatory disease, which is a serious infection of the reproductive organs
- uterine prolapse, which occurs when the uterus drops through the cervix and protrudes from the vagina
- endometriosis, which is a disorder in which the inner lining of the uterus grows outside of the uterine cavity, causing pain and bleeding
- adenomyosis, which is a condition in which the inner lining of the uterus grows into the muscles of the uterus
Alternatives to a Hysterectomy
According to the National Women’s Health Network, a hysterectomy is the second most common surgical procedure performed on women in the United States. It’s considered to be a safe, low-risk surgery. However, a hysterectomy may not be the best option for all women. It shouldn’t be performed on women who still want to have children unless no other alternatives are possible.
Luckily, many conditions that can be treated with a hysterectomy may also be treated in other ways. For instance, hormone therapy can be used to treat endometriosis. Fibroids can be treated with other types of surgery that spare the uterus. In some circumstances, however, a hysterectomy is clearly the best choice. It’s usually the only option for treating uterine or cervical cancer.
You and your doctor can discuss your options and determine the best choice for your specific condition.
What Are the Types of Hysterectomy?
There are several different types of hysterectomy.
During a partial hysterectomy, your doctor removes only a portion of your uterus. They may leave your cervix intact.
During a total hysterectomy, your doctor removes the entire uterus, including the cervix. You’ll no longer need to get an annual Pap test if your cervix is removed. However, you should continue to have regular pelvic examinations.
Hysterectomy and Salpingo-Oophorectomy
During a hysterectomy and salpingo-oophorectomy, your doctor removes the uterus along with one or both of your ovaries and fallopian tubes. You may need hormone replacement therapy if both of your ovaries are removed.
How Is a Hysterectomy Performed?
A hysterectomy can be performed in several ways. All methods require a general or local anesthetic. A general anesthetic will put you to sleep throughout the procedure so that you don’t feel any pain. A local anesthetic will numb your body below the waistline, but you’ll remain awake during the surgery. This type of anesthetic will sometimes be combined with a sedative, which will help you feel sleepy and relaxed during the procedure.
During an abdominal hysterectomy, your doctor removes your uterus through a large cut in your abdomen. The incision may be vertical or horizontal. Both types of incisions tend to heal well and leave little scaring.
During a vaginal hysterectomy, your uterus is removed through a small incision made inside the vagina. There are no external cuts, so there won’t be any visible scars.
During a laparoscopic hysterectomy, your doctor uses a tiny instrument called a laparoscope. A laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front. The instrument is inserted through incisions in the abdomen. Three or four small incisions are made instead of one large incision. Once the surgeon can see your uterus, they’ll cut the uterus into small pieces and remove one piece at a time.
During the procedure
An anesthesiologist will give you either:
- General anesthesia in which you will not be awake during the procedure; or
- Regional anesthesia (also called epidural or spinal anesthesia) in which medications are placed near the nerves in your lower back to “block” pain while you stay awake.
The surgeon removes the uterus through an incision in your abdomen or vagina. The method used during surgery depends on why you need the surgery and the results of your pelvic exam.
During a vaginal hysterectomy, some doctors use a laparoscope (a procedure called laparoscopically assisted vaginal hysterectomy or LAVH) to help them view the uterus and perform the surgery.
A laparoscope with advanced instruments can also be used to perform hysterectomy completely through tiny incisions (total or supracervical laparoscopic hysterectomy). In more difficult cases, surgeons may employ assistance of robotic instruments placed through the laparoscope to complete the laparoscopic hysterectomy (robotic-assisted laparoscopic hysterectomy).
How long does the procedure last?
The procedure lasts 1 to 3 hours. The amount of time you spend in the hospital for recovery varies, depending on the type of surgery performed.
Risks of Hysterectomy
Most women who undergo hysterectomy have no serious problems or complications from the surgery. However, hysterectomy is considered a major surgery and is not without risks. Those complications include:
- Urinary incontinence
- Vaginal prolapse (part of the vagina coming out of the body)
- Fistula formation (an abnormal connection that forms between the vagina and bladder)
- Chronic pain
Other risks from hysterectomy include wound infections, blood clots, hemorrhage, and injury to surrounding organs, although these are uncommon.
What to Expect After Hysterectomy
Most women are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.
After a hysterectomy, the vast majority of women surveyed feel the operation was successful at improving or curing their main problem (for example, pain or heavy periods).
How long it takes you to recover depends on the type of hysterectomy. Average recovery times are:
- Abdominal hysterectomy: 4 to 6 weeks
- Vaginal hysterectomy: 3 to 4 weeks
- Robot-assisted or total laparoscopic hysterectomy: 2 to 4 weeks
A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy. Discuss with your provider the risks and benefits of this therapy.
If the hysterectomy was done for cancer, you may need further treatment.