A hysterectomy is a surgery to remove a woman’s uterus. It’s one of the most common major surgeries performed on women in the United States. About 600,000 hysterectomies are performed each year.
During a hysterectomy, the whole uterus is removed, including the cervix. The ovaries and fallopian tubes may or may not be removed along with the uterus, depending on the reason for the surgery. Removing the ovaries results in surgical menopause.
Types of hysterectomy
There are three main types of hysterectomy:
Total hysterectomy
In a total hysterectomy, the uterus and cervix are removed. This is the most common type of hysterectomy.
Partial hysterectomy
In a partial hysterectomy, the upper part of the uterus is removed but the cervix is left in place.
Radical hysterectomy
A radical hysterectomy removes the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina. A radical hysterectomy is done when cancer is present.
Why a hysterectomy may be needed
Some common reasons a doctor may recommend a hysterectomy include:
- Uterine fibroids – Noncancerous tumors that grow in and around the uterus. Fibroids can cause heavy bleeding, pain, and pressure on nearby organs.
- Endometriosis – A condition where tissue similar to the uterine lining grows outside the uterus, causing pain and abnormal bleeding.
- Uterine prolapse – When the uterus drops down into the vagina, often after childbirth.
- Cancer – Cervical, uterine, or ovarian cancers.
- Chronic pelvic pain – Long-lasting pelvic pain that does not respond to treatment.
- Abnormal vaginal bleeding – Very heavy periods or bleeding between periods.
If a gynecologic cancer is present, a hysterectomy may be recommended to treat the cancer, along with radiation therapy and chemotherapy in some cases.
What organs are removed during a hysterectomy?
The uterus (womb) and cervix are always removed in a hysterectomy. The extent of the surgery depends on the type of hysterectomy:
Total hysterectomy
A total hysterectomy removes the entire uterus, including the cervix. The ovaries and fallopian tubes are not removed.
Total hysterectomy with salpingo-oophorectomy
This is a total hysterectomy plus bilateral salpingo-oophorectomy, which means the ovaries and fallopian tubes are removed on both sides. This causes surgical menopause.
Radical hysterectomy
A radical hysterectomy removes the uterus, cervix, surrounding tissue, upper vagina, and usually the pelvic lymph nodes. The ovaries may or may not be removed.
Partial hysterectomy
In a partial hysterectomy, only the upper part of the uterus is removed. The cervix is left in place. The ovaries are not removed.
| Procedure | Uterus Removed? | Cervix Removed? | Ovaries Removed? | Fallopian Tubes Removed? |
|---|---|---|---|---|
| Total hysterectomy | Yes | Yes | No | No |
| Total hysterectomy with salpingo-oophorectomy | Yes | Yes | Yes | Yes |
| Radical hysterectomy | Yes | Yes | Sometimes | Sometimes |
| Partial hysterectomy | Upper portion | No | No | No |
How is a hysterectomy performed?
There are several ways a hysterectomy can be performed:
Abdominal hysterectomy
This is the most common approach. The surgeon makes an incision in the abdomen to access and remove the uterus. A bikini cut along the pubic hairline is often used. Recovery time is 4-6 weeks.
Vaginal hysterectomy
The uterus is removed through the vagina. No abdominal incision is needed. Recovery time is quicker than an abdominal hysterectomy.
Laparoscopic hysterectomy
The surgeon operates through several small incisions in the abdomen using long, thin surgical tools and a tiny camera. The uterus is removed in pieces through the incisions. Recovery is faster than an abdominal hysterectomy.
Robotic hysterectomy
This type of laparoscopic hysterectomy uses a specialized robotic system to help the surgeon operate through small incisions. Recovery time is short.
The best surgical approach will depend on each patient’s situation and the surgeon’s expertise. The vaginal and laparoscopic methods allow faster recovery times but may not be options for all patients.
Recovery after hysterectomy
Recovery time after a hysterectomy varies from about 2-6 weeks, depending on the type of procedure. Pain and discomfort after surgery should gradually get better over the first several weeks.
Here’s what to expect during the recovery period:
- Stay in the hospital 1-2 days for postoperative care
- Bleeding and discharge lasting 1-2 weeks
- Burning feeling when urinating the first week
- Moderate pain and fatigue lasting about 2-3 weeks
- Avoid strenuous activity for 4-6 weeks
- No heavy lifting for 6 weeks
- No sexual intercourse for 6-8 weeks
- Driving may be restricted 2-4 weeks
- Need 6-8 weeks off work for full recovery
The incision site will heal over the first month. Internal healing of the top of the vagina will continue for several months.
Long-term effects of hysterectomy
After recovering from a hysterectomy, most women can return to their usual activities. But there are some long-term effects to understand:
- Infertility – A hysterectomy results in permanent infertility since the uterus is removed.
- Early menopause – Removal of the ovaries causes menopause to begin if you are premenopausal. Estrogen and other hormone levels rapidly decline.
- Loss of sexual pleasure – Some women notice less vaginal lubrication and reduced sensation in the vagina after the surgery.
- Osteoporosis risk – Loss of estrogen increases the risk of osteoporosis. Bone density screening is recommended.
- Greater surgical risks – Any future surgery has increased risks due to the hysterectomy.
- Emotional effects – Some women report depression or grief after hysterectomy since they can no longer bear children.
Hormone replacement therapy can help manage symptoms of surgical menopause. Vaginal moisturizers or lubricants may help maintain sexual pleasure. Staying active, eating healthy and taking calcium supplements can help prevent osteoporosis.
Conclusion
A hysterectomy is a major surgery to remove a woman’s uterus and cervix. It can also involve removal of the ovaries and fallopian tubes. This results in permanent infertility and, if the ovaries are removed, causes immediate menopause. While hysterectomy provides relief from underlying conditions, women need to understand the emotional and lifelong physical changes they may experience after the surgery. Following post-operative recovery guidelines, maintaining a healthy lifestyle and hormone therapy can help manage long-term effects.
