What Is a Hysterectomy?
A hysterectomy is an operation to remove the uterus, or womb. Your uterus is where a fetus grows when you're pregnant.
This surgery often also removes your cervix, the canal that links the uterus and vagina. Depending on why you're having it, the surgeon may remove nearby structures like your ovaries and fallopian tubes as well.
The operation may be done for several reasons, including:
- Uterine fibroids that cause pain, bleeding, or other problems
- Uterine prolapse, which is when the uterus slides from its normal position into the vaginal canal
- Cancer of the uterus, cervix, or ovaries
- Abnormal vaginal bleeding
- Chronic pelvic pain
- Adenomyosis, in which tissue grows into your uterine wall, causing it to thicken
- Serious menstrual pain
- Uterine polyps (growths) that keep coming back
- Hyperplasia, which is when the lining of your uterus becomes too thick
- Gender affirmation
Hysterectomy for reasons other than cancer is usually considered only after other treatments have been tried without success.
Still, this is the second most common surgery women have, after cesarean section delivery. About 300,000 are done in the U.S. every year.
Types of Hysterectomy
Depending on the reason for your operation, your surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly. But they generally refer to whether your cervix and/or ovaries are also removed:
- A supracervical or subtotal hysterectomy removes only the upper part of the uterus, keeping the cervix in place.
- A total hysterectomy removes the whole uterus and cervix.
- A radical hysterectomy removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.
The surgeon may remove your ovaries – a procedure called oophorectomy – or leave them in place. The procedure to remove the tubes is called salpingectomy. When you entire uterus, both tubes, and both ovaries are removed, the entire procedure is called a total hysterectomy and bilateral salpingectomy-oophorectomy.
Surgical Techniques for Hysterectomy
Surgeons use different approaches for hysterectomy surgery, depending on their experience, the reason for your hysterectomy, and your overall health. The technique will partly determine how long your healing time will be and the kind of scar, if any, you'll have after the operation.
There are two approaches to surgery: a traditional or open surgery, and surgery using a minimally invasive procedure, or MIP.
Open Surgery Hysterectomy
An abdominal hysterectomy is an open surgery. This is the most common type, accounting for about 54% of hysterectomies done for all non-cancerous (benign) conditions.
To do an abdominal hysterectomy, the surgeon makes a 5- to 7-inch cut, either up-and-down or side-to-side, across your belly. The surgeon then removes the uterus through this cut.
After this type of surgery, you'll usually spend 2-3 days in the hospital. After healing, you'll have a visible scar where the cut was made.
Several approaches can be used for a minimally invasive procedure:
- Vaginal hysterectomy: The surgeon makes a cut in the vagina and does the uterus removal through this cut. The cut is closed, leaving no visible scar.
- Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera. Surgical tools are put in through several small cuts made in your belly or, in the case of a single-site laparoscopic procedure, one small cut made in your bellybutton. The surgeon does the procedure from outside your body, viewing it on a video screen.
- Laparoscopic-assisted vaginal hysterectomy: The surgeon uses laparoscopic tools in your belly to remove your uterus through a cut in your vagina.
- Robot-assisted laparoscopic hysterectomy: This is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside your body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a 3-dimensional screen.
Comparison of MIP Hysterectomy and Abdominal Hysterectomy
Using an minimally invasive approach to remove the uterus has several benefits, when compared to the more traditional open surgery. In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection.
With an MIP, you're generally able to resume your normal activity within about 3-4 weeks, compared to 4-6 weeks for an abdominal hysterectomy. And the cost of an MIP is considerably lower, depending on the instruments used and the time spent in the operating room. But robotic procedures can be much more expensive. There's also less risk of incisional hernias with an MIP.
A minimally invasive procedure isn't suitable for everyone. Scar tissue from previous surgeries, obesity, the size of your uterus, and your overall health status can all affect whether an MIP might be right for you. Talk with your doctor about whether you might be a good candidate.
Risks of Hysterectomy
Most people who get a hysterectomy have no serious problems or complications. Still, it's major surgery and is not without risks. Possible complications include:
- Urinary incontinence
- Vaginal prolapse (part of the vagina coming out of your body)
- Vaginal fistula formation (an abnormal connection that forms between your vagina and bladder or rectum)
- Chronic pain
Other risks from a hysterectomy include wound infections, blood clots, hemorrhage, reactions to anesthesia, and injury to surrounding organs, although these are uncommon.
What to Expect After a Hysterectomy
After the surgery, if your ovaries were also removed, you'll be in menopause and will no longer have periods. If your ovaries weren't removed, you may enter menopause at an earlier age than you would have otherwise.
Regardless of whether or not your ovaries were removed, you'll no longer be able to have children after uterus removal. It's very rare, but you could have an ectopic pregnancy after the surgery if your ovaries and fallopian tubes were left intact. This happens when a fertilized egg implants outside your uterus, and it's a medical emergency.
During hysterectomy recovery, most people are told to abstain from sex and avoid lifting heavy objects for 6 weeks.
Hysterectomy side effects might include spotty vaginal bleeding for up to 6 weeks after the surgery. You could also notice some irritation in the area of your cuts.
If your ovaries were removed, you could have symptoms of menopause like:
- Hot flashes
- Loss of sex drive
- Trouble sleeping
- Vaginal dryness
Talk to your doctor if you're bothered by these symptoms
After a hysterectomy, most people surveyed say they feel the operation improved or cured their main problem (for example, pain or heavy periods).
Hysterectomy Pros and Cons
Benefits of hysterectomy
When you have cancer of the uterus, cervix, or ovaries, this surgery can be life-saving. For those with other conditions, like fibroids or endometriosis, it can mean freedom from symptoms like pelvic pain and irregular or heavy periods.
If you have a high genetic risk of uterine cancer, a voluntary hysterectomy (one that's not necessary to save your life) can reduce it. Having your ovaries and fallopian tubes removed can lower your odds of other cancers, such as ovarian cancer and some types of breast cancer.
A hysterectomy is considered an essential part of gender-affirming surgery for those transitioning to male.
Risks of hysterectomy
Like any major surgery, this operation has risks and potential complications. You may need to go into the hospital. And you'll need downtime to recover.
If your procedure included ovary removal, you'll enter menopause and may have symptoms like hot flashes and sleep loss.
A hysterectomy also permanently prevents pregnancy.
A hysterectomy is a major surgery that's only recommended when other treatments don't work. But it can save your life if you have certain cancers, and relieve serious symptoms from some other conditions. Your doctor can help you weigh the benefits and risks.
What happens to a woman's body after a hysterectomy?
For many, the most notable change is that they no longer have symptoms of the condition that led to the operation. If you aren't yet menopausal when you have the surgery, you'll go into early menopause. You might notice a reduced sex drive or vaginal dryness. But you might find that freedom from symptoms like pain or heavy periods actually improves your sex life.
What is the main reason for a hysterectomy?
Uterine fibroids are the most common reason for this surgery. These are noncancerous growths in or on your uterus that can cause symptoms like belly pain and heavy bleeding. Other common reasons include abnormal period bleeding and prolapse, which is when the uterus drops down into the vaginal canal.
Is having a hysterectomy a major surgery?
The procedure is considered major surgery. You may stay in the hospital for 1-2 days, or longer if you had it to treat cancer. It can take up to 6 weeks to recover, depending on what type of operation you had.