Hysterectomy: Uses, methods, and recovery

A hysterectomy is an operation to remove the uterus, or womb, and sometimes also the cervix, fallopian tubes, and ovaries. It is a common procedure and it is done for a number of reasons.

After a hysterectomy, a woman will no longer have periods or be able to carry a pregnancy. If the ovaries are removed, menopause will occur.

Fast facts about a hysterectomy

A hysterectomy removes the uterus and possibly other nearby organs.

It is used to treat cancer or a precancerous condition, excessive bleeding, polyps, and endometriosis.

The type of procedure depends on the reason for doing it.

Recovery can take several weeks, but symptoms of menopause can last for longer.

Reasons for treatment

docotr holding a model of a uterus
A hysterectomy is carried out to remove the uterus, usually to relieve symptoms or to prevent cancer.

A woman’s uterus, cervix, fallopian tubes, and ovaries are located within the pelvis.

A hysterectomy can be carried out for several reasons.

These include:

gynecologic cancers of the cervix, uterus, ovaries, or fallopian tubes

some precancerous gynecologic conditions

uterine fibroids or benign uterine growths

chronic pelvic pain

heavy vaginal bleeding that severely affects a woman’s quality of life

uterine prolapse, where the uterus drops from its location within the pelvis and sits in or out of the vagina

endometriosis, in which uterine-like tissue grows in locations other than within the uterus, including the outside of the uterus, fallopian tubes, ovaries, pelvic ligaments, lining of the abdomen, bladder, vagina, rectum, bladder, intestines, appendix and or rectum, or, more rarely in the lungs

adenomyosis, where the uterine tissue grows through the uterine wall instead of staying confined to the inner portion of the uterus

Types

The type of hysterectomy will depend on a range of factors, including the reason for the procedure.

Total Hysterectomy: This procedure includes the removal of the uterus and cervix, the part of the uterus where the baby or menstrual blood exits the womb into the vagina. The ovaries and fallopian tubes may or may not also be considered for removal, depending on individual health circumstances.

Supracervical, subtotal or partial hysterectomy: The upper portion of the uterus is removed and the cervix is left in place. The ovaries and fallopian tubes may or may not also be considered for removal, depending on individual health circumstances.

Radical hysterectomy: This procedure is typically reserved for certain gynecologic cancers, including cervical cancer. During a radical hysterectomy, the uterus, cervix, and other structures are removed. These include the tissue located on the sides of the cervix and the uppermost portion of the vagina. The surgeon may or may not recommend removing the fallopian tubes and ovaries.

Removal of the fallopian tubes and ovaries

The decision to do this depends on several factors, including why the procedure is being performed.

In some cases, ovary and fallopian tube removal may be recommended to prevent some ovarian or fallopian tube cancers in women who are at higher risk.

Women should speak with their healthcare provider to discuss their individual risks, especially if there is a high chance of developing breast or ovarian cancer.

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Procedure

There are several ways of performing a hysterectomy.

Abdominal hysterectomy: The surgeon makes an incision through the abdomen to remove the uterus and possibly other pelvic structures or tissues.

Vaginal hysterectomy: The uterus and possibly other structures are removed through an incision at the top of the vagina.

Laparoscopic hysterectomy: Small incisions on the abdomen, around 1 to 2 centimeters (cm) long, allow for surgical tools to be used. The surgeon uses a laparoscope, or lighted camera, to view inside the pelvis and evaluate the pelvic organs.

The surgeon will remove the uterus and possibly other pelvic organs, for example the fallopian tubes, and ovaries, through small incisions in the upper portion of the vagina or the abdomen. This is also known as a “keyhole” procedure.

Robotic laparoscopic hysterectomy: A robotic arm, controlled by the surgeon, performs the procedure through small incisions. This is associated with shorter healing times and fewer complications than the traditional methods of hysterectomy. It is similar to a laparoscopic hysterectomy.

Risks and complications

As with any surgical procedure, a hysterectomy involves some risks.

These may include:

reaction to anesthesia

bleeding or hemorrhage

damage to surrounding urinary tract, bowel, or other surrounding organs

infection

blood clots including pulmonary emboli (lung blood clot)

vaginal complications, such as prolapse

ovarian failure

surgically induced menopause if ovaries are removed

wound healing issues, including blood clot formation

a rectal or urinary tract fistula, where a hole develops between the vagina and the rectum or urinary bladder, increasing the risk of infection

bowel obstruction

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