Hysterectomy

Hysterectomy — removal of the uterus — is a way of treating problems that affect the uterus. Many conditions can be cured with hysterectomy. Because it is major surgery, your doctor may suggest trying other treatments first. For conditions that have not responded to other treatments, a hysterectomy may be the best choice.

About the Uterus
The uterus is a muscular organ in the pelvis. The opening of the uterus is the cervix.

What Is Hysterectomy?
Hysterectomy is the surgical removal of part or all of the uterus. It is the second most common major surgery among women of child-bearing age.

Some reasons a hysterectomy may be needed include:

  1. Uterine fibroids
  2. Endometriosis
  3. Pelvic support problems (such as uterine prolapse)
  4. Abnormal uterine bleeding
  5. Cancer
  6. Chronic pelvic pain

A hysterectomy can be:

  1. Subtotal (also called partial or supracervical), in which the upper part of the uterus is removed but the cervix is left in place
  2. Total, in which the entire uterus, including the cervix, is removed
  3. Radical, in which the entire uterus and support structures around the uterus are removed (this is done if certain types of cancer are present)

A hysterectomy does not include removal of the ovaries and fallopian tubes.

Types of Hysterectomy
The type of hysterectomy chosen depends on the reason for the surgery. It also depends on the findings of a pelvic exam.

Abdominal Hysterectomy
In abdominal hysterectomy, the doctor makes an incision (cut) through the skin and tissue in the lower abdomen to reach the uterus. The incision may be vertical or horizontal.

Abdominal hysterectomy requires a longer healing time than vaginal or laparoscopic surgery. But there can be advantages to having an abdominal hysterectomy. This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation

Vaginal Hysterectomy
In vaginal hysterectomy, the surgery is done through the vagina. With this type of surgery, you will not have any scarring on your abdomen. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. A vaginal hysterectomy is not always feasible. For example, women who have intra-abdominal scar tissuefrom previous surgery or who have a very large uterus may not be able to have this type of surgery.

Laparoscopic Hysterectomy
Laparoscopic hysterectomy is done through small incisions in the abdomen. The uterus is removed in small pieces through these incisions. There are three types of laparoscopic hysterectomy:

  1. Total Laparoscopic Hysterectomy— a small incision is made in the navel for the laparoscope, and one or more small incisions are made in the abdomen for other instruments. The uterus is detached from its attachments and removed in pieces through the abdomen or through the vagina. In some cases, the surgeon will advise to leave the cervix behind. This is called a Laparoscopic Supracerical Hysterectomy.
  2. Laparoscopically Assisted Vaginal Hysterectomy (LAVH)— with laparoscopically assisted vaginal hysterectomy (LAVH), the doctor removes the uterus through the vagina. Your doctor may suggest LAVH if standard vaginal surgery cannot be done. LAVH involves the use of a small light-transmitting device called a laparoscope.
  3. Robot-Assisted Laparoscopic Hysterectomy— some surgeons use a robot attached to the laparoscopic instruments to help perform the surgery. Experience using this technology is limited. More information is needed to see if robotic surgery has added benefits over the other methods.

What to Expect
It is helpful to know what to expect before any major surgery. Before hysterectomy:

  1. Your blood and urine may be tested.
  2. You may be given one or more enemas.
  3. Your abdominal and pelvic areas may be partially shaved.
  4. Antibiotics will be given to prevent infection.

Risks
The risk of problems related to hysterectomy is among the lowest for any major surgery. As with any surgery, though, problems can occur. These problems could include:

  1. Blood clots in the veins or lungs
  2. Infection
  3. Bleeding during or after surgery
  4. Bowel blockage
  5. Injury to the urinary tract or nearby organs
  6. Problems related to anesthesia
  7. Early menopause (if ovaries are removed)
  8. Death

Removal of the Ovaries During Hysterectomy
If the ovaries are removed before menopause, you are likely to experience effects caused by lack of estrogen. These effects are similar to those of menopause and include hot flashes, vaginal dryness, and sleep problems. Women who have had their ovaries removed are also at greater risk for osteoporosis.

Women having these symptoms can receive a course of hormone replacement therapy (HRT). There are many different ways to receive HRT, including patches, pills, and vaginal rings. Speak to you doctor about your options. Although, in the past, HRT was considered safe for many years, the recommendations for the duration of HRT have changed.

Your Recovery
If you have a hysterectomy, you may need to stay in the hospital for a few days. The length of your hospital stay will depend on the type of hysterectomy you had.

Effects of Hysterectomy
Hysterectomy can have both physical and emotional effects.

Physical Effects
After hysterectomy, a woman’s periods will stop. If the ovaries are left in place, they continue to produce hormones. Although the ovaries still function, a woman can no longer get pregnant.

Emotional Effects
Many women have an emotional response to the loss of their uterus. This response depends on a number of factors and differs for each woman.

Sexual Effects
Some women notice a change in their sexual response after a hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.

Some women feel more sexual pleasure after hysterectomy. This may be because they no longer have to worry about getting pregnant. It also may be because they no longer have the discomfort or heavy bleeding caused by the problem leading to hysterectomy.

Finally…
Hysterectomy is just one way to treat uterine problems. It is major surgery. Before you decide whether it is right for you, find out as much as you can about:

  1. Your condition
  2. Other treatment options
  3. How hysterectomy may affect you

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months

Copyright © November 2007 The American College of Obstetricians and Gynecologists