Hysterectomy: A Comprehensive Procedure Guide
Key takeaways:
A hysterectomy is the surgical removal of the uterus. Although it’s a major surgery, your provider can use a minimally invasive technique to reduce healing time.
Most hysterectomies are for benign conditions such as fibroids, endometriosis, or uterine prolapse. Sometimes hysterectomies are part of the treatment plan for cervical, uterine, or ovarian cancer.
Hysterectomy is generally a safe procedure, but there are some risks. If you have underlying medical problems, your risks may be higher.
Table of contents
Making the choice to remove your uterus by having a hysterectomy is a big decision. And it’s a major surgery. But there are many reasons why having a hysterectomy may be a good choice for you.
Most of the time, a hysterectomy is used as a treatment for a common condition like fibroids or endometriosis. And it can be a lifesaving procedure for women with cancer of their reproductive organs or severe bleeding.
No matter what your journey to hysterectomy may be, here you’ll find information to explain the procedure and why it’s done.
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus or womb. It’s one of the most common major surgeries performed in the U.S. And it’s not a new procedure. There are records of women having hysterectomies back in ancient times.
As you can imagine, the complication rates were high during those times. Fortunately, with current advances, hysterectomies are much safer and easier to recover from.
Why do some women get hysterectomies?
There are many reasons a provider may recommend a hysterectomy. You may need a hysterectomy due to symptoms you’re having. These symptoms may include:
Pelvic pain
Heavy or irregular menstrual bleeding
Abnormal pap smears
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Several different conditions can cause these symptoms. Hysterectomy is only an option if you no longer want to be pregnant and after other treatments haven’t worked.
Let’s review five common conditions that a hysterectomy can help treat.
Uterine fibroids
Uterine fibroids are benign (noncancerous) tumors of the uterus. They can grow throughout a woman’s lifetime until menopause. Often they have no symptoms and go unnoticed.
When they get large enough, they can cause symptoms. There’s a wide range of treatment options for uterine fibroids. But sometimes a hysterectomy is the preferred treatment.
Symptoms of uterine fibroids include:
Pelvic pain
Painful sex
Heavy menstrual bleeding
Anemia
Endometriosis or adenomyosis
Endometriosis is a condition where tissue from the lining of the uterus gets planted outside of the uterus. In adenomyosis, the tissue implants within the wall of the uterus rather than in the lining. These conditions are similar in that they both cause you to have tissue that moves outside of where it belongs. This can lead to extremely painful periods, cramping, and heavy bleeding.
Uterine prolapse
Uterine prolapse happens when the pelvic floor weakens and the uterus falls down through the vagina. Hysterectomy is generally considered a safe and effective treatment. There are more conservative treatments, but prolapse tends to recur. Hysterectomy is a more definitive treatment.
Gynecologic cancers
Gynecologic cancers can occur in any part of the female reproductive tract. Uterine cancer (of the uterus) is the most common type of gynecologic cancer. Removing the uterus may be a part of the treatment plan for uterine cancer. It may also help to treat other gynecologic cancers, including:
Ovarian cancer
Cervical cancer
Fallopian tube cancer (this is rare)
In these cases, hysterectomy can be a lifesaving measure to treat cancer.
Severe cervical dysplasia or precancerous cells
In rare cases, a hysterectomy can be done for a precancerous condition of the cervix or uterus. In general, this is not a first choice because there are other medications or minor procedures that can also treat these conditions. But, if you’re sure that you’re not interested in preserving your fertility for any reason, hysterectomy may be a good option for you.
What are the different types of hysterectomy?
There are different surgical approaches to hysterectomy. Your provider may suggest removing or keeping other female reproductive organs. Let’s review the different types of hysterectomy.
Total hysterectomy
A total hysterectomy removes the uterus and cervix. Your provider may suggest this if there’s a concern for any current or future cervical changes. When the cervix is removed, the risk of cervical cancer goes away. This means that you will no longer need a pap smear screening for cervical cancer.
Many providers who perform hysterectomy prefer to remove the cervix at the time of hysterectomy. In rare cases, scar tissue may prevent removal of the cervix during a hysterectomy. This can happen in people who have had multiple (more than two) C-sections.
Subtotal hysterectomy
A subtotal or supracervical hysterectomy is the removal of the uterus without the removal of the cervix. There was some belief that keeping the cervix could help prevent the remaining pelvic organs from prolapse. But the evidence hasn’t consistently shown that keeping the cervix benefits the pelvic floor.
If you keep your cervix after hysterectomy, you will still need regular pap smear screening for cervical cancer. Sometimes, when the cervix is left after hysterectomy, you can still have a menstrual cycle. This is because there can be functioning uterine tissue in the cervix that remains. If you’re considering a hysterectomy for heavy periods, you may want to consider removing the cervix as well.
Hysterectomy with salpingectomy
Many gynecologists now recommend salpingectomy — removal of the fallopian tubes — during hysterectomy. This is because there’s evidence that removing the fallopian tubes decreases the lifelong risk of ovarian cancer.
The fallopian tubes are only necessary for getting pregnant. Once you decide to have a hysterectomy, you won’t be able to get pregnant or carry a baby. Removing the fallopian tubes may be a good option — even if just to decrease your ovarian cancer risk.
Radical hysterectomy
Radical hysterectomy is done for people with cervical cancer. It’s a more extensive surgery. A radical hysterectomy removes the:
Uterus
Cervix
Parametrium (tissue near the cervix)
Upper vagina
Only a gynecologic oncologist can do this type of hysterectomy. This is a specialist with additional training in cancer treatment.
How are hysterectomies performed?
There are a few different ways to perform hysterectomies. And there are advantages and disadvantages to each approach. Let’s take a closer look at each surgery technique.
Abdominal hysterectomy
This type of surgery is done through a large incision on the belly, when the uterus is extremely large. Common reasons for this approach are:
Large fibroids or tumors
Prior abdominal surgeries and scar tissue
Less invasive attempts have failed
Your provider may have a good surgical view with this approach, but there are a few downsides.
Disadvantages of the abdominal route include:
Increased pain
Longer recovery time
Inpatient hospital stay
Increased risk for infection, blood clots, and nerve damage
The typical recovery time from an abdominal hysterectomy is about 6 weeks.
Vaginal hysterectomy
During a vaginal hysterectomy, your provider reaches the uterus through the vagina. There are no skin incisions. Instead, your surgeon will make an incision behind the cervix and into the pelvis. Once the uterus is free, it can be removed through the vagina.
Benefits of the vaginal approach include:
Less pain
Quicker recovery time
Lower costs
Less risk of complications
This type of hysterectomy has a recovery time of about 4 weeks.
Laparoscopic hysterectomy
Laparoscopic surgery is a minimally invasive surgery, and the incisions are small. Your provider removes the uterus through the vagina or one of the incisions. They use a camera as a guide.
The advantages of a laparoscopic hysterectomy include:
Possible outpatient surgery
Less pain
Less blood loss
Shorter recovery time
Less risk of complications
Recovery time for this type of surgery is about 2 to 4 weeks.
Robotic hysterectomy
A robotic hysterectomy is very similar to a laparoscopic hysterectomy. But with this technique, the surgeon uses robotic equipment to complete the surgery.
The advantages of robotic surgery are similar to laparoscopic surgery, except the surgeon has a much better view. This is especially helpful when there’s a large amount of scar tissue (adhesions) or widespread gynecologic cancer.
Recovery time is about 2 to 4 weeks for this surgery.
What are the risks of a hysterectomy?
When considering a hysterectomy it’s important to know there are potential risks. Complications are rare, but they can occur — regardless of the technique. Complications can include:
Bleeding or the need for a blood transfusion
Severe pain
Damage to nearby organs (like bowel or bladder)
Infection
Blood clots (deep venous thrombosis or pulmonary embolism)
Nerve damage
Issues related to anesthesia
Disability
Death
Keep in mind, most people having a hysterectomy have no complications at all. But your risk of complications may be greater if you have underlying medical conditions.
The bottom line
Many factors can play into your decision to have a hysterectomy. And there are many options to consider. Fortunately, providers can usually perform hysterectomies with minimally invasive techniques. While a hysterectomy is a safe procedure, there are some risks. Talk to your provider about all of the options and possible outcomes of hysterectomy. This will help you weigh your options and make the choice that’s best for you.
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References
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Centers for Disease Control and Prevention. (2022). Uterine cancer.
Pillarisetty, L. S., et al. (2022). Vaginal hysterectomy. StatPearls.
Sasaki, K. J., et al. (2014). Persistent bleeding after laparoscopic supracervical hysterectomy. JSLS: Journal of the Society of Laparoendoscopic Surgeons.
ScienceDirect. (n.d.). Radical hysterectomy.
Sutton, C. (1997). Hysterectomy: A historical perspective. Bailliere's Clinical Obstetrics and Gynaecology.
The American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice. (2017). Choosing the route of hysterectomy for benign disease.
The American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice. (2019). Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention.
The American College of Obstetricians and Gynecologists. (2023). Hysterectomy.
Tsai, S., et al. (2021). 41. Pelvic organ function after total versus subtotal abdominal hysterectomy. 50 Studies Every Obstetrician-Gynecologist Should Know.
UAB Medicine. (n.d.). Supracervical hysterectomy.
Wiser, A., et al. (2013). Abdominal versus laparoscopic hysterectomies for benign diseases: Evaluation of morbidity and mortality among 465,798 cases. Gynecological Surgery.
