Hysterectomy

Hysterectomy at a glance

• A hysterectomy is a surgical procedure to remove a woman’s uterus (womb).
• Removal may be a partial hysterectomy (usually the top part of the uterus), total hysterectomy (usually all of the uterus and the cervix) or radical hysterectomy (uterus, cervix and upper part of the vagina).
• The ovaries and Fallopian tubes may also be removed in hysterectomies.
• Hysterectomies are performed as open abdominal surgery, through an incision in the vagina, or using minimally invasive surgery.
• Removing the uterus means that a woman can no longer become pregnant and no longer has menstrual periods.

What is a hysterectomy?

A hysterectomy is a surgery to remove a woman’s uterus. The uterus, more commonly known as the womb, is a part of the female reproductive system responsible for the development of the embryo and fetus during pregnancy. Depending upon the reasons for the hysterectomy, a surgeon may choose to remove all or parts of the uterus, as well as other reproductive organs.

Hysterectomies are the second most common surgical procedure performed on women. Each year in the U.S. more than 600,000 women receive a hysterectomy.

Reasons for a hysterectomy

Cancers of the cervix, ovaries and endometrium are the cause of only 10 percent of hysterectomies. The other reasons most often relate to severity of symptoms a woman experiences from underlying conditions. Because it is a major operation, with life-changing effects, a hysterectomy is only recommended when other treatments have failed to correct the symptoms.

Reasons a woman may have a hysterectomy, partial, total or radical, include:

• Uterine fibroids. These noncancerous tumors in or around the uterus can cause pain and heavy bleeding due to their growth putting pressure on surrounding organs.
• Abnormal vaginal bleeding. Hormonal changes, fibroids, infection or cancer can cause heavy blood loss and long bouts of bleeding.
• Endometriosis. When cells of the endometrium (the lining of the uterus) grow outside the uterus but continue to act as if they are shedding tissue in the womb during the menstrual cycle, they can damage tissues and cause infections, resulting in pain, heavy and abnormal bleeding and infertility.
• Pelvic pain. This can be caused by some of the causes listed here and also by pelvic inflammatory disease (PID). PID is a bacterial infection that can damage the Fallopian tubes and uterus and cause long-term pain.
• Adenomyosis (uterus thickening). Endometrial cells grow in the muscle wall of the womb, resulting in heavy bleeding during periods and pelvic pain.
• Uterine prolapse. If the tissues and ligaments supporting the uterus weaken, the uterus can drop down from its normal position, resulting in back pain, urinary incontinence, discomfort and pain during sexual intercourse.
• Uterine, cervical, ovarian and endometrial cancers at an advanced stage generally require a hysterectomy.

Hysterectomy procedures

There are several types of hysterectomy categorized by the extent of the uterus and other organs that need to be removed. Patients should discuss with their physician which type of hysterectomy is right for them, and make sure they completely understand the effects.

Types of hysterectomies

Partial (supracervical or subtotal) hysterectomy: includes removal of only the body of the uterus (its upper part) but keeps the cervix.

Total hysterectomy: includes the removal of the entire uterus and cervix but not the Fallopian tubes or ovaries. Total hysterectomies are the most common type of hysterectomy.

Radical hysterectomy: includes the removal of the entire uterus, the cervix, most of the tissue around the cervix and the top portion of the vagina. This procedure, generally only for cases of cancer, may also include the removal of the pelvic lymph nodes.

Hysterectomy with salpingo-oophorectomy: combines a total hysterectomy plus removal of the Fallopian tubes and either one or both ovaries (oophorectomy).

Surgical procedures for hysterectomy

Depending on which section of the uterus and reproductive organs need removal, a hysterectomy is performed as either open surgery or minimally invasive surgery (such as robotic surgery or laparoscopy).

In addition, a hysterectomy can be performed using different surgical techniques: through the vagina, through the abdomen or with laparoscopy. A doctor will make the determination based on a patient’s health and other factors.

Surgical techniques

Abdominal (or open) hysterectomy. The uterus is removed through the abdomen via a surgical incision (either vertical or horizontal). This procedure is most commonly used when the ovaries and fallopian tubes are being removed, when the uterus is enlarged, or when disease has spread to the pelvic cavity, as in endometriosis or cancer.

Vaginal hysterectomy. The uterus is accessed through an incision in the vagina and removed through the vaginal opening. Since no external incision is made, there is no visible scarring with this surgical technique and there is a shorter recovery time. However, this procedure is not optimal for all women or all conditions hysterectomy treats, including patients with abnormal adhesions or a large uterus.

Laparoscopy hysterectomy. In a laparoscopic hysterectomy, small incisions are made either in the vagina or the abdomen. The organs are visible through a laparoscope (thin, flexible tube with video camera). Surgical tools are also inserted and the uterus is then removed.

Robotic laparoscopic hysterectomy. A surgeon uses a computer to control the robotic arm that manipulates surgical instruments during the hysterectomy. Robotic-assisted surgery is more precise and typically involves smaller incision points.

Recovery from a hysterectomy

The length of time it takes to recover after a hysterectomy is different for every woman and depends upon the type of surgery she had.

For an open hysterectomy, it can take up to a couple of months to get back to full health. For minimally invasive surgeries, typical recovery is three to four weeks.

After a hysterectomy, a woman will no longer have periods or be able to get pregnant. If the ovaries weren’t removed, they will continue producing hormones and eggs until a patient reaches menopause. If ovaries were removed, a woman will begin menopause immediately after surgery.

Risks and side effects

Hysterectomies’ risks are low. But any surgery carries risks. While a hysterectomy generally does not cause any serious problems, complications may occur in a small number of women and include:

• Reaction to the anesthesia
• Infection
• Blood clots
• Blood loss
• Injury to surrounding organs caused by surgical instruments
• Chronic pain
• Urinary incontinence
• Vaginal prolapse (part of the vagina coming out of the body)
• Fistulas (development of an abnormal connection between the vagina and bladder).