A hysterectomy is a surgical procedure that removes all or part of the uterus. The procedure may also remove the fallopian tubes, ovaries and/or the cervix.
A hysterectomy may be recommended to treat a variety of gynecologic conditions, including the following:
- Uterine fibroids. Hysterectomy is the only sure way to cure uterine fibroids completely. Health care providers usually recommend a hysterectomy treat uterine fibroids if your fibroids are large, you have very heavy bleeding, and you are near or past menopause.
- Abnormal uterine bleeding (AUB) or heavy periods (menorrhagia)
- Pelvic organ prolapse. This is a condition in which the uterus drops out of its normal position, causing women to urinate more frequently, limit their movements or avoid sex due to pain.
- Uterine or cervical cancer. Some uterine and cervical cancers may be treated with hysterectomy or with other treatment methods.
Your doctor will recommend a hysterectomy based on several factors, including the following:
- The medical condition being treated
- Your age
- Your personal preferences
Having a hysterectomy means that you will no longer be able to get pregnant. Talk to your partner or spouse before deciding to have a hysterectomy. This process cannot be reversed, so be certain about your choice before having the surgery.
If you have not gone through menopause and are considering a hysterectomy, talk to your health care provider about keeping your ovaries. The ovaries make hormones that help maintain bone density and sexual health even if the uterus is removed. If your body can continue to make these hormones on its own, you might not need hormone replacement after the hysterectomy. In some cases, the removal of the ovaries may be required to achieve the desired outcome.
Types of Hysterectomies
Hysterectomies may be categorized by the organs that are removed. Types of hysterectomies include:
- Supracervical Hysterectomy. This is also called a “Subtotal Hysterectomy” or “Partial Hysterectomy”. This removes the uterus but leaves the cervix in place. This may be suggested to reduce the risk of pelvic organ prolapse and preserve sexual function.
- Total Hysterectomy. Sometimes referred to as a “Traditional Hysterectomy”, this approach removes the uterus and cervix.
- Bilateral Salpingo-oophorectomy (BSO). This refers to the removal of the ovaries. This may be performed as part of a total hysterectomy.
- Radical Hysterectomy. This type of hysterectomy removes the uterus and all of surrounding organs, including the cervix, fallopian tubes, ovaries and, in some cases, the pelvic lymph nodes.
A hysterectomy may be performed in a variety of ways. Newer techniques may be less invasive, resulting in a faster recovery times and less risk of scarring compared to traditional procedures.
Types of surgical techniques include the following:
- Abdominal (Open): This hysterectomy method requires a small, 4-8 inch incision in the abdomen. This incision may be similar to what is done during a cesarean section (C-section). The incision is just large enough to remove the uterus. This type of hysterectomy is performed under general anesthesia, with a typical hospital stay of 3-6 days and up to 6 weeks of recovery time.
- Vaginal Hysterectomy. Instead of making a cut into the abdomen, the surgeon removes the uterus through the vagina. This method is less invasive than an abdominal hysterectomy, so recovery time is usually shorter. Vaginal hysterectomies usually require a 1-3 day hospital stay and a 3-4 week recovery. Vaginal hysterectomy may not be an option if your fibroids are very large.
- Laparoscopic Hysterectomy. Minimally-invasive approaches may include laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, or robotic-assisted laparoscopic hysterectomy. Not all cases of uterine fibroids can be approached with such approaches, but these methods may result in reduced post-operative recovery time. With this hysterectomy method, a thin, lighted, telescope-like instrument called a laparoscope, along with small surgical instruments, are inserted into the abdomen through 3 to 4 tiny incisions, to remove the uterus. It usually requires no more than 1-3 days in the hospital. Recovery takes from 6 days to about 3-4 weeks, depending on the type of laparoscopic hysterectomy. Based upon your clinical need, your doctor might perform a Laparoscopic Supracervical Hysterectomy (LSH), allowing you to keep your cervix, or a Total Laparoscopic Hysterectomy (TLH).
All medical procedures present risks, including potential blood loss, infection and damage to other internal organs. Be sure to speak with your doctor about possible risks.
Reference: National Institutes of Child Health and Human Development