Hysterectomy

Topic Overview

What is a hysterectomy?

A hysterectomy is surgery to take out a woman’s uterus, the organ in a woman's belly where a baby grows during pregnancy. After a hysterectomy, you will not be able to get pregnant.

Other organs might also be removed if you have severe problems such as endometriosis or cancer. These organs include the cervix (the lower part of the uterus that opens into the vagina), the ovaries (glands on both sides of the uterus that release eggs for pregnancy), and the fallopian tubes (the passageway between the uterus and the ovaries).

Whether or not the ovaries are removed will depend on your age and risk for certain types of cancer. For example, removing the ovaries lowers the risk of ovarian cancer and some types of breast cancer. But, if you have your ovaries removed before the age of menopause, you will go into early menopause, and you may be more likely to get heart disease or osteoporosis. Be sure to discuss all the benefits and risks of removing your ovaries with your doctor.

See an illustration of the female reproductive system.

What problems does this surgery treat?

Most often, hysterectomy is done to treat problems with the uterus, such as pain and heavy bleeding caused by endometriosis or fibroid tumors. The surgery may also be needed if there is cancer in the uterus, cervix, or ovaries. Some women may have the surgery during childbirth to save their lives if there is heavy bleeding that cannot be stopped.

Before you choose to have a hysterectomy, consider all of your treatment options. In many cases, this surgery is a last resort after trying other treatments for the problem.

How is the surgery done?

There are many different ways to do hysterectomy surgery. The type of surgery you have depends on three main things: the reason for the surgery, the size of the uterus and its position in the belly, and your overall health. The most common types are:

• Abdominal hysterectomy. In this type, the doctor makes a cut in the belly, either across the bikini line or straight up and down. The doctor takes out the uterus and the cervix. This type is most often done when cancer might be present or when severe endometriosis, a lot of scar tissue (adhesions), or a very large uterus makes the uterus hard to remove.
• Vaginal hysterectomy. With this type, the doctor takes out the uterus through the vagina. He or she makes a small cut in the vagina instead of the belly. Your doctor will not use this method when there is a chance that cancer may be in the uterus, cervix, or ovaries. Doctors use this type of surgery only in cases where the uterus is small and easy to remove.
• Laparoscopically assisted vaginal hysterectomy (LAVH). To do this surgery, the doctor puts a lighted tube (laparoscope) through small cuts in your belly. The doctor can see your organs with the scope and can insert surgical tools to cut the tissue that holds your uterus in place. Then he or she can remove the uterus through your vagina.
• Laparoscopic supracervical hysterectomy (LSH). With LSH, the doctor inserts the scope and tools through small cuts in your belly. He or she takes out the uterus in small pieces and leaves the cervix in place. This surgery is done only if you don't have cervical cancer.^1,
• Total laparoscopic hysterectomy (TLH). In this type, the doctor inserts a scope and tools through several small cuts in the belly. The doctor takes out the uterus and the cervix in small pieces through one of the cuts.

How long will it take to recover from surgery?

Feeling better after surgery takes time. Most women are in the hospital 1 or 2 days after the surgery. Some women stay in the hospital up to 4 days.

When you get home, make sure you move around, but also be sure you don't do too much. You can walk around the house and up and down stairs, but take it slow. During the first 2 weeks, it’s important to get plenty of rest. Even after you start to feel stronger, you should not lift heavy things (anything over 20 pounds). Also, you should not have sex until your doctor says it’s okay. It usually takes 4 to 8 weeks to get back to a normal routine.

Frequently Asked Questions

Learning about hysterectomy:	What is hysterectomy? What is oophorectomy? What is hysterectomy used to treat? How does a subtotal hysterectomy compare with a total hysterectomy? What are the different procedures used for hysterectomy? What are the advantages and disadvantages of different hysterectomy procedures? What questions should I ask my health professional about hysterectomy? When is hysterectomy used for chronic pelvic pain? When is hysterectomy used for heavy, irregular menstrual bleeding? When is hysterectomy used for endometriosis? When is hysterectomy used for uterine fibroids? When is hysterectomy used for uterine prolapse? Should I have my ovaries removed when I have a hysterectomy?
Being diagnosed:	What examinations and tests do I have before a hysterectomy?
Ongoing concerns:	What are the risks of hysterectomy? What do I need to know about physical and emotional recovery from a hysterectomy? Should I use estrogen replacement therapy (ERT) after a hysterectomy or oophorectomy?

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Author:	Kathe Gallagher, MSW	Last Updated: August 25, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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