Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. After this surgery, you can no longer become pregnant and will not have menstrual periods. It is one of the most common surgeries for women, with approximately 600,000 performed each year in the United States.

Table of contents

• What is a hysterectomy?
• Types of hysterectomy
• Conditions treated with hysterectomy
• Surgical approaches
• Preparing for surgery
• Recovery and timeline
• Risks and complications
• Long-term effects

What is a hysterectomy?

A hysterectomy is a major surgical procedure in which a surgeon removes your uterus. The uterus, also called the womb, is the organ where a baby grows during pregnancy. Depending on the reason for surgery, the procedure may also involve removing your cervix (the lower part of the uterus that opens into the vagina), fallopian tubes, and ovaries.^[1]

After a hysterectomy, you will no longer have menstrual periods and cannot become pregnant. The ovaries are not necessarily removed during every hysterectomy. If you are not yet in menopause (the time when menstrual periods naturally stop) and your ovaries remain, you will not immediately enter menopause after surgery.^[1]

• Uterus
• Cervix
• Ovaries
• Fallopian tubes

Types of hysterectomy

Your healthcare provider will discuss which type of hysterectomy you need based on your medical condition. The different types determine which organs and tissues are removed during surgery.^[2]

The main types of hysterectomy include:

• Total hysterectomy: This is the most common type. The surgeon removes the entire uterus and cervix. The ovaries and fallopian tubes may or may not be removed. Because the ovaries can remain, you may not enter menopause immediately after surgery.^[1]
• Partial hysterectomy (also called subtotal or supracervical hysterectomy): The surgeon removes only the upper part of the uterus while leaving the cervix in place. If you have this type, you will still need regular cervical cancer screening tests because the cervix remains.^[1]
• Radical hysterectomy: The surgeon removes the uterus, cervix, the upper portion of the vagina, and surrounding tissue and lymph nodes (small organs that are part of the immune system). This type is most commonly used to treat cancer, such as cervical cancer.^[2]
• Total hysterectomy with bilateral salpingo-oophorectomy: This procedure removes the uterus, cervix, both fallopian tubes, and both ovaries. Removing the ovaries will cause menopause to begin immediately if you have not already completed it.^[1]

Conditions treated with hysterectomy

Healthcare providers often suggest alternative treatments before recommending a hysterectomy. However, sometimes these treatments do not help, or surgery is the only option depending on the condition.^[1]

A hysterectomy may be recommended if you have:^[2][4]

• Uterine fibroids: Noncancerous growths in the uterus that can cause pain and heavy bleeding. This is the most common reason for hysterectomy.
• Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, causing pain and bleeding that has not been cured by medicine or other surgery.
• Uterine prolapse: When the uterus drops into the vagina, which can happen after several vaginal births, menopause, or because of obesity. This can lead to urinary incontinence (leaking urine) or fecal incontinence (leaking stool).
• Abnormal uterine bleeding: Heavy or unusual vaginal bleeding that persists despite treatment.
• Chronic pelvic pain: Long-lasting pain in the pelvic area that starts in the uterus. A hysterectomy is considered a last resort since it does not fix all types of pelvic pain.
• Adenomyosis: A thickening of the walls of the uterus where endometrial tissue grows into the muscle wall. A hysterectomy is only considered if pain is severe and no other treatments have worked.
• Cancer: Cancer of the uterus, cervix, ovaries, or endometrium (the lining of the uterus).

Many people also have a hysterectomy to prevent cancer. For those at high risk for certain types of cancer, removing the uterus and possibly surrounding organs can reduce the chances of developing cancer.^[1]

Surgical approaches

A hysterectomy can be performed using different surgical methods. Your provider will determine the best approach based on your general health, the reason for surgery, the size of your uterus, and other factors.^[2]

Vaginal hysterectomy

During a vaginal hysterectomy, the surgeon removes the uterus through a small incision made inside the vagina. This method is usually preferred over an abdominal hysterectomy because it is less invasive, involves a shorter hospital stay, and has a quicker recovery time. To be eligible for this approach, your uterus must be a certain size and not too large.^[3]

Laparoscopic hysterectomy

A laparoscopic hysterectomy uses a laparoscope, an instrument with a thin, lighted tube and a small camera. The surgeon inserts it through a small cut in your abdomen to see your pelvic organs. Other surgical instruments are inserted through additional small cuts to remove the uterus. This minimally invasive procedure results in less pain after surgery, shorter hospital stay, faster recovery, and lower risk of infection compared to open surgery.^[2]

Robotic hysterectomy

This is a type of laparoscopic hysterectomy where the surgeon guides a robotic arm to perform the surgery through small cuts in the lower abdomen. The robotic equipment can assist with better visualization and control.^[2]

Abdominal hysterectomy

During an abdominal hysterectomy, the surgeon makes a cut in your lower abdomen. The incision is either made horizontally along your bikini line or vertically from your belly button to your bikini line. This approach may be recommended if you have a large uterus, if your provider wants to check other pelvic organs for signs of disease, or if other methods are not suitable.^[2][6]

An abdominal hysterectomy usually requires general anesthesia (you are unconscious during the procedure). Most patients stay in the hospital for three days, and full recovery typically takes about six weeks.^[12]

Preparing for surgery

Before your hysterectomy, your healthcare provider will explain the procedure in detail, including possible complications and side effects. You may need to provide blood and urine samples to make sure you are healthy enough for surgery.^[1]

If you know you are going to have a hysterectomy, it is important to be as fit and healthy as possible. Good health before your operation will reduce your risk of developing complications and speed up your recovery. You should:^[3]

• Stop smoking
• Eat a healthy, balanced diet
• Exercise regularly
• Lose weight if you are overweight

You may need to have a pre-assessment appointment a few days before your operation. This may involve having some blood tests and a general health check to ensure you are fit for surgery. It is also a good opportunity to discuss any concerns and ask questions.^[3]

Tell your anesthesiologist about any health problems you have, any negative reactions you have had to anesthesia, and all prescribed and over-the-counter medicines, vitamins, and supplements you take. This information affects decisions about how to safely administer anesthesia during your procedure.^[7]

Recovery and timeline

Recovery time after a hysterectomy depends on the type of surgery you have. It typically takes four to six weeks to fully recover, though the recovery time may be shorter for some people. Recovery is generally faster with minimally invasive procedures.^[1]

For a vaginal hysterectomy, you will likely spend two nights in the hospital. You will experience significant pain for 24 hours and mild pain for about 10 days. Full recovery usually takes four weeks.^[12]

For an abdominal hysterectomy, you will typically stay in the hospital for three days. Recovery usually takes six weeks, although some women experience complications that require a longer recovery time.^[12]

For a laparoscopic or minimally invasive hysterectomy, recovery time is typically two to three weeks.^[17]

Self-care during recovery

During your recovery at home:^[18]

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Walking boosts blood flow and helps prevent complications.
• Avoid lifting anything heavy. This may include heavy grocery bags, a heavy briefcase or backpack, bags of cat litter or dog food, a vacuum cleaner, or a child.
• Hold a pillow over your incisions when you cough or take deep breaths. This will support your belly and may help decrease pain.
• Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• You may shower 24 to 48 hours after surgery if your doctor approves. Do not take a bath for the first two weeks, or until your doctor tells you it is okay.
• Eat a well-balanced diet, including protein, fruits and vegetables, which will help with healing.
• Drink about 8 to 10 glasses of fluids a day (especially water) to keep your body well hydrated.

You may have some light vaginal bleeding after surgery. Wear sanitary pads if needed. Do not use tampons or douche.^[19]

Ask your doctor when you can drive again and when it is okay to have sex. Most doctors recommend waiting at least six weeks after a hysterectomy before resuming sexual activity.^[17]

Risks and complications

Like all surgeries, a hysterectomy has risks, even though the results are usually good. More serious risks can include:^[2]

• Too much bleeding during surgery
• Infection
• Blood clots
• Injury to the bowel, bladder, or ureter (the tube that carries urine from the kidney to the bladder)
• Nerve damage

About 5 percent of women develop an infection after surgery that is treated with antibiotics in the hospital for as many as five days.^[12]

After surgery, you may experience pain at the incision site, nausea or vomiting as a side effect of anesthesia, spotting, bloating, and gas. Pain medication and a cold compress may be helpful in the initial 24 hours after surgery. If symptoms are more severe than expected, you should seek immediate medical attention.^[17]

Long-term effects

Hormonal changes

If your ovaries are not removed during the hysterectomy, hormonal changes do not usually occur because the ovaries continue to produce hormones. However, if both ovaries are removed before you have gone through menopause, you will experience immediate menopause signs and symptoms. These may include hot flashes, night sweats, vaginal dryness, and weight gain.^[4][17]

When the ovaries are removed, you may also be at increased risk of osteoporosis (weakening of the bones). Hormone therapy can be given to relieve signs and symptoms of menopause and may help reduce the risk of osteoporosis. Hormone therapy can be started immediately after surgery. Other medications can be given to prevent osteoporosis if you are at high risk.^[4]

Physical changes

Some individuals may notice changes in vaginal discharge after a hysterectomy. If the cervix is removed, there will be a loss of cervical mucus. When the ovaries are removed, a notable reduction in vaginal discharge and dryness may occur. Your doctor may recommend topical vaginal estrogen cream to restore vaginal moisture.^[17]

Most individuals do not experience any changes in sexual activity after a hysterectomy. However, a small number may encounter pain during deep penetration. This issue can usually be relieved by engaging in sexual activity within appropriate limits.^[17]

Emotional changes

Emotional changes after a hysterectomy vary from person to person. Some individuals may experience grief because they can no longer have a pregnancy or conceive a child, while others may feel relieved because the procedure addresses their health problem, stops menstruation, and eliminates the need for birth control. If negative emotions or severe mood swings arise, it is advisable to consult a specialist physician.^[17]