Hysterectomy at a glance
- A hysterectomy is the surgical removal of the uterus or “womb”
- Hysterectomies can be performed as open surgery or minimally invasive surgery
- Like all surgeries, a hysterectomy has risks
- A hysterectomy makes pregnancy impossible
What is a hysterectomy?
A hysterectomy is a surgical procedure that removes a woman’s uterus, detaching it from the ovaries, fallopian tubes and upper vagina. Depending on the condition the hysterectomy is meant to treat, other reproductive organs may also be removed.
A procedure called an oophorectomy will be performed if the ovaries are removed. A procedure called a salpingectomy will be performed if the fallopian tubes are removed.
A supracervical hysterectomy will leave the cervix (the lower part of the uterus) intact, while a total hysterectomy will remove the uterus completely.
If the woman has not already reached menopause, a hysterectomy will stop monthly periods and make pregnancy impossible.
A woman may need to have her uterus and/or fallopian tubes and ovaries removed for several reasons, including:
- Uterine fibroids (sometimes symptomatic, noncancerous tumors that grow in the walls of the uterus)
- Abnormal vaginal bleeding
- Chronic pelvic pain
- Uterine prolapse (when the uterus moves from its normal position into the vaginal canal)
- Adenomyosis (a thickening of the uterine tissue)
- Cancer prevention
- Cancer of the uterus, cervix or ovaries
Generally, a hysterectomy for non-cancerous conditions is performed after other treatment options have been tried without success.
Women who want to have children should consider alternatives to a hysterectomy. Options depend upon the condition the surgery is trying to treat. Please see the sidebar to the right to learn more about these options.
Depending on the size of the uterus and patients anatomy, a hysterectomy can be performed as an open surgery or minimally invasive surgery (including vaginal surgery, and laparoscopic, and laparoscopic assisted robotic surgery).
Open abdominal surgery
The surgeon makes an incision 5 inches to 7 inches in length in the lower abdomen, either in an up-and-down or side-to-side orientation. The surgeon performs the hysterectomy and removes the uterus through this incision.
Because it is open surgery, recovery time can range from four to six weeks, with an average three-day hospital stay following the procedure. The site of the incision will also show a visible scar.
Minimally invasive surgery
Hysterectomies can also be performed using minimally invasive techniques that allow shorter recovery times. Relatively normal activity can usually be resumed within two to four weeks.
Minimally invasive surgery also causes less pain, less potential scarring and less risk of an incisional hernia.
Not all women are candidates for a minimally invasive hysterectomy.
Minimally invasive hysterectomy includes the following approaches:
- Vaginal hysterectomy: The surgeon removes the uterus through an incision in the vagina, allowing the incision to be closed easily, leaving no visible scar. In general, vaginal hysterectomies are associated with better patient outcomes and fewer complications than a traditional abdominal or laparoscopic hysterectomy.
- Laparoscopic hysterectomy: The surgeon makes several small incisions in the woman’s abdomen and inserts a laparoscope (a small tube with a light and tiny camera) as well as surgical instruments through the incisions to remove the uterus through the vagina. The surgeon is able to view the surgical area on a monitor.
- Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical instruments, the surgeon makes a small incision in the abdomen and inserts a laparoscope (a small tube with a light and tiny camera) as well as surgical instruments through the incisions to remove the uterus. An incision is also made in the vagina and the uterus is removed through the vagina.
- Laparoscopic assisted robotic surgery: Using a computer system to control robotic surgical instruments inserted through small incisions in the abdomen, the surgeon operates remote controls to remove the uterus, allowing for greater precision and flexibility than traditional laparoscopy.
As with all surgeries, there are possible complications.
Uncommon complications that may occur in a small number of women include:
- Blood clots
- Injury to the bladder or ureter (tube that connects the kidney to the bladder)
- Injury to other surrounding organs including intestines, muscles, nerves, or blood vessels
- Infections including bladder infections, pelvic abscesses, skin infections, etc.
- Fistula formation (an abnormal connection the develops between the vagina and bladder)
- Allergic reaction to medications used including anesthetic, pain medication, adhesives, or skin prep
What to expect after a hysterectomy
Hysterectomies are usually effective in treating the targeted condition. If the uterus is removed and the ovaries are left intact, patients can expect to enter menopause at the average expected age of 52 years old. If the ovaries are removed, menopause will begin immediately. These symptoms include hot flashes, night sweats, and difficulty sleeping.
After a hysterectomy, women should avoid sex and lifting heavy objects until their physician has cleared them to resume normal activity.
Alternatives to Hysterectomy
Many alternatives to hysterectomy exist today. Unfortunately, most of the treatments prevent pregnancy from occurring in the future. We divide these treatments into two categories: fertility sparing and fertility non-sparing treatments.
Fertility sparing procedures (for women who want to have a baby):
Myomectomy – A surgical procedure that removes uterine fibroids (noncancerous growths) and reconstructs the uterus instead of removing it.
Levonorgestrel IUD – An intrauterine device that emits progestin hormone to the uterus. This device is particularly helpful for stopping heavy bleeding. It is also an excellent contraceptive method. When an IUD is removed, a woman can get pregnant immediately.
Medications – Many medications exist that can help control or decrease vaginal bleeding. Some medications also act as a temporary birth control, while other medications are safe to get pregnant while taking.
Fertility non-sparing procedures (for women who don’t want more children)
Uterine artery embolization – A procedure performed by an interventional radiologist to treat fibroids. The arteries that supply fibroids are occluded with small, permanent beads. Women can expect a decrease in bleeding and some decrease in the size of fibroids. Pregnancy is not recommended after this procedure. Women should use a reliable form of birth control after this procedure is completed.
Ablation – A short procedure that destroys the uterus lining, known as the endometrium. This procedure will lighten a woman’s period. Women with abnormally heavy bleeding may be good candidates for this procedure. Pregnancy is not recommended after this procedure. Ablation is not a birth control; therefore, women who have had an ablation should use a reliable contraceptive method as well.
Talk with one of our physicians to decide on the best treatment option.