Hysterectomy

What is a hysterectomy?

A hysterectomy is the surgical removal of a woman’s uterus to treat a variety of diseases, disorders and conditions of the uterus and reproductive system. The uterus is a pear-shaped organ located in the lower abdominal (pelvic) area where a baby grows during pregnancy. Hysterectomy is a common but major surgery with significant risks and potential complications. Removing the uterus also means that you will no longer be able to bear children. Your body may experience other changes as well. Less invasive treatment options may be available to you depending on your condition and specific circumstance, so you should consider getting a second opinion about your treatment options before having a hysterectomy.

Types of hysterectomy

The types of hysterectomy procedures include:

• Supracervical hysterectomy (subtotal or partial hysterectomy) is removal of part of the uterus leaving the cervix intact.
• Total hysterectomy is removal of both the uterus and the cervix.
• Radical hysterectomy is an extensive surgery that includes removal of the uterus, the top of the vagina, and tissues around the cervix. Your doctor may perform a radical hysterectomy if you have cancer.

Other surgical procedures that may be performed

In addition to a hysterectomy, your doctor may also recommend one or more additional procedures to treat certain conditions. These include:

• Oophorectomy is the removal of one or both ovaries, which are glands that produce a woman’s eggs and female hormones.
• Salpingectomy is the removal of one or both fallopian tubes, which connect your ovaries to your uterus.

Why is a hysterectomy performed?

A hysterectomy is a major surgical procedure that may be recommended to treat a variety of diseases and conditions of the uterus and reproductive system. For many of these conditions, a hysterectomy may only be considered if other treatment options that involve less risk and fewer complications have been ineffective in treating your condition. Talk with your doctor about all of your treatment options and consider getting a second opinion, especially if you still want to bear children or have not yet reached menopause.

Your doctor may recommend a hysterectomy for:

• Abnormal vaginal bleeding that does not get better with other treatments, such as medication or procedures that do not involve removal of the uterus
• Adenomyosis, a thickening of the uterus that causes heavy, painful periods. Adenomyosis may be treated in some cases without a hysterectomy with medications and may go away on its own after menopause.
• Cancer of the cervix, ovaries or uterus (often endometrial cancer). Certain cases of cervical cancer or precancerous changes of the cervix may be treated without removing the uterus.
• Childbirth complications, such as uncontrolled bleeding or uterine rupture (rare)
• Chronic pelvic pain that does not improve with other treatments
• Endometriosis, an abnormal uterine tissue growth that causes severe menstrual pain, chronic low back and pelvic pain, and abnormal vaginal bleeding. Endometriosis can often be treated without a hysterectomy with medications or a minimally invasive laparoscopic procedure to remove the endometrial lesions.
• Uterine fibroids, benign tumors of the uterus that can cause significant bleeding and pain in some cases. Fibroids often need no treatment or may be treated without a hysterectomy with medications or less invasive procedures, such as uterine artery embolization myomectomy.
• Uterine prolapse, dropping or sliding of the uterus into the vagina. Uterine prolapse is often treated with a hysterectomy. However, if there are no symptoms, uterine prolapse may need no treatment other than lifestyle changes. Other treatment options include a vaginal device (pessary) that holds the uterus in place, and a surgical procedure that uses ligaments to support the uterus.

How is a hysterectomy performed?