Hysterectomy
Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus; Laparoscopic hysterectomy; Laparoscopically assisted vaginal hysterectomy; LAVH; Total laparoscopic hysterectomy; TLH; Laparoscopic supracervical hysterectomy; Robotically assisted hysterectomy
Hysterectomy is surgery to remove a woman's womb (uterus). The uterus is a hollow muscular organ that nourishes the developing baby during pregnancy.
Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.
Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A hysterectomy may be done through an abdominal or a vaginal incision.
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
The uterus is joined at the cervix to the vagina and by the fallopian or uterine tubes to the ovaries.
Description
You may have all or part of the uterus removed during a hysterectomy. The fallopian tubes and ovaries may also be removed.
There are many different ways to perform a hysterectomy. It may be done through:
- A surgical cut in the belly (called open or abdominal)
- Three to four small surgical cuts in the belly and then using a laparoscope
- A surgical cut in the vagina, aided by the use of a laparoscope
- A surgical cut in the vagina without the use of a laparoscope
- Three to four small surgical cuts in the belly, in order to perform robotic surgery
You and your doctor will decide which type of procedure. The choice will depend on your medical history and the reason for the surgery.
The female reproductive system is a very complex system. And as with any system, occasionally, things go wrong. When treatments and therapies can't fix an issue, sometimes surgery is required. Surgery to remove a woman's uterus or womb, a major component of this system, is called hysterectomy. Let's talk about this procedure. There are many reasons a woman may need a hysterectomy cancer of the uterus, usually endometrial cancer; cancer of the cervix; childbirth complications, such as uncontrolled bleeding; other long-term vaginal bleeding problems; long-term pelvic pain. Other reasons include severe endometriosis, including growths outside the uterus; slipping of the uterus into the vagina and perhaps tumors in the uterus, such as uterine fibroids. During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes, which connect the ovaries to the uterus, and the ovaries themselves may also be removed. There are several different ways to perform a hysterectomy. It may be done through a surgical cut in either the belly or vagina. It may be done using laparoscopy, using a camera and smaller incisions, or it may be performed using robotic surgery. Your doctor will help you decide which type of procedure is best for you. After surgery, you will receive pain medications to relieve discomfort. You may also have a tube, called a catheter, inserted into your bladder for a day or two to pass urine. You will be asked to get up and move around as soon as possible after surgery; this helps prevent blood clots from forming in your legs and speeds up recovery. How long you stay in the hospital depends on the type of hysterectomy. If you have a robot-assisted hysterectomy, you will likely go home the next day. Most women who have a hysterectomy, however, will stay in the hospital for 2 to 3 days, maybe even longer if you have a hysterectomy due to cancer. Recovery may take anywhere from 2 to 6 weeks, depending on the type of hysterectomy you have. A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor, then, may recommend estrogen replacement therapy. There is some good news. Removing the problematic organs should keep you from having problems in this area again.
Why the Procedure is Performed
There are many reasons a woman may need a hysterectomy, including:
- Adenomyosis, a condition that causes heavy, painful periods
- Cancer of the uterus, most often endometrial cancer
- Cancer of the cervix or changes in the cervix called cervical dysplasia that may lead to cancer
- Cancer of the ovary
- Long-term (chronic) pelvic pain
- Severe endometriosis that does not get better with other treatments
- Severe, long-term vaginal bleeding that is not controlled with other treatments
- Slipping of the uterus into the vagina (uterine prolapse)
- Tumors in the uterus, such as uterine fibroids
- Uncontrolled bleeding during childbirth
Hysterectomy is a major surgery. Some conditions can be treated with less invasive procedures such as:
- Uterine artery embolization
- Endometrial ablation
- Using birth control pills
- Using pain medicines
- Using an IUD (intrauterine device) that releases the hormone progestin
- Pelvic laparoscopy
Risks
Risks of any surgery are:
- Allergic reactions to medicines
- Breathing problems
- Blood clots, which may cause death if they travel to the lungs
- Bleeding
- Infection
- Injury to nearby body areas
Risks of a hysterectomy are:
- Injury to the bladder or ureters
- Pain during sexual intercourse
- Early menopause if the ovaries are removed
- Decreased interest in sex
- Increased risk of heart disease if the ovaries are removed before menopause
Before the Procedure
Before deciding to have a hysterectomy, ask your health care provider what to expect after the procedure. Many women notice changes in their body and in how they feel about themselves after a hysterectomy. Talk with provider, family, and friends about these possible changes before you have surgery.
Tell your health care team about all the medicines you are taking. These include herbs, supplements, and other medicines you bought without a prescription.
During the days before the surgery:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
- Ask your provider which drugs you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your provider for help quitting.
On the day of your surgery:
- You will most often be asked not to drink or eat anything for 8 hours before the surgery.
- Take any medicines your provider told you to take with a small sip of water.
- Arrive at the hospital on time.
After the Procedure
After surgery, you will be given pain medicines.
You may also have a tube, called a catheter, inserted into your bladder to pass urine. Most of the time, the catheter is removed before leaving the hospital.
You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds recovery.
You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea and vomiting.
How long you stay in the hospital depends on the type of hysterectomy.
- You can likely go home the next day when surgery is done through the vagina, with a laparoscope, or after robotic surgery.
- When a larger surgical cut (incision) in the abdomen is made, you may need to stay in the hospital for 1 to 2 days. You may need to stay longer if the hysterectomy is done because of cancer.
Outlook (Prognosis)
How long it takes you to recover depends on the type of hysterectomy. Average recovery times are:
- Abdominal hysterectomy: 4 to 6 weeks
- Vaginal hysterectomy: 3 to 4 weeks
- Robot-assisted or total laparoscopic hysterectomy: 2 to 4 weeks
A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy. Discuss with your provider the risks and benefits of this therapy.
If the hysterectomy was done for cancer, you may need further treatment.
References
Committee on Gynecologic Practice. Committee opinion no 701: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017;129(6):e155-e159. PMID: 28538495
Karram MM. Vaginal hysterectomy. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 51.
Prescott LS, Yunker AC, Alvarez R. Gynecologic surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 71.
Thakar R. Is the uterus a sexual organ? Sexual function following hysterectomy. Sex Med Rev. 2015;3(4):264-278. PMID: 27784599
Version Info
Last reviewed on: 1/10/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
