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Hysterectomy
Definition
A hysterectomy is surgery to remove a woman’s womb (uterus). The womb is the area where a baby grows when a woman is pregnant.
Alternative Names
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
Description
During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes and ovaries may also be removed.
Types of hysterectomy:
- Partial (supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
- Total hysterectomy: The entire uterus and cervix are removed.
- Radical hysterectomy: The uterus, upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.
There are many different ways to perform a hysterectomy. It may be done through a surgical cut in either the belly (abdomen) or vagina. Types include:
- Abdominal hysterectomy
- Laparoscopic hysterectomy
- Laparoscopy-assisted vaginal hysterectomy
- Robotic hysterectomy
Your doctor will help you decide which type of hysterectomy is best for you. The specific procedure depends on your medical history and reason for the surgery.
Why the Procedure Is Performed
There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:
- Cancer of the uterus, most often endometrial cancer
- Cancer of the cervix or a precancerous condition of the cervix called cervical dysplasia
- Cancer of the ovary
- Childbirth complications, such as uncontrolled bleeding
- 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
- Adenomyosis, which causes heavy, painful periods
Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor or nurse about all your treatment options. Less invasive procedures include:
- Uterine artery embolization
- Pelvic laparoscopy
- Endometrial ablation
- Using birth control pills
- Using pain medicines
Risks
The risks for 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 that are possible from 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
Estrogen replacement therapy can help decrease the risk of heart disease and may help menopause symptoms.
Before the Procedure
Before deciding to have a hysterectomy, ask your doctor or nurse what to expect after the procedure. Many women who have had a hysterectomy notice changes in their body and in how they feel about themselves. Talk with your doctor, nurse, family, and friends about these possible changes before you have surgery.
Always tell your health care team about all the medicines you are taking, including 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 doctor which drugs you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your doctor or nurse for help quitting.
On the day of your surgery:
- You will usually be asked not to drink or eat anything for 8 hours before the surgery.
- Take any medicines your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
After surgery, you will be given pain medicines to relieve any discomfort.
You may also have a tube, called a catheter, inserted into your bladder for 1 to 2 days 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.
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 or vomiting.
How long you stay in the hospital depends on the type of hysterectomy. Sometimes, you can go home the next day. Other times, most women who have a hysterectomy stay in the hospital 2 to 3 days. The hospital stay may be longer if the hysterectomy is done because of cancer.
Outlook (Prognosis)
How long it takes you to recover depends on the type of hysterectomy. Recovery may take anywhere from 2 to 6 weeks. Average recovery times are:
- Abdominal hysterectomy: 4 - 6 weeks
- Vaginal hysterectomy: 3 - 4 weeks
- Robot-assisted hysterectomy: 2 - 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.
References
Entman SS, Graves CR, Jarnagin BK, Rao GG. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 75.
Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.
Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93.
National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical Cancer. v.1.2010
Middleton LJ, Champaneria R, Daniels JP, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16;341:c3929.
ACOG Committee Opinion No. 444: choosing the route ofhysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-1158.
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.
