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.

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

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, and using 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.

Hysterectomy is surgical removal of the utereus, 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.

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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

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.

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 using 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 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

ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-1158. PMID: 20168127 www.ncbi.nlm.nih.gov/pubmed/20168127.

Burney RO, Giudice LC. Endometriosis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 130.

Jones HW III. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): cervical cancer. Version 1.2016. www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed April 18, 2016.