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Hysterectomy

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Gynecologic Oncologist, CTCA Program Director, Gynecologic Oncology.

This page was reviewed on July 12, 2022.

A hysterectomy is surgical removal of  a woman’s uterus. Uterus is commonly known as the “womb”, where a baby grows during a pregnancy. It is the second most common surgery among women in the United States.

A hysterectomy may treat conditions other than cancer, including:

  • Uterine fibroids - non-cancerous, muscular tumors that grow in the wall of the uterus and can cause pain, pressure and abnormal bleeding.
  • Endometriosis -occurs when the tissue that lines the uterus grows outside the uterus and on other organs and causes pain and abnormal bleeding.
  • Prolapse of the uterus- occurs when the uterus slips down from its usual place into the vagina and can cause pain, pressure, bulge and incontinence.
  • Adenomyosis - when the tissue that lines the uterus grows inside the walls of the uterus and causes pain and abnormal bleeding.
  • Chronic pelvic pain - may be treated with a hysterectomy, particularly if it is clear the pain comes from the uterus.
  • Abnormal vaginal bleeding - may be caused by multiple factors, including changes in hormone levels, infection, cancer or fibroids.

A hysterectomy may be used to treat endometrial, cervicalovarian and uterine cancers. The type of hysterectomy performed depends on the type of cancer, as well as its extent. The procedure may involve removing the ovaries and fallopian tubes in a surgery called a salpingo-oophorectomy. If you haven’t yet reached menopause, a hysterectomy that removes the ovaries will cause your menstrual periods to stop and put you into surgical menopause. Ask your doctor about taking estrogen after the surgery to help lower your risk of heart disease, osteoporosis and relieve menopausal symptoms.

Endometrial or Uterine cancer treatment: Removal of the uterus and cervix is the most common treatment for endometrial cancer. Sometimes the removal of fallopian tubes with or without ovaries and lymph nodes is also necessary. This may be done with an abdominal hysterectomy, a vaginal hysterectomy, a laparoscopic hysterectomy (in which the organs are removed through the vagina laparoscopically, with tiny abdominal incisions made for the camera and instruments to pass through) or robotic-assisted surgery (in which a laparoscopic hysterectomy is performed with the assistance of tools with robotic arms that allow for more precision). A total abdominal hysterectomy involves the removal of these organs through an abdominal incision, whereas in a vaginal hysterectomy, the cervix and uterus are removed through the vagina. In cases where cancer has spread outside of the cervix, a radical hysterectomy to remove the upper portion of the vagina and the tissues near the uterus (the parametrium and uterosacral ligaments) may be performed.

Cervical cancer treatment: A simple hysterectomy to remove the uterus and cervix may be used to treat severe cases of cervical intraepithelial neoplasia (abnormal cervical cells), some early cervical cancers or invasive cervical cancer.

Ovarian cancer treatment: If ovarian cancer has spread, most times hysterectomy is performed along with removal of tubes and ovaries. Other tissue like omentum, lymph nodes and peritoneal biopsies may also be removed. These surgeries may be called “debulking”.

There are different types of hysterectomy that can be performed depends on your individual situation. These include:

  • Supra-cervical (laymen terminology for this is “partial hysterectomy”) hysterectomy: The upper part of the uterus is removed, and the cervix is left intact. This type is also called subtotal or supracervical.
  • Total hysterectomy: The entire uterus and the cervix are removed.
  • Radical hysterectomy: The entire uterus, the tissue on both sides of the cervix and the upper part of the vagina are removed. This type of surgery is performed mainly to treat cancer.
  • Total hysterectomy with bilateral salpingo-oophorectomy: The entire uterus and the cervix are removed, as well as both ovaries and fallopian tubes. A unilateral salpingo-oophorectomy is similar, but the ovary and fallopian on only one side are removed.

Surgeons may choose from a number of techniques to perform a hysterectomy, including:

  • Abdominal surgery: The surgeon makes a 5- to 7-inch incision in the lower part of the belly. The incision, or cut, may be up and down or across the belly.
  • Vaginal surgery: To perform the procedure, the surgeon makes an incision in the vagina near the cervix, enabling the surgeon to access the uterus. The surgeon detaches the uterus and cervix from blood vessels and connective tissue, in addition to the ovaries, fallopian tubes and the upper vagina, and removes the uterus through the vagina.
  • Laparoscopic surgery: The surgeon makes three or four small incisions in the belly and inserts surgical tools and a special camera called a laparoscope inside the body. The surgeon operates while watching the video from the laparoscope on high-resolution monitors in the operating room. The surgeon removes the uterus through the vagina since an incision is necessary in the vagina to detach the uterus from the vagina.
  • Robotic-assisted surgery: Similar to a laparoscopic hysterectomy, the surgeon inserts a surgical tool and a laparoscope through small incisions in the belly. The surgeon uses specialized robotic technology to perform the surgery.

What to expect after a hysterectomy

The exact length of your recovery depends on what type of hysterectomy you have, but it generally lasts about six weeks, according to the American Cancer Society.

  • Abdominal hysterectomy: You will need to stay in the hospital for a minimum of two  days after an abdominal hysterectomy. Thereafter, expect to spend another six to eight weeks recovering at home.
  • Radical hysterectomy: Your hospital stay after this more-invasive surgery may be approximately three to seven days.
  • Laparoscopically assisted vaginal hysterectomy or robotic-assisted hysterectomy: Because these procedures are much less invasive than abdominal and radical hysterectomies, your hospital stay may last one to two days. At home, recovery may take about two to three weeks however the internal healing takes the same time of six-eight weeks. Therefore there will be some restrictions for that time period.

Complications and side effects

It’s normal to have side effects after surgery, such as pain and fatigue, but these are short-term.

You may also experience some nausea, and it may be difficult to urinate or have a bowel movement immediately after surgery.

You will gradually return to normal diet.

If your ovaries were removed, you may experience menopausal symptoms, such as hot flashes, night sweats and vaginal dryness. Discuss any side effects that you’re experiencing with your provider and the care team so that  they can help you manage them.

Following a hysterectomy, a woman will no longer have periods and cannot get pregnant (carry a child). Having a hysterectomy may result in changes to your body and may affect how you feel about yourself. It’s important to discuss potential changes with your doctor or nurse, as well as trusted family members and friends, before the surgery.

The following complications are rare but serious:

  • Excessive bleeding and/or blood clots
  • Damage to the ureter during surgery
  • Damage to the bladder or bowel, causing infection, incontinence or frequent urination
  • Vaginal problems, such as prolonged wound healing or vaginal prolapse
  • Ovarian failure due to decreased blood supply
  • Wound or urinary tract infection
  • Allergic reaction to anesthesia

If both of your ovaries were removed, you’re still at risk of developing primary peritoneal cancer (PPC), a rare cancer that affects the peritoneum, a thin layer of tissue that covers the abdominal organs.

Symptoms of PPC include:

  • Bloating
  • Nausea or vomiting
  • Bowel habit changes
  • Feeling full after eating very little

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