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Hysterectomy

Definition

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, the surgeon 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, cervix upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.

Your doctor will help you decide which type of hysterectomy is best for you. The choice often 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:

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:

Risks

Risks of any surgery are:

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

Ask your doctor if taking estrogen can help lower the risk of heart disease and 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.

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 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.
  • Arrive at the hospital on time.

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 to pass urine. The catheter will likely be removed before you go home.

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 or 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 doctor the risks and benefits of this therapy.

If the hysterectomy was done for cancer, you may need further treatment.

References

American College of Obstetricians and Gynecologists. Committee Opinion No. 444: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114:1156-1158.

Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.

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.

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;341:c3929.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Cervical cancer. Version 2.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed February 22, 2012.


Review Date: 2/8/2013
Reviewed By: 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. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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