What is a hysterectomy?
Hysterectomy is the surgical removal of the uterus. It ends menstruation and the ability to become pregnant. Depending on the reason for the surgery, a hysterectomy may also involve the removal of other organs and tissues, such as the ovaries and/or fallopian tubes.
- A supracervical hysterectomy is the removal of the upper part of the uterus leaving the cervix behind.
- A total hysterectomy is the removal of the uterus and cervix.
- A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes (salpingo) and ovaries (oophor). If you haven't experienced menopause, removing the ovaries will usually start it since your body can no longer produce as much estrogen.
- A radical hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and some surrounding tissue, and lymph nodes. A radical hysterectomy may be performed to treat cervical or uterine cancer.
Top image: Pelvic organs before hysterectomy
Bottom image: Pelvic organs after hysterectomy
Why is hysterectomy performed?
A hysterectomy may be performed to treat:
- Abnormal vaginal bleeding that is not controlled by other treatment methods.
- Severe endometriosis (uterine tissue that grows outside the uterus).
- Leiomyomas or uterine fibroids (not cancerous tumors) that have increased in size, are painful or are causing bleeding.
- Increased pelvic pain related to the uterus but not controlled by other treatment.
- Uterine prolapse (uterus that has "dropped" into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements.
- Cervical or uterine cancer or abnormalities that may lead to cancer for cancer prevention.
Are there alternatives to hysterectomy?
Yes. A hysterectomy is only one way to treat problems affecting the uterus. For certain conditions, however, hysterectomy may be the best choice. Please ask your healthcare provider to discuss what alternatives are available to treat your specific condition.
What happens before, during, and after a hysterectomy?
Before the procedure
A healthcare provider will explain the procedure in detail, including possible complications and side effects. He or she will also answer your questions.
- Blood and urine tests are taken.
- Hair in the abdominal and pelvic areas may be clipped.
- An intravenous (IV) line is placed in a vein in your arm to deliver medications and fluids.
During the procedure
An anesthesiologist will give you either:
- General anesthesia in which you will not be awake during the procedure; or
- Regional anesthesia (also called epidural or spinal anesthesia) in which medications are placed near the nerves in your lower back to "block" pain while you stay awake .
The surgeon removes the uterus through an incision in your abdomen or vagina. The method used during surgery depends on why you need the surgery and the results of your pelvic exam.
During a vaginal hysterectomy, some doctors use a laparoscope (a procedure called laparoscopically assisted vaginal hysterectomy or LAVH) to help them view the uterus and perform the surgery.
A laparoscope with advanced instruments can also be used to perform hysterectomy completely through tiny incisions (total or supracervical laparoscopic hysterectomy). In more difficult cases, surgeons may employ assistance of robotic instruments placed through the laparoscope to complete the laparoscopic hysterectomy (robotic-assisted laparoscopic hysterectomy).
How long does the procedure last?
The procedure lasts one to three hours. The amount of time you spend in the hospital for recovery varies, depending on the type of surgery performed.
The day of discharge
A responsible adult must drive you home the day you are discharged from the hospital.
Risks / Benefits
What are the complications of hysterectomy?
As with any surgery, there is a slight chance that problems may occur. Problems could include blood clots, severe infection, bleeding after surgery, bowel blockage, urinary tract injury, or problems related to anesthesia.
Recovery and Outlook
What should I know about recovering at home after a hysteretomy?
- You may resume your normal diet, as tolerated.
- You may take a bath or shower. Wash the incision with soap and water (the stitches do not have to be removed, as they will dissolve in about six weeks). A dressing over the incision is not necessary. If skin clips (staples) were used, they will need to be removed by your healthcare provider.
- You may use lotions and creams on the skin around the incision to relieve itching.
- Increase your activity gradually every day, when you feel capable and aren't in pain. Completely normal activities can be resumed within four to six weeks or sooner if the procedure was performed vaginally or through the laparoscope.
- Drive when you feel capable and are no longer requiring narcotic pain medications — about two weeks after surgery.
- You can travel out of town three weeks after surgery, including air travel.
- Avoid lifting heavy objects (over 10 pounds) for at least four weeks.
- Do not douche or put anything into the vagina for four weeks.
- You may have intercourse six weeks after surgery, or as directed by your healthcare provider.
- Light swimming is permitted two weeks after surgery in a swimming pool, but avoid vigorous swimming until four weeks after surgery.
- Resume your exercise routine in four to six weeks, depending on how you feel.
- Your doctor can tell you when it's best to go back to work. You can usually go back to work in three to six weeks, depending on the procedure.
- People who undergo a subtotal or partial hysterectomy may continue to have a light period for a year after the procedure. This happens because small amounts of the endometrial lining can remain in the cervix, causing light periods.
How will I feel after hysterectomy?
After hysterectomy, your periods will stop. Occasionally, you may feel bloated and have symptoms similar to when you were menstruating. It is normal to have light vaginal bleeding or a dark brown discharge for about four to six weeks after surgery.
You may feel discomfort at the incision site for about four weeks, and any redness, bruising or swelling will disappear in four to six weeks. Feeling burning or itching around the incision is normal. You may also experience a numb feeling around the incision and down your leg. This is normal and, if present, usually lasts about two months.
If the ovaries remain, you should not experience hormone-related effects. If the ovaries were removed with the uterus before menopause, you may experience the symptoms that often occur with menopause, such as hot flashes. Your healthcare provider may prescribe hormone replacement therapy to relieve menopausal symptoms.
Emotional reactions to hysterectomy vary, depending on how well you were prepared for the surgery, the reason for having it, and whether the problem has been treated.
Some women may feel a sense of loss or become depressed, but these emotional reactions are usually temporary. Other women may find that hysterectomy improves their health and well-being, and may even be a life-saving operation. Please discuss your emotional concerns with your healthcare provider.
When to Call the Doctor
When should I call my healthcare provider if I have had a hysterectomy?
Call your healthcare provider if you have:
Does hysterectomy affect sexual function?
A woman's sexual function is usually not affected after hysterectomy, and her sexual desire should not change. Only if the ovaries were removed with the uterus prior to menopause, decreased sex drive may occur and vaginal dryness may be a problem during sex. However, estrogen therapy can relieve vaginal dryness and other hormone-related effects.