A hysterectomy (his-te-REK-toh-me) is the surgical removal of the uterus. This surgery is performed for a number of different reasons. There are many factors to consider and choices to think about when facing this surgery. It is important to talk with your doctor to decide which option is best for you.
There are different types of hysterectomies. The medical terms and common terms for the types of hysterectomy are different. A hysterectomy does not include removal of the ovaries or fallopian tubes. Your doctor may recommend that these organs be removed at the same time, depending on your age and the condition of the organs. Your doctor will talk with you about this.
||Removal of the uterus, leaving the cervix in place|
||Removal of entire uterus and cervix|
|Hysterectomy for cancer
||Removal of the uterus and cervix along with additional tissues. These tissues include the tissues in the area next to the uterus. Usually, these tissues also include the ovaries and fallopian tubes. As part of surgery for cancer of the uterus, the doctor will usually also remove some or all lymph nodes and part of the vagina.|
Why is a hysterectomy performed?
Your doctor will discuss with you the reason for your hysterectomy as well as alternative treatments. Reasons for a hysterectomy may include:
- Persistent, abnormal vaginal bleeding
- Cancer of the uterus, cervix, fallopian tubes, ovaries, or vagina
- Dysplasia (dis-PLAY-zha), or the presence of abnormal cells, which, if severe, may signal a pre-cancerous condition
- Endometriosis (EN-doh-mee-tree-OH-sis), or the presence of endometrial tissue (the lining of the uterus) in unusual locations outside the uterus, such as the bladder, intestines, and rectum
- Hyperplasia (hi-per-PLAY-zha), or the fast growth of endometrial cells in the uterus
• Adenomyosis (AD-eh-no-my-OH-sis), or too much endometrial tissue in the muscle tissue of the uterus
- Fibroid, or noncancerous tumor(s), in the uterus
- Inflammatory disease (PID), a chronic infection of the uterus, fallopian tubes, and/or ovaries
- Prolapsed uterus, which occurs when the uterus drops downward into the vagina
How is a hysterectomy performed?
A hysterectomy may be performed through the abdomen or the vagina.
- Abdominal hysterectomy — an incision (cut) is made in the abdomen to do all of the surgery to remove the uterus
- Vaginal hysterectomy — an incision is made at the top of the vagina to remove the uterus through the vagina. No incisions are needed in the abdomen, and recovery is usually faster than for an abdominal hysterectomy.
- Laparoscopic hysterectomy (la-peh-reh-SCOP-ik) — in laparoscopic surgery, tiny
instruments, including a microscopic camera, are inserted into the belly through small incisions. These small incisions, or ports, allow the doctor to perform the surgery without making a large incision. A small incision is made at the navel. The camera is inserted here.
Other small incisions are made to provide the entry way for other surgical tools.
- Laparoscopic assisted vaginal hysterectomy (LAVH): the doctor will use the laparoscopic instruments to free up part of the uterus. The doctor will then remove the rest of the uterus through the vagina.
- Laparoscopic hysterectomy: the doctor will remove the uterus with the laparoscopic instruments. A special laparoscopic instrument is used to cut the uterus into tiny pieces for easy removal through the ports. There are no incisions in the abdomen or vagina.
Will my ovaries be removed?
In general, ovaries are removed only if there is a problem with them. Two factors in this decision are a woman’s age and whether she has gone through menopause. In women who have not gone through menopause, the ovaries are important because they produce the hormones estrogen (ESS-tro-jen) and progesterone (pro-JESS-tuh-rohn).
These hormones provide extra protection from certain diseases, including heart disease and osteoporosis. The ovaries stop making eggs after menopause, so they may be removed during hysterectomy in women who have completed or are close to menopause. Removing the ovaries reduces the risk of ovarian cancer, which is deadly and difficult to detect in its early stages.
When a woman who has not completed menopause has both ovaries removed during hysterectomy, a condition called “surgical menopause” occurs. Women who experience surgical menopause may have the same symptoms as those who have had natural menopause. These include hot flashes, night sweats, and shrinkage of vaginal tissue.
If there are reasons to consider removing your ovaries, your doctor will discuss this with you.
Physical changes after hysterectomy
The uterus typically takes up a very small space in the abdomen or pelvis. After a hysterectomy, the other abdominal organs shift slightly to fill the space. During the surgery, ligaments that helped to support the uterus are connected to the top of the vagina to support it and help keep it in its normal position. Unless extensive surgery is performed, the vagina remains the same after a hysterectomy. Once healing has occurred, the vagina will continue to function normally.
Following a hysterectomy, menstrual periods will stop and pregnancy will no longer be possible. If one or both of the ovaries are left in place, the normal production of estrogen and progesterone will continue until natural menopause occurs, which is usually between the ages of 45 and 55.
The emotional effects of hysterectomy may vary from person to person. Some women may feel better because they no longer have the physical and emotional discomforts they had before surgery, including pain, bleeding, or fear of pregnancy or cancer. Some women may feel sad about the permanent loss of menstrual periods and about their inability to bear children.
Both reactions are normal. Even women who are generally positive about their hysterectomy may have feelings of sadness and may feel like crying. However, this usually lasts a short time and as women recover from surgery and begin to feel better and stronger, these feelings should stop. If feelings of sadness last more than 2 weeks after surgery, talk with your surgeon or primary care doctor.
A woman’s sexuality and femininity are not changed by a hysterectomy. Most doctors tell women to avoid sexual activity for 4 to 6 weeks after surgery. This allows time for the body to recover and heal. Some women have a temporary loss of vaginal sensation and less lubrication during sexual activity. These are common side effects of the surgery. Vaginal sensation and lubrication will usually return to normal when healing is complete. If you experience vaginal dryness, you may want to try a water-soluble lubricant.
Some women find they have a lack of sexual desire. This can be caused by anxiety, fatigue, and fear of pain. Allowing time to heal and recover, sharing your feelings with your partner and using a gentle approach may help you achieve sexual pleasure.
Some women may notice a change in their sexual response after hysterectomy. Talk with your doctor if you have concerns.
Myths associated with hysterectomy
Some of the fears women have about a hysterectomy are due to myths that claim a hysterectomy will cause unpleasant changes in appearance. Some of these myths include:
- Facial and body hair growth will increase. A hysterectomy does not directly affect facial and body hair growth. Increased facial and body hair growth can be caused by the removal of both ovaries and the lack of estrogen production.
- Skin wrinkles and aging will occur more rapidly. A hysterectomy has no effect on aging or the development of wrinkles. Again, the lack of estrogen may cause skin
changes, especially in women who have had both ovaries removed at a young age. For these women, hormone therapy may be helpful to keep the skin looking healthy.
- Weight gain will occur rapidly. Weight gain is related to diet and physical activity
and is not related directly to a hysterectomy. The time needed for rest and healing during the first few weeks after surgery, and a possible desire to eat more as you feel better, may cause slight weight gain. This is usually temporary and will stop after you go back to your normal activities and lifestyle.
For more information
For more specific tips on preparing for a hysterectomy, see the UPMC patient education sheet Hysterectomy: Getting Ready
This information was written to address the most common questions and concerns about hysterectomy. If you would like more information about hysterectomy, you should talk with your doctor.