Hysterectomy

A hysterectomy is surgery to remove a woman's uterus, or womb. The womb is the area where a baby grows when a woman is pregnant.

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

During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes (the tubes that connect the ovaries to the uterus) and ovaries may also be removed.

Types of hysterectomy:

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

There are many different ways to perform a hysterectomy. It may be done through a surgical cut in either the belly (abdomen) or vagina.

Your doctor will help you decide which type of hysterectomy is best for you. The specific procedure depends on your medical history and reason for the surgery.

• Abdominal hysterectomy: The surgeon makes a 5- to 7-inch surgical cut in the lower part of your belly. The cut may go either up and down, or it may go across your belly, just above your pubic hair. This is called a "bikini cut."
• Vaginal hysterectomy: The surgeon makes a cut in your vagina and removes the uterus through this opening. The wound is be closed with stitches.
• Laparoscopic hysterectomy: A laparoscope is a narrow tube with a tiny camera on the end. Your surgeon will make 3 to 4 small cuts in your belly. The laparoscope and other surgical instruments will be inserted through the openings. The surgeon cuts the uterus into small pieces that can be removed through these openings.
• Laparoscopy-assisted vaginal hysterectomy: The surgeon removes the uterus through a cut that is made inside your vagina. A laparoscope is used to guide the procedure.
• Robotic hysterectomy: This procedure is like laparoscopic surgery, but a special machine (robot) is used. Robotic surgery is most often used to perform a hysterectomy when a patient has cancer or is very overweight and vaginal surgery is not safe.

There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:

• Cancer of the uterus, most often endometrial cancer
• Cancer of the cervix or a precancerous condition of the cervix called cervical dysplasia
• Cancer of the ovary
• Childbirth complications, such as uncontrolled bleeding
• Long-term (chronic) pelvic pain
• Severe endometriosis that does not get better with other treatments
• Severe, long-term vaginal bleeding that cannot be controlled by medicines or other surgeries
• Slipping of the uterus into the vagina (uterine prolapse)
• Tumors in the uterus, such as uterine fibroids
• Adenomyosis, which causes heavy, painful periods

Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor about all your treatment options. Less invasive procedures include:

• Uterine artery embolization
• Pelvic laparoscopy
• Endometrial ablation

The risks for 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 that are possible from a hysterectomy are:

• Injury to the bladder or ureters
• Pain during sexual intercourse
• Early menopause, if the ovaries are removed or if a woman is close to menopause
• Decreased interest in sex

Before deciding to have a hysterectomy, ask your doctor 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, family, and friends about these possible changes before you have surgery.

Always tell your health care team about all the medicines you are taking, including 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.
• Your doctor or nurse will tell you when to arrive at the hospital.

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 for 1 to 2 days to pass urine.

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 up 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. If you have a robot-assisted hysterectomy, you will likely go home the next day. Other times, most women who have a hysterectomy stay in the hospital 2 to 3 days. The hospital stay may be longer if the hysterectomy is done because of cancer.

How long it takes you to recover depends on the type of hysterectomy. Recovery may take anywhere from 2 to 6 weeks. Average recovery times are:

• Abdominal hysterectomy: 4 - 6 weeks
• Vaginal hysterectomy: 3 - 4 weeks
• Robot-assisted hysterectomy: 2 - 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.

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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 Aug 16;341:c3929.

Review Date: 02/28/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and 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.