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A hysterectomy is surgery to take out a
woman's uterus, the organ in a woman's belly where a baby grows during
pregnancy. After a hysterectomy, you will not be able to get pregnant.
Other organs might also be removed if you have severe problems such as
endometriosis or cancer. These organs include the
cervix (the lower part of the uterus that opens into
the vagina), the
ovaries (glands on both sides of the uterus that
release eggs for pregnancy), and the
fallopian tubes (the passageway between the uterus and
Whether or not the ovaries are removed will depend
on your age and risk for certain types of cancer. For example, removing the
ovaries lowers the risk of ovarian cancer and some types of breast cancer. But
if you have your ovaries removed before the age of menopause, you will go into
early menopause, and you may be more likely to get heart disease or
osteoporosis. Be sure to discuss with your doctor all the benefits and risks of
removing your ovaries.
See a picture of the
female reproductive system.
hysterectomy is done to treat problems with the uterus, such as pain and heavy
bleeding caused by
fibroid tumors. The surgery may also be needed if
there is cancer in the uterus, cervix, or ovaries. Some women may have the
surgery during childbirth to save their lives if there is heavy bleeding that
cannot be stopped.
Before you choose to have a hysterectomy,
consider all of your treatment options. In many cases, this surgery is a last
resort after trying other treatments for the problem.
For more information, see:
There are many different
ways to do hysterectomy surgery. The type of surgery you have depends on three
main things: the reason for the surgery, the size of the uterus and its
position in the belly, and your overall health. The most common types
Feeling better after surgery takes time. Most women are in the hospital 1
or 2 days after the surgery. Some women stay in the hospital up to 4 days.
When you get home, make sure you move around, but also be sure
you don't do too much. You can walk around the house and up and down stairs,
but take it slow. During the first 2 weeks, it's important to get plenty of
rest. Even after you start to feel stronger, you should not lift heavy things
(anything over 20 pounds). Also, you should not have sex until your doctor says
it's okay. It usually takes 4 to 6 weeks to get back to a normal routine.
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In most cases,
hysterectomy is an elective surgery used to treat
female reproductive system (gynecologic) conditions that haven't improved with
medical treatment. For women who have no plans for pregnancy and have
considered and tried other treatment options without success, a hysterectomy
may be a reasonable treatment choice.
Hysterectomy is also a
potentially lifesaving measure when used to stop severe bleeding after
childbirth or to remove
cervical cancer or
endometrial (uterine) cancer.
the surgical removal of a woman's
uterus. In some cases, the
ovaries and fallopian tubes are also removed during a hysterectomy procedure.
This is called a
There are three
major types of hysterectomy:
Deciding whether to have a total or subtotal hysterectomy
can be difficult. This is because research that compares the two is limited and
shows only small differences. In the past, experts believed that a subtotal
hysterectomy reduced problems after surgery and prevented problems with urinary
incontinence and/or sexual dysfunction. But research has shown that for certain
conditions, a subtotal hysterectomy does not prevent these problems better than
a total hysterectomy does.1
considering a hysterectomy,
ask your doctor what other treatments can be used for your condition, what hysterectomy
options are available to you, and how well hysterectomy is likely to work for
you. If you have a hysterectomy, the type of procedure you have will depend on
the medical reason for the hysterectomy, the size and position of your uterus,
and your general state of health.
Hysterectomy procedures (how the uterus is removed) include:
hysterectomy procedures, each with advantages and
disadvantages. Depending on your reason for considering a hysterectomy, you may
have a choice between two or more procedures. For complicated or cancer-related
conditions that require maximum access and careful examination, your doctor
will likely recommend an abdominal hysterectomy.
This type of hysterectomy is
done through a small incision (cut) in the
vagina, rather than through an abdominal incision. The
ovaries and other organs may also be removed. Vaginal
hysterectomy tends to cause less pain, and takes less healing time than
abdominal hysterectomy. A vaginal hysterectomy can be done:
Vaginal hysterectomy requires more specialized surgical
skill than an abdominal hysterectomy. It can pose a higher risk of injury to
other organs. Vaginal hysterectomy is not used when there is a question about
possible cancer in the uterus,
cervix, or ovaries.
This type of hysterectomy
is done through a larger abdominal incision, giving the surgeon the best
possible access to the pelvic organs. The cervix may be removed with the uterus
(total hysterectomy) or left in place (subtotal hysterectomy). The
ovaries and other organs may also be removed. An
abdominal hysterectomy is typically done when:
If a hysterectomy is chosen to treat endometriosis, an
abdominal hysterectomy is usually required. One example is when endometriosis
growths (implants) or scar tissue (adhesions) must be removed to restore the
function of other organs.
Laparoscopic hysterectomy is done with a viewing instrument (laparoscope)
and surgical instruments inserted through a vaginal incision and one or more
small abdominal incisions. The ovaries and other organs may also be removed.
The uterus is removed through the vagina. It is done:
LAVH requires the surgeon to have
Laparoscopic supracervical hysterectomy is done by
inserting a laparoscope and surgical instruments through several small
abdominal incisions. The uterus is removed in small pieces through one of the
incisions and the cervix is left intact. This is also known as subtotal or partial
hysterectomy. This type of procedure usually causes minimal blood loss and
pain. The hospital stay is shorter than for total abdominal surgery. Most women
can return to normal activity a week or two afterward. LSH can be done:
LSH usually takes longer to do than abdominal or vaginal hysterectomy. LSH is
not available in some areas.
The total laparoscopic hysterectomy is done by
inserting a laparoscope and surgical instruments through several small
incisions in the abdomen. The uterus and the cervix are removed in small pieces
through one of the incisions. TLH can be done:
TLH requires the surgeon to have
special training. It usually takes longer to do than abdominal or vaginal
hysterectomy. But recovery and hospital stay are shorter than for total
abdominal hysterectomy. TLH is not available in many parts of the
Some laparoscopic surgery is done using only one incision. This is called laparoendoscopic
single-site surgery (LESS) or single-port surgery.
Some doctors offer robot-assisted surgery for hysterectomy. For this method, the surgeon controls robotic arms that hold the surgery scope and tools. Robotic surgery for hysterectomy may be an option for women who have certain conditions. But it usually costs more money, and studies have not shown that it is better than other hysterectomy procedures.2
poses some risks of major and minor complications. But most women do not have
complications after a hysterectomy.
Some studies have shown
complication rates that are about the same for total laparoscopic hysterectomy
(TLH), laparoscopically assisted vaginal hysterectomy (LAVH), and total
abdominal hysterectomy (TAH).3, 4 Your risk of problems after surgery may be higher or lower
than average. This may depend in part on how experienced the surgeon is.
Complications after a hysterectomy include:
Infection risk is lowest when
your doctor gives you
antibiotic medicine at the time of surgery.5
Other ongoing complications of hysterectomy
hysterectomy, you may have:
Your doctor may order additional tests based on your
physical exam and medical history. These tests may include:
See a list of
questions to ask your doctor when you are considering
hysterectomy, call your doctor or go to the emergency
Your doctor will give you specific instructions after your
hysterectomy. Be sure to follow them. Usually, getting some rest and following
those instructions will help postoperative problems diminish over time.
Recovering from a
hysterectomy takes time. You will stay in the hospital
for 1 to 2 days for postsurgery care. Some women stay in the hospital up to 4
Abdominal hysterectomy. As soon as
you feel strong enough, get up and around as much as you can. This helps
prevent problems after surgery like blood clots, pneumonia, and gas pains.
During the first 2 to 3 weeks, it is important to also get plenty of rest. Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
will gradually be able to increase your activities. To help you heal well,
avoid lifting more than 20 pounds during the first 4 to 6 weeks after surgery.
For the same reason, this is also an important time to avoid vaginal
As soon as you can move easily without pain or
without using narcotic pain medicine, you can drive. Complete recovery usually
takes 4 to 6 weeks. Your return to a work routine will depend not only on how
quickly you get back your energy and strength but also on how demanding your
Vaginal or laparoscopic hysterectomy. As soon as you feel strong enough, get up and around as
much as you can. This helps prevent problems after surgery like blood clots,
pneumonia, and gas pains. When you can move easily without pain, you can drive.
To help you heal well, avoid lifting more than 20 pounds during the first 4 to
6 weeks after surgery. For the same reason, this is also an important time to
avoid vaginal intercourse.
Recovery from a vaginal or
laparoscopic hysterectomy takes much less time than from an abdominal surgery.
After a routine laparoscopic surgery removing the
uterus but not the
cervix (laparoscopic supracervical hysterectomy, or
LSH), most women are able to return to normal activity in 1 to 2 weeks. About 4
to 6 weeks after the hysterectomy, see your doctor for a follow-up
Pelvic weakness. After a hysterectomy, some women
develop other physical problems that are related to weakness of the pelvic
muscles and ligaments that support the vagina, bladder, and rectum.
Kegel exercises may help strengthen the pelvic muscles
and ligaments. But some women need other treatments, including additional
Vaginal dryness from low estrogen
levels may develop if your ovaries were removed (oophorectomy). This can also
develop gradually after a hysterectomy. If sexual intercourse is painful
because of vaginal dryness:
Pain during intercourse may occur if
your vagina was shortened during your hysterectomy. Changing positions may help
make intercourse less painful. Talk with your doctor if you have any difficulty
during intercourse after a hysterectomy.
It is normal to have various
concerns when faced with the possibility of having a
hysterectomy. A woman's emotions are often based on her
beliefs about the importance of her uterus, her fears
about her health or personal relationships after a hysterectomy, and concerns
enjoyment of sexual activities after surgery. If you
are considering a hysterectomy, talk with your doctor about your specific fears
and anxieties concerning the surgery.
Your doctor may suggest
other treatments before recommending a hysterectomy. If you are considering a
hysterectomy and would like more information about other treatments or
surgeries, talk with your doctor. Ask about the risks and benefits of each
option. Consider both the immediate and long-term risks and benefits of all
Hysterectomy is a necessary and effective treatment
for cancer of the pelvic organs, a severe infection of the uterus, or
Following hysterectomy, you will not be
able to become pregnant. If you have plans for a future pregnancy, hysterectomy
is not an appropriate treatment option for conditions such as
pelvic organ prolapse. Talk with your doctor about
Hysterectomy is not used to prevent pregnancy.
There are many methods of birth control that are safe and effective. If you are
not sure which method is best for you, talk with your doctor about your
Women who have
early, sudden menopause after hysterectomy are usually advised to use
estrogen therapy (ET) to protect against
bone loss. The low estrogen levels of menopause cause bone thinning. Compared
with women who are not taking hormone therapy, women taking ET have fewer hip
fractures (a sign of estrogen's bone-protecting effect).6
American College of Obstetricians and Gynecologists
(2007, reaffirmed 2010). Supracervical hysterectomy. ACOG Committee Opinion No. 388.
Obstetrics and Gynecology, 110(5):
American College of Obstetricians and Gynecologists (2009, reaffirmed 2011). Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion No. 444. Obstetrics and Gynecology, 114(5): 1156–1158. DOI: 10.1097/AGOC.0b013e3181c33c72. Accessed November 26, 2013.
Hoffman CP, et al. (2005). Laparoscopic hysterectomy: The Kaiser Permanente San Diego experience. Journal of Minimally Invasive Gynecology, 12(1): 16–24.
Ghezzi F, et al. (2006). Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: A randomized clinical trial. Journal of Minimally Invasive Gynecology, 13(2): 114–120.
Antimicrobial prophylaxis for surgery (2013). Treatment Guidelines From The Medical Letter, 10(122): 73–78.
Women's Health Initiative Steering Committee (2004).
Effects of conjugated equine estrogen in postmenopausal women with
hysterectomy. JAMA, 291(14): 1701–1712.
Current as of:
March 12, 2014
Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
How this information was developed to help you make better health decisions.
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