Patient education: Hysterectomy (The Basics)

What is a hysterectomy? — A hysterectomy is surgery to remove the uterus (figure 1). The uterus is the part of the body that carries a baby when a person is pregnant. If you have a hysterectomy, you will not be able to get pregnant.

Are there different kinds of surgery for hysterectomy? — Yes. There are 4 main kinds of surgery:

●Vaginal hysterectomy – To do a vaginal hysterectomy, the doctor makes cuts inside the vagina and removes the uterus through the vagina (figure 2).

●Laparoscopic hysterectomy – To do a laparoscopic hysterectomy, the doctor inserts a tiny camera and tools through small cuts in the belly. Then they remove the uterus in a bag through one of the cuts in the belly. Sometimes, doctors use the tools that are inserted through the belly, but remove the uterus through the vagina.

●Robot-assisted laparoscopic hysterectomy – This is another type of laparoscopic hysterectomy. The tools used for the surgery are attached to a robot that the doctor controls.

●Abdominal hysterectomy – To do an abdominal hysterectomy, the doctor makes a cut in the belly and removes the uterus through that opening (figure 3). This is only done if you can't have the other types of hysterectomy. That's because it takes longer to recover from an abdominal hysterectomy.

Why might a person need a hysterectomy? — A hysterectomy might be done to treat any of the following:

●Abnormal bleeding – Some people bleed too much during their period or at times when they should not be bleeding. This can lead to a condition called anemia, which can make you feel very tired.

●Fibroids – Fibroids are tough balls of muscle that form in the uterus. They can get very big and press on the organs inside the belly. They can also cause abnormal bleeding.

●Pelvic organ prolapse – Pelvic organ prolapse is when the uterus falls down into the vagina (figure 4).

●Cancer or conditions that could lead to cancer – Cancer can affect the uterus or the cervix, the organ that separates the uterus and the vagina. Sometimes doctors suggest removing these organs if tests show "precancer," or cells that could turn into cancer.

●Ongoing pelvic pain – Some people have "chronic pelvic pain." This is pain in the area just below the belly button that does not go away. This can be caused by a condition called endometriosis. Hysterectomy can sometimes help treat this pain.

What if I do not want a hysterectomy? — Many of the conditions that are treated with hysterectomy can be treated in other ways instead. If you do not want the surgery, ask your doctor or nurse if you have other treatment options. It's also important to ask what will happen if you choose not to have a hysterectomy.

What if I want to get pregnant? — If you have a hysterectomy, you will not be able to get pregnant. Unfortunately, if you have cancer or another serious problem, hysterectomy might be the best way to treat it. If you want to have children, your doctor or nurse can talk to you about your options.

Is the uterus the only organ that is removed during a hysterectomy? — That depends on what you want and why you are having a hysterectomy. During a hysterectomy, doctors sometimes also remove the:

●Cervix – The cervix is the lowest part of the uterus and connects to the vagina. For a vaginal hysterectomy, the cervix must be removed.

For an laparoscopic or abdominal hysterectomy, the upper part of the uterus can be removed, and the cervix can either be removed or left in place. If the cervix is removed, it is called a "total" hysterectomy. If the cervix is left in place, it is called a "supracervical" hysterectomy. People who keep their cervix will continue to need regular Pap tests to screen for cervical cancer.

●Ovaries – The ovaries are the organs that make eggs and female hormones, including estrogen and progesterone. The hormones made by the ovaries help keep the heart and bones healthy and are important for other aspects of health. People who have their ovaries removed sometimes need hormone treatment.

●Fallopian tubes – The fallopian tubes carry eggs from the ovaries to the uterus. The fallopian tubes can be removed with the ovaries or by themselves. Sometimes the fallopian tubes are removed at the time of hysterectomy to lower the risk of developing cancer in the future.

If you are planning to have a hysterectomy, ask your doctor whether they are planning to remove your cervix, ovaries, or fallopian tubes. This is important because you might need different medical care depending on which parts are removed.

Should I have my ovaries and tubes removed if I have a hysterectomy? — It's important to talk with your doctor before your surgery about whether or not to have your ovaries removed. You will need to think about how old you are, your overall health, and about how not having ovaries might affect you.

●In people who have not yet been through menopause, having the ovaries removed can lead to hot flashes, bone loss, reduced interest in sex, and other problems.

●In people who have been through menopause, having the ovaries removed might also increase the risk of health problems, such as heart disease. However, the research is still not clear on this.

On the other hand, people who have health problems that get worse at certain times in the menstrual cycle sometimes feel better without their ovaries. Plus, in rare cases, the ovaries can develop cancer, so people sometimes choose to have them removed. Before you have surgery, ask your doctor about the benefits and risks of having your ovaries removed.

The fallopian tubes are sometimes removed at the time of hysterectomy, even if the ovaries are left behind. This can lower the risk of a rare type of cancer that can start in the fallopian tubes. You do not need fallopian tubes if you are not going to get pregnant.

What will my life be like? — Studies show that people who have a hysterectomy can have happy, full lives. Many people feel better after the surgery because their symptoms no longer bother them.

More on this topic

Patient education: Heavy periods (The Basics)
Patient education: Uterine fibroids (The Basics)
Patient education: Uterine cancer (The Basics)
Patient education: Ovarian cancer (The Basics)
Patient education: Sertoli-Leydig cell tumor (The Basics)
Patient education: Pelvic organ prolapse (The Basics)

Patient education: Abdominal hysterectomy (Beyond the Basics)
Patient education: Vaginal hysterectomy (Beyond the Basics)