After a hysterectomy, a woman will no longer have periods or be able to carry a pregnancy. If the ovaries are removed, menopause will occur.

Reasons for treatment

A hysterectomy is carried out to remove the uterus, usually to relieve symptoms or to prevent cancer.

A woman's uterus, cervix, fallopian tubes, and ovaries are located within the pelvis.

A hysterectomy can be carried out for several reasons.

These include:

• gynecologic cancers of the cervix, uterus, ovaries, or fallopian tubes
• some precancerous gynecologic conditions
• uterine fibroids or benign uterine growths
• chronic pelvic pain
• heavy vaginal bleeding that severely affects a woman's quality of life
• uterine prolapse, where the uterus drops from its location within the pelvis and sits in or out of the vagina
• endometriosis, in which uterine-like tissue grows in locations other than within the uterus, including the outside of the uterus, fallopian tubes, ovaries, pelvic ligaments, lining of the abdomen, bladder, vagina, rectum, bladder, intestines, appendix and or rectum, or, more rarely in the lungs
• adenomyosis, where the uterine tissue grows through the uterine wall instead of staying confined to the inner portion of the uterus

Types

The type of hysterectomy will depend on a range of factors, including the reason for the procedure.

Total Hysterectomy: This procedure includes the removal of the uterus and cervix, the part of the uterus where the baby or menstrual blood exits the womb into the vagina. The ovaries and fallopian tubes may or may not also be considered for removal, depending on individual health circumstances.

Supracervical, subtotal or partial hysterectomy: The upper portion of the uterus is removed and the cervix is left in place. The ovaries and fallopian tubes may or may not also be considered for removal, depending on individual health circumstances.

Radical hysterectomy: This procedure is typically reserved for certain gynecologic cancers, including cervical cancer. During a radical hysterectomy, the uterus, cervix, and other structures are removed. These include the tissue located on the sides of the cervix and the uppermost portion of the vagina. The surgeon may or may not recommend removing the fallopian tubes and ovaries.

Removal of the fallopian tubes and ovaries

The decision to do this depends on several factors, including why the procedure is being performed.

In some cases, ovary and fallopian tube removal may be recommended to prevent some ovarian or fallopian tube cancers in women who are at higher risk.

Women should speak with their healthcare provider to discuss their individual risks, especially if there is a high chance of developing breast or ovarian cancer.

Procedure

There are several ways of performing a hysterectomy.

Abdominal hysterectomy: The surgeon makes an incision through the abdomen to remove the uterus and possibly other pelvic structures or tissues.

Vaginal hysterectomy: The uterus and possibly other structures are removed through an incision at the top of the vagina.

Laparoscopic hysterectomy: Small incisions on the abdomen, around 1 to 2 centimeters (cm) long, allow for surgical tools to be used. The surgeon uses a laparoscope, or lighted camera, to view inside the pelvis and evaluate the pelvic organs.

The surgeon will remove the uterus and possibly other pelvic organs, for example the fallopian tubes, and ovaries, through small incisions in the upper portion of the vagina or the abdomen. This is also known as a "keyhole" procedure.

Robotic laparoscopic hysterectomy: A robotic arm, controlled by the surgeon, performs the procedure through small incisions. This is associated with shorter healing times and fewer complications than the traditional methods of hysterectomy. It is similar to a laparoscopic hysterectomy.

Risks and complications

As with any surgical procedure, a hysterectomy involves some risks.

These may include:

• reaction to anesthesia
• bleeding or hemorrhage
• damage to surrounding urinary tract, bowel, or other surrounding organs
• infection
• blood clots including pulmonary emboli (lung blood clot)
• vaginal complications, such as prolapse
• ovarian failure
• surgically induced menopause if ovaries are removed
• wound healing issues, including blood clot formation
• a rectal or urinary tract fistula, where a hole develops between the vagina and the rectum or urinary bladder, increasing the risk of infection
• bowel obstruction

A woman's personal risk will be discussed by her surgical team before undergoing surgery.

Loss of ability to bear children

If a hysterectomy is carried out as a treatment for cancer, for example, it may mean that a woman of childbearing age will be unable to bear children. This can lead to depression.

In 2007, researchers found that, in a study of 1,140 premenopausal women who underwent a hysterectomy to treat a benign condition, 10.5 percent wished they could have had a child or more children.

The team concluded that:

"The issue of loss of fertility should be discussed candidly with women considering hysterectomy, and those who express ambivalence, sadness, or regret at the loss of future childbearing options may benefit from further exploration of fertility-sparing treatments."

Other options may be available.

Alternatives

The alternatives to a hysterectomy will depend on the reason for the procedure.

These may include:

• watchful waiting
• hormone therapy (HT)
• laser ablation or cryosurgery for uterine fibroids
• dilation and curettage (D and C) or endometrial ablation for excessive endometrial lining
• laparoscopy to relieve symptoms of endometriosis

In the case of cervical cancer, a more limited procedure known as cervical conization may successfully remove the cancer cells. This can preserve fertility. However, if more cells are detected, further surgery may be necessary.

Women should discuss the need for a hysterectomy and possible alternatives with a healthcare provider.

Recovery

Recovery will depend on the type, extent, and reason for the procedure.

A brief hospital stay may be needed. Full recovery can take from 4 to 8 weeks depending on the procedure and the health status of the patient.

Some activities, such as heavy lifting, sex, tub bathing, and tampon use may be temporarily advised against.

Immediately after the procedure and in the following days or weeks, a woman can expect to experience:

• pain, which is typically controlled with medication
• vaginal bleeding and discharge
• constipation
• difficulty urinating, in some cases
• emotional symptoms like grief, depression, or relief

If the ovaries are removed, she may start to experience symptoms of menopause. These may continue for weeks or months.

Hormone therapy can help relieve the symptoms of menopause and reduce the risk of osteoporosis.

Sex after a hysterectomy

Sex after hysterectomy depends on many factors, including:

• the reason for the procedure
• the extent and type of procedure
• side effects and complications following surgery

Often times, sex after hysterectomy returns to normal or improves.

However, the menopausal symptoms associated with some hysterectomies may cause unwanted changes.

These include:

• a negative impact on sex drive
• vaginal dryness, leading to painful intercourse

Vaginal dryness can be relieved with the use of over-the-counter vaginal lubrication and increased foreplay.

Orgasm is not normally affected by a hysterectomy, but some women experience changes, probably due to the need to cut certain pelvic nerves during surgery.

Any woman who is concerned about the impact on sexual activity or other consequences of the procedure should discuss these first with the surgeon or health care provider.