A hysterectomy is a surgical procedure to remove the uterus. Other organs, such as the cervix, ovaries, fallopian tubes, lymph nodes and parts of the vagina may also be removed at the same time.
Why a hysterectomy is done
A hysterectomy may be done to:
- treat cancers of the female reproductive organs (gynecological cancers), including cervical, uterine, ovarian, fallopian tube and vaginal cancers
- treat precancerous conditions of the cervix
- stage a cancer, or find out how far it has spread
- remove as much cancer as possible before using other therapies such as chemotherapy or radiation therapy
A hysterectomy may also be done for medical conditions other than cancer.
Types of hysterectomy
There are different types of hysterectomy surgery. The type of surgery done depends mainly on the type of cancer, the size of the tumour and the stage of the cancer. When deciding on which type of hysterectomy to do, doctors will also consider the woman’s age, if she wants to become pregnant, her overall health, other treatments she’s had and other factors.
A total hysterectomy is also called a simple hysterectomy or extrafascial hysterectomy. During this surgery, the cervix and the uterus are removed. This is the most common type of hysterectomy done for gynecological cancers.
In a radical hysterectomy, the cervix and the uterus are removed. The upper part of the vagina next to the cervix as well as some of the supporting tissues and nearby lymph nodes in the pelvis are also removed.
When possible, the surgeon will do a modified radical hysterectomy. This surgery removes less surrounding and supportive tissues around the cervix and uterus. It is done to help lessen trauma to the surrounding tissues and may help prevent urinary problems that can occur with a standard radical hysterectomy.
A salpingo-oophorectomy is a surgery to remove the ovaries and the Fallopian tubes. It may be done at the same time as a hysterectomy to treat cancers of the uterus or cervix. It is used to treat ovarian and Fallopian tube cancers.
A bilateral salpingo-oophorectomy (BSO) removes both ovaries and Fallopian tubes.
A unilateral salpingo-oophorectomy removes just one ovary and one Fallopian tube. This surgery may be used in younger women who want to have children. It is also done so the woman has one healthy ovary that continues to make the sex hormones estrogen and progesterone. This prevents a woman from going into menopause earlier than normal.
How a hysterectomy is done
A hysterectomy is a major operation. It is done in the hospital under a general anesthetic (you will be unconscious). You will stay in the hospital for a few days after any type of hysterectomy. Your doctor may prescribe pain medicine and antibiotics to prevent infection.
A hysterectomy can be done using different incisions, or surgical cuts:
- An abdominal hysterectomy is done through a large incision in the abdomen. This is the most common way of doing a hysterectomy for gynecological cancers.
- A laparoscopic hysterectomy is done by laparoscopy. Laparoscopic surgery uses a thin, tube-like instrument with a light and lens (called a laparoscope). The laparascope and surgical tools are passed through small incisions (cuts) in the abdomen to remove tissue.
- Robotic surgery can also be used to remove the uterus. This is called a robotic hysterectomy. It is also done by laparoscopy but the surgeon sits at a station a short distance away from the operating table. The surgeon uses a computer to move robotic arms that are connected to surgical instruments. Learn more about robotic surgery.
- A vaginal hysterectomy is done through small incisions in the upper part of the vagina. The uterus is removed through the vagina. A vaginal hysterectomy may be used to treat early stage cancers of the cervix and uterus.
Women who have a vaginal hysterectomy or a laparoscopic hysterectomy generally recover more quickly and resume regular activities sooner than women who have an abdominal hysterectomy. Complete recovery from an abdominal hysterectomy will take 6–8 weeks. To help you recover from surgery:
- Get plenty of rest for the first 2–4 weeks after surgery.
- Don’t do any heavy lifting of more than 20 pounds for at least 6 weeks after surgery.
- The level of activity and exercise may slowly be increased beginning 2 weeks after surgery. Check with your doctor when it’s safe for you to increase your level of activity.
- Your doctor will recommend when it is safe to go back to work. Taking enough time to recover is especially important if you have a physically demanding job.
- Your doctor will also let you know when it is safe for you to drive, do heavy or strenuous exercise, start taking baths again and have sexual intercourse.
Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. Side effects of surgery will depend mainly on:
- the type of hysterectomy you have
- your overall health
Short-term side effects
Short-term side effects can happen during, immediately after or a few weeks after a hysterectomy. They are usually temporary. Short-term side effects of hysterectomy include:
- vaginal discharge
- wound or pelvic infection
- lung infection (pneumonia)
- bladder problems
- constipation or a more serious condition called paralytic ileus
- blood clots in the legs (deep vein thrombosis, or DVT)
- blood clots in the lungs (pulmonary embolism, or PE)
Short-term bladder problems may include losing the feeling of having to urinate or not being able to empty the bladder completely. These problems can happen if the nerves that supply the bladder muscle are damaged. Some women also may develop long-term bladder problems.
Paralytic ileus is when the intestine isn’t working properly and the contents can’t move through it normally. This can lead to a blockage of the intestine that leads to infrequent bowel movements.
Long-term side effects
Long-term side effects can develop months or years after a hysterectomy is over and can last a long time. All women who have had a hysterectomy will be infertile (not able to become pregnant) because their uterus has been removed. Some women may also experience:
- a buildup of lymph fluid (called lymphedema) if lymph nodes in the pelvis are removed during a radical hysterectomy
- treatment-induced menopause (only occurs if both ovaries are removed in premenopausal women)
- vaginal shortening (may occur after a radical hysterectomy)
- blockage of the intestine (called bowel obstruction) caused by bands of scar tissue (called adhesions)
- fistulas, or abnormal openings, between the bladder and the vagina, between the ureters and the vagina or between the rectum and the vagina, which may cause some urine or feces to leak through the vagina
- sexual problems such as vaginal dryness, painful intercourse or loss of interest in sex