Hysterectomy: Facts About Removal of the Uterus, Including Risks, Benefits, Minimally Invasive Versions, and Alternatives

A hysterectomy is a surgical operation to remove the uterus, the hollow, pear-shaped muscular organ located in the female lower abdomen and pelvis. This organ, essential to reproduction, sits behind the bladder and in front of the rectum. (1)

Attached to the uterus on each side is a single fallopian tube and one ovary.

During pregnancy, a fertilized egg implants itself in the lining of the uterus where the developing fetus is nourished prior to birth. (2)

After undergoing hysterectomy, a woman no longer has menstrual periods and she cannot become pregnant.

How Common Is Hysterectomy, or Surgical Removal of the Uterus?

Among American women, hysterectomy is a very common type of surgery. After cesarean section, it is the second most frequently performed surgical procedure for women who are of reproductive age in the United States. (3)

Each year, approximately 600,000 hysterectomies are performed in the United States. (4)

According to the Centers for Disease Control and Prevention (CDC), approximately 20 million women in the United States have had a hysterectomy. (5) By age 60, more than one-third of all women in the United States have had a hysterectomy. (3)

The majority of these procedures are performed as a treatment for health conditions when alternate therapies, such as medication, hormone treatments, or less invasive surgical procedures have been unsuccessful in completely alleviating symptoms such as bleeding and pain.

In far fewer instances, a hysterectomy may be necessary to save a women’s life (for example, to stop life-threatening bleeding after the birth of a baby) or to help prevent the spread of certain gynecological cancers.

Hysterectomy Surgery: What Is Removed or Taken Out?

There are essentially three types of hysterectomy, depending on which structures are removed:

• Total Hysterectomy This is the removal of the entire uterus, including the cervix (the lower narrower portion of the uterus).
• Supracervical (Also Known as a Subtotal or Partial) Hysterectomy This is the removal of the upper part of the uterus. The cervix is left in place.
• Radical Hysterectomy This is a total hysterectomy that also involves removing surrounding tissues around the uterus, called the parametrium. This procedure is usually reserved for cases where cancer is present. (6)

Besides the Uterus and the Cervix, What Other Organs or Structures Are Removed as Part of a Hysterectomy?

Sometimes a surgeon will perform additional surgeries at the time of hysterectomy.

One or both of your ovaries may also be removed. This is called a salpingo-oophorectomy. An oophorectomy is the surgical removal of the ovaries.

A salpingectomy is the removal of the fallopian tubes. The ovaries and tubes may be removed in certain situations — for example, when they are affected by endometriosis. (7)

There are several approaches to hysterectomy. The uterus can be removed through an open incision in the lower abdomen, through the vagina, or with a laparoscopic technique in which the uterus is removed through a few small incisions made in the abdomen.

Each option involves unique risks and benefits, and recovery time can vary depending on the method used. In some instances a women’s choice of procedure is limited — for example, if she has a very large uterus, a vaginal or laparoscopic procedure may not be an option.

An abdominal hysterectomy offers the surgeon the most flexibility. It may be recommended over other types of hysterectomy if you have a large uterus, or you have lots of scar tissue from previous abdominal surgeries, are obese, or if there is a known cancer. Abdominal hysterectomy is the most common method used in the United States.

An average surgery takes approximately one to two hours. (8)

What Less or Minimally Invasive Hysterectomy Options Are Available?

Both vaginal and laparoscopic techniques are considered minimally invasive because surgeons make smaller incisions and use smaller surgical instruments. (9)

During a vaginal hysterectomy, the uterus is removed through the vagina. No abdominal incision is made. Vaginal hysterectomy generally causes fewer complications than either abdominal or laparoscopic surgery. Recovery time is also shorter for the most part. Whenever possible, it is the preferred method. You can expect to be in the operating room for about one to two hours. (8)

Learn More About Types and Methods of Hysterectomy

Ultimately, the root cause or origin of the problematic symptoms governs the solutions. For example, the growth of uterine fibroids, which are noncancerous tumors, may be slowed with medication. Pain from endometriosis may respond to Orilissa — the brand name for elagolix, a new medication — or other therapies.

Learn More About Symptoms and Conditions That May Be Treated With Hysterectomy

Conditions and Symptoms That May Warrant Hysterectomy

Hysterectomy can be used to treat several different conditions and problems, many of which have been considered “women problems.”

Uterine Fibroids: Noncancerous Tumors That Can Cause Pain and Other Symptoms

Fibroids are benign (noncancerous) tumors that arise from the smooth muscle cells of the uterus. Some estimate that up to 80 percent of all women develop fibroids during their childbearing years. (10) Because they often cause no symptoms, doctors usually detect them incidentally during a pelvic exam or a prenatal ultrasound.

Signs and Symptoms of Uterine Fibroids

Symptoms include heavy menstrual bleeding, prolonged menstrual periods (lasting more than a week), pelvic pain, frequent urination, low back pain, or painful intercourse.

While symptoms often respond to medication or nonsurgical treatment, sometimes the symptoms are severe enough to warrant hysterectomy. Hysterectomy is the only permanent solution for uterine fibroids. (11)

Endometriosis: A Disease in Which Uterine Lining Grows Outside the Uterus, Causing Symptoms Such as Pain and Infertility

Endometrioisis is a disease in which tissue similar to the lining of the uterus grows in other places in the body. This often painful condition affects about 10 percent of all women of childbearing age. (12) Most often endometriosis is found on the ovaries, fallopian tubes, and the peritoneum (pelvic sidewall). It can also appear in the bowel and bladder. Rarely, it appears in other parts of the body such as the lungs.

Symptoms include very painful menstrual cramps, chronic pain in the lower back and pelvis, intestinal pain, bleeding or spotting between periods, and digestive problems, including diarrhea, constipation, or nausea, especially when you are having your period. (13)

Hormone therapy and pain medication may help alleviate pain. Minimally invasive procedures may be performed to remove disease, but often lesions return within a year or two. (14) Sometimes after repeated surgical treatments to remove the disease, or instances where hormonal therapy has failed to keep the disease at bay, women opt for a hysterectomy, though it's generally considered a last resort.

Other Conditions That May Warrant Surgical Removal of Uterus or Hysterectomy

Pelvic Support Problems, Such as Pelvic Organ Prolapse

Pregnancy, childbirth, and aging can weaken or stretch a woman’s pelvic supporting tissues and ligaments. In some cases, the uterus can lower or sag into the vagina. Women with this condition may experience pelvic pressure, urinary incontinence, or difficulty making a bowel movement.

You can sometimes find relief from these symptoms through hysterectomy, along with repair.  (15)

Abnormal Uterine Bleeding

Heavy bleeding during your period is one example of abnormal uterine bleeding. Other instances include bleeding and spotting between periods, bleeding or spotting after sex, menstrual cycles that last longer than 38 days or shorter than 24 days, and bleeding after menopause. Benign growths in the uterus, either polyps or fibroids, are common causes. Medication is often the first line of treatment. If medication fails to reduce the bleeding, surgical procedures, like endometrial ablation or uterine artery embolization, are further options.

Sometimes when all other treatments have failed, a woman may opt for a hysterectomy. (16)

Chronic Pelvic Pain

Chronic pelvic pain is pain in the pelvic area that last six months or longer. Most chronic pelvic pain can be attributed to endometriosis. Other conditions that can lead to chronic pelvic pain include fibroids, ovarian cysts, irritable bowel syndrome, and interstitial cystitis (painful bladder syndrome).

Depending on the condition, treatment can include medication, physical therapy, biofeedback, or minimally invasive procedures, such as trigger point injections or peripheral nerve blocks. As a last resort, hysterectomy may be suggested for chronic pelvic pain that hasn’t responded to any other treatment. (17)

Adenomyosis

Adenomyosis is a condition in which the tissue that lines the uterus grows inside the walls of the uterus where it doesn’t belong. The displaced tissue continues to act normally — thickening, breaking down, and bleeding — during each menstrual cycle. The condition sometimes results in an enlarged uterus and painful, heavy periods. The disease usually resolves after menopause. Doctors treat it in the same way as they do endometriosis. Sometimes hormonal treatments help.

Hysterectomy is the definitive cure for adenomyosis. (8)

Is Hysterectomy a Treatment for Cancer?

About 10 percent of hysterectomies are performed to treat cancer. (19) Hysterectomy is the main treatment for endometrial cancer, which is the most common gynecologic cancer. Physicians consider the surgery the best option in many cases.

Endometrial cancer is often detected at an early stage due to symptoms like abnormal vaginal bleeding, which might precipitate a doctor visit. Hysterectomy can often cure the cancer. (20)

Unlike endometrial cancer, which is often caught in earlier stages, ovarian cancer, which begins in the ovaries, often goes undetected until it has spread within the pelvis and abdomen. Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. The surgery may involve hysterectomy, especially if the cancer is extensive. (21)

Hysterectomy is also the most common treatment for early-stage cervical cancers, which begin in the cells lining the cervix, the lower part of the uterus.

Only about 10 percent of the more than 600,000 hysterectomies performed in the United States each year are for cancer treatment and are considered potentially lifesaving. The rest of the hysterectomies performed are essentially elective procedures, and some experts believe that many of them are unnecessary.

For example, problematic uterine fibroids may be addressed via alternative treatments, such as hormonal medication, uterine artery embolization, or myomectomy.

Learn More About Hysterectomy: Do You Really Need It?

Is Hysterectomy, or Surgical Removal of the Uterus, Considered Safe?

Yes. With a less than 1 percent mortality rate, the procedure is considered to be a safe, low-risk surgery. (3)

The Health Risks of Hysterectomy Surgery

While hysterectomy is one of the safest surgical procedures, it is still surgery, so problems can occur.

Risks associated with hysterectomy include: (22)

• Blood clots
• Infection
• Excessive bleeding
• Adverse reaction to anesthesia
• Damage to the urinary tract, rectum, or other pelvic structures

Related: Hysterectomy Linked to Increased Risk for Depression, Other Mood Disorders, Says Study

You may need to stay in the hospital for a day or two, sometimes a bit longer following abdominal hysterectomy. If a woman has a laparoscopic hysterectomy, she can often go home the same day.

Recovery From Hysterectomy and What Post-Op Healing Involves

You can expect some pain for the first few days, but medication should help.

You must avoid vaginal intercourse and any heavy (over 20 pounds) lifting for six weeks following surgery.

Recovery time for an abdominal hysterectomy is approximately six weeks.

Full recovery after vaginal hysterectomy may take three to four weeks. (23)

Learn More About Recovery After Hysterectomy

Despite the fact that hysterectomy is one of the most common surgeries for women living in the United States, many myths and misunderstandings about the surgical removal of the uterus exist.

The procedure has been performed for thousands of years, and was used to treat women diagnosed with "hysteria" or problems similar to anxiety and depression. Today hysterectomy is one of many options if you have fibroids (noncancerous tumors) or excessively heavy periods. If you are considering undergoing the surgery, be sure to have a comprehensive and frank discussion with your doctor before making any decisions.

Learn More About What Your Doctor Won’t Tell You About Hysterectomy