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Hysterectomy

Definition

A hysterectomy is surgery to remove a woman’s womb (uterus). The womb is the area where a baby grows when a woman is pregnant.

Alternative Names

Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus; Laparoscopic hysterectomy; Laparoscopically assisted vaginal hysterectomy; LAVH; Total laparoscopic hysterectomy; TLH; Laparoscopic supracervical hysterectomy; Robotically assisted hysterectomy

Description

During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes and ovaries may also be removed.

Types of hysterectomy:

  • Partial (supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
  • Total hysterectomy: The entire uterus and cervix are removed.
  • Radical hysterectomy: The uterus, upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.

There are many different ways to perform a hysterectomy. It may be done through a surgical cut in either the belly (abdomen) or vagina. Types include:

  • Abdominal hysterectomy 
  • Laparoscopic hysterectomy
  • Laparoscopy-assisted vaginal hysterectomy
  • Robotic hysterectomy

Your doctor will help you decide which type of hysterectomy is best for you. The specific procedure depends on your medical history and reason for the surgery.

Why the Procedure Is Performed

There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:

Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor or nurse about all your treatment options. Less invasive procedures include:

Risks

The risks for any surgery are:

Risks that are possible from a hysterectomy are:

  • Injury to the bladder or ureters
  • Pain during sexual intercourse
  • Early menopause if the ovaries are removed
  • Decreased interest in sex
  • Increased risk of heart disease if the ovaries are removed before menopause

Estrogen replacement therapy can help decrease the risk of heart disease and may help menopause symptoms.

Before the Procedure

Before deciding to have a hysterectomy, ask your doctor or nurse what to expect after the procedure. Many women who have had a hysterectomy notice changes in their body and in how they feel about themselves. Talk with your doctor, nurse, family, and friends about these possible changes before you have surgery.

Always tell your health care team about all the medicines you are taking, including herbs, supplements, and other medicines you bought without a prescription.

During the days before the surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything for 8 hours before the surgery.
  • Take any medicines your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After surgery, you will be given pain medicines to relieve any discomfort.

You may also have a tube, called a catheter, inserted into your bladder for 1 to 2 days to pass urine.

You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds up recovery.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea or vomiting.

How long you stay in the hospital depends on the type of hysterectomy. Sometimes, you can go home the next day. Other times, most women who have a hysterectomy stay in the hospital 2 to 3 days. The hospital stay may be longer if the hysterectomy is done because of cancer.

Outlook (Prognosis)

How long it takes you to recover depends on the type of hysterectomy. Recovery may take anywhere from 2 to 6 weeks. Average recovery times are:

  • Abdominal hysterectomy: 4 - 6 weeks
  • Vaginal hysterectomy: 3 - 4 weeks
  • Robot-assisted hysterectomy: 2 - 4 weeks

A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy.

References

Entman SS, Graves CR, Jarnagin BK, Rao GG. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 75.

Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.

Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93.

National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology: Cervical Cancer. v.1.2010

Middleton LJ, Champaneria R, Daniels JP, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16;341:c3929.

ACOG Committee Opinion No. 444: choosing the route ofhysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-1158.


Review Date: 2/26/2012
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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