Patient education: Deciding to have a 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. After a hysterectomy, a person cannot get pregnant.

Are there different kinds of surgery for hysterectomy? — Yes. The surgery can be done in 3 ways:

●Open surgery – During an open surgery, the doctor makes a cut, or "incision," in the belly to remove the uterus.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller cuts in the belly. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the belly. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

●Vaginal surgery – For this type of surgery, the doctor makes a cut in the vagina to remove the uterus.

You might be able to return to normal activities sooner if you had minimally invasive surgery or vaginal surgery.

Are other organs removed during a hysterectomy? — Sometimes, other organs are removed in addition to the uterus (figure 2). This 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 a 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. These hormones help keep the heart and bones healthy. They are also 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 tubes can be removed along with the ovaries or by themselves. Sometimes, the fallopian tubes are removed to lower the risk of developing cancer in the future.

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

Why might a person need a hysterectomy? — A hysterectomy might be done to treat certain problems when other treatments have not helped. Conditions that might be treated with a hysterectomy include:

●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 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 pushes down into the vagina (figure 3).

●Cancer or precancer – Cancer can affect the uterus or the cervix. Sometimes, doctors suggest removing these organs if tests show "precancer," or cells that could turn into cancer. People who have genetic tests showing an increased risk of certain cancers might also choose to have a hysterectomy to prevent 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 other things should I think about? — If you are planning to have a hysterectomy, it's important to think about:

●Whether you might want to get pregnant in the future – After 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.

●Whether to have your ovaries removed, too – Talk with your doctor before your surgery about whether or not to have your ovaries removed. You 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.

People who have health problems related to their 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.

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: Hysterectomy (The Basics)
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)