Hysterectomy

In this article, we’ll explore the reasons for having a hysterectomy, the types of procedures available, recovery expectations, and the emotional impact it may have on patients. We’ll also cover what to discuss with your doctor before surgery and how to prepare for life after the operation. Whether you’re facing this decision or supporting someone who is, this guide will help you understand the process with clarity and confidence.

What is a hysterectomy?

A hysterectomy is a major surgical procedure to remove the uterus, effectively ending menstruation and future fertility. Depending on your specific medical needs, the surgeon may also remove the cervix, ovaries, or fallopian tubes.

Doctors recommend this surgery to treat severe conditions like uterine fibroids, heavy bleeding, endometriosis, or gynecologic cancer. The procedure can be performed through the abdomen, the vagina, or using minimally invasive laparoscopic techniques. Since this operation is permanent and irreversible, it is typically considered only after other treatment options have failed.

Hysterectomy surgery

Hysterectomy surgery is the medical procedure to remove a woman’s uterus. It is a major operation that permanently ends menstruation. After this surgery, pregnancy is no longer possible. Doctors recommend a hysterectomy for various reasons. These include treating uterine fibroids that cause pain or bleeding. It is also used for endometriosis and adenomyosis.

In some cases, it is a necessary treatment for gynecological cancers. The surgery can be total, removing the uterus and cervix. A partial hysterectomy leaves the cervix intact.

What Is The Function of The Uterus And Ovaries?

The uterus, the source of monthly menstruation, also houses a developing fetus. In the absence of pregnancy, a woman has about 400 menstrual cycles during her reproductive life. The ovaries are the sites of egg development Ovulation takes place, along with the production of estrogen and progesterone. Estrogen prepares the lining of the uterus for pregnancy in the first 14 days of the cycle.

Progesterone then prepares the endometrium between days 14 to 28 of a cycle for the first step of pregnancy, implantation. When a sperm fertilizes an egg, the developing embryo travels down the fallopian tube and implants into the mature uterine lining. Then, the pregnancy continues to develop in the uterus for an average of nine months and ten days.

The uterus is not responsible for the production of estrogen, progesterone, or any other hormones. The ovaries produce these hormones and then feed them into the uterus.

Hysterectomy complications

While generally considered as a safe procedure, a hysterectomy carries potential risks, both during and after surgery. Key complications may include:

• Excessive bleeding: The uterus is highly vascularized, so careful surgical technique is essential to prevent hemorrhage.
• Infection: Incision sites or deeper pelvic tissues may become infected, especially if fluid buildup or poor wound healing occurs.
• Injury to nearby organs: Because of the uterus’s close proximity to the bladder, ureters, and bowel, these structures may be inadvertently injured and may require surgical repair.

Blood clots: Reduced mobility after surgery increases the risk of deep vein thrombosis (DVT) or pulmonary embolism.

Life After Hysterectomy

Recovery after a hysterectomy is often marked by relief from preoperative symptoms such as pain or heavy bleeding. Many patients report improved quality of life, increased energy, and emotional stability within weeks of surgery.

• If the ovaries are preserved, natural hormone production continues, minimizing menopausal symptoms.

Recovery Time

Recovery depends on the surgical approach:

• Minimally invasive procedures (laparoscopic or robotic): typically 4 to 6 weeks
• Open abdominal hysterectomy: may require up to 8 weeks

Minimally invasive techniques involve smaller incisions, less tissue trauma, and faster healing—often allowing patients to return to work and normal activities sooner.

Is Hysterectomy the Same as Uterus Removal?

Yes, a hysterectomy is surgery to remove the uterus, but the exact organs removed can vary by type.A standard (total) hysterectomy removes the uterus and cervix. A supracervical (subtotal) hysterectomy removes the uterus only, leaving the cervix in place.

Types of Hysterectomy

There are several types of hysterectomy procedures, each tailored to specific medical conditions and individual health needs:

Total Hysterectomy

This involves the removal of both the uterus and the cervix. It is the most common type and is often performed to treat conditions like uterine fibroids, endometriosis, and cancer.

Partial or Subtotal Hysterectomy

Also known as a supracervical hysterectomy, this procedure removes the uterus while leaving the cervix intact.

Radical Hysterectomy

Typically used in cancer treatment, this surgery removes the uterus, cervix, part of the vagina, and surrounding tissues, including lymph nodes. It is a more extensive procedure and may require a longer recovery period.

Reasons for a Hysterectomy

There are several medical reasons why a hysterectomy might be recommended:

• Uterine fibroids causing pain or heavy bleeding
• Endometriosis
• Uterine or cervical cancer
• Chronic pelvic pain
• Abnormal uterine bleeding
• Uterine prolapse

Each case is evaluated individually, and a hysterectomy is generally considered only after other treatments have failed or are unsuitable.

How Is a Hysterectomy Performed?

A hysterectomy can be performed using different surgical techniques depending on the patient’s medical condition, the size of the uterus, the surgeon’s expertise, and the desired recovery outcomes. There are three main approaches, each with its own indications and advantages:

Abdominal Hysterectomy

This is the traditional method involving a horizontal or vertical incision in the lower abdomen. It provides the surgeon with direct access to the uterus and surrounding organs, which is particularly useful in cases of large fibroids, extensive endometriosis, or cancer. While this method allows for comprehensive visualization, it typically requires a longer hospital stay and recovery time.

Vaginal Hysterectomy

In a vaginal hysterectomy, the uterus is removed through the vaginal canal without any external incisions. This technique is often preferred for cases involving uterine prolapse or smaller uterine sizes. It offers the benefit of a quicker recovery, less pain, and no visible scarring.

Laparoscopic or Robotic-Assisted Hysterectomy

This minimally invasive approach involves several small incisions in the abdomen through which a laparoscope (a thin tube with a camera) and surgical instruments are inserted. The surgeon can either operate directly or use a robotic system for enhanced precision. This method is associated with less bleeding, reduced pain, shorter hospital stays, and faster recovery. It’s increasingly popular due to its cosmetic and functional advantages.

Hysterectomy side effects

Hysterectomy side effects can include hormonal changes, fatigue, pain, and emotional shifts, especially if ovaries are removed.

Short-term effects often involve post-surgical pain, bloating, and limited mobility during recovery. Long-term side effects depend on the type of hysterectomy and whether the ovaries were removed. Without ovaries, menopause may begin immediately, leading to hot flashes, mood swings, and vaginal dryness. Some women experience changes in libido or emotional well-being. Others may feel relief from previous symptoms like heavy bleeding or pelvic pain.

Why is a hysterectomy so common?

Hysterectomy is the second most frequently performed surgery for women of reproductive age, primarily because it provides a permanent cure for very common conditions. Uterine fibroids alone account for nearly a third of all procedures, as they often cause debilitating pain and heavy bleeding that less invasive treatments fail to resolve.

Additionally, doctors frequently recommend this surgery as the definitive solution for endometriosis, uterine prolapse, and chronic pelvic pain. Since it completely eliminates the source of symptoms (the uterus itself) it is widely considered the gold standard for restoring quality of life when conservative therapies are ineffective.

When is it necessary?

A hysterectomy should have justifiable indications. Pelvic pain may have multiple causes. In the absence of uterine disease, doctors and patients should be cautious in proceeding with a hysterectomy.

In addition, pre-operative tests like MRIs do have false sensitivity in detecting uterine pathologies such as endometriosis or adenomyosis. Therefore, any need for a hysterectomy should be confirmed with laparoscopic surgery. Nevertheless, there are several conditions where a hysterectomy is unavoidable. These are:

• multiple uterine fibroids
• recurrent fibroids after a myomectomy
• diffuse adenomyosis and extensive endometriosis
• cervical dysplasia (pre-inclination of cervical cancer)
• cervical cancer
• uterine cancer

What diagnostic tests can confirm these conditions?

Diagnostic Test	Purpose
Endovaginal and abdominal sonogram	Intravaginal and abdominal ultrasound imaging will help confirm the presence and location of adenomyosis and fibroids, as well as help to determine the condition of the ovaries.
MRI and contrast	An MRI produces high-quality images of the body, which can give confirmation for a presumptive diagnosis of endometriosis, adenomyosis, and fibroids. This test allows your surgeon to visualize the status of the ureters, which serve as the kidney outlet to the bladder.
Dilation and curettage (D&C)	In the operating room, a surgeon will look inside your uterus with a video camera in order to rule out cervical or uterine cancer, diffuse adenomyosis, submucosal fibroids, or any other findings that call for a hysterectomy.

What are the different classifications?

Aside from the route of the hysterectomy, there are specific techniques as to how to remove the uterus. While your doctor should always provide the best recommendation for your particular case, you should remember that you always have a choice. A hysterectomy is a very personal and emotionally-taxing surgery, and you should feel comfortable discussing your options. Here are a few options that your surgeon may suggest if a hysterectomy is a right procedure for you.

Supracervical hysterectomy (partial)

This procedure involves the removal of the uterus above the cervix. Surgeons refer to this as a “partial hysterectomy” as the cervix is preserved. Retention of the cervix usually improves patients’ outcomes in sexual function and pelvic support. Nevertheless, patients risk ongoing cyclic bleeding from the cervix or reoperation to remove the cervix in the future.

Hysterectomy (total)

This form of hysterectomy removes the uterus and the cervix but preserves the ovaries. Patients often think that ovary removal is standard in a hysterectomy procedure. But in reality, ovaries will only be removed if specified.

Although the ovaries are preserved, surgical “menopause” will occur. This means that periods will cease. However, the ovaries will continue to produce key hormones such as progesterone and estrogen. As a result, menopause symptoms such as hot flashes, mood swings, and fatigue will not occur.

Hysterectomy with bilateral salpingo-oophorectomy

This procedure removes the uterus, fallopian tubes, and ovaries in their entirety. Only when the term salpingo-oophorectomy accompanies a hysterectomy are the fallopian tubes and ovaries also removed. With this procedure, the body goes through menopause.

It no longer produces estrogen and progesterone and symptoms such as hot flashes, mood swings, and fatigue occur. This form of hysterectomy can have emotionally taxing consequences. It should, therefore, only be conducted if a patient chooses to have their ovaries removed.

Partial vs. total hysterectomy

A common misconception among patients concerns the difference between a partial and total hysterectomy. They may think that a partial hysterectomy involves the removal of the uterus while preserving the ovaries and that a total hysterectomy is the complete removal of the uterus, along with the ovaries. However, what patients refer to as a total hysterectomy is what surgeons call a total hysterectomy with bilateral salpingo-oophorectomy. In other words, the removal of the ovaries is not normally part of a hysterectomy procedure, unless specified.

When patients hear the term hysterectomy, they should not be concerned about losing their ovaries unless doctors mention bilateral salpingo-oophorectomy. When doctors use the term partial hysterectomy, they refer to the removal of the upper half of the uterus, while preserving the cervix. To surgeons, a total hysterectomy means the removal of the uterus in its entirety, which includes the cervix.

Will menopause occur following a hysterectomy?

One of the side effects of a hysterectomy is that a woman will no longer menstruate. This can bring on different symptoms depending on the form of hysterectomy.

In a partial or total hysterectomy, because the ovaries are preserved, estrogen and progesterone levels remain the same. In turn, “surgical menopause” takes place.

A woman’s period stops due to the removal of the uterus. But menopause symptoms such as hot flashes, vaginal dryness, and mood swings do not occur as the ovaries remain. Female reproductive hormone levels are normal, and menopause symptoms do not surface.

This is not the case in hysterectomies with bilateral salpingo-oophorectomies, where the ovaries are not preserved. Removing the ovaries means the loss of estrogen and progesterone, thus normal hormonal menopause begins.

Strong consideration should be given to conserving the ovaries when possible. Therefore, it is imperative to carefully consider whether to seek an oophorectomy with your hysterectomy.

Hysterectomy as a treatment for endometriosis

Is it necessary to treat endometriosis?

A hysterectomy is not always necessary to achieve a comprehensive treatment for endometriosis. This is a common misconception among many physicians and we cannot stress this enough.

First and foremost, the primary treatment of endometriosis should always be laparoscopic excision of all endometriotic lesions. Only in cases of endometriosis with diffuse adenomyosis, multiple fibroids with recurrence even after a myomectomy, and/or cervical or uterine cancer, is a hysterectomy necessary.

For a definitive treatment of endometriosis when hysterectomy is necessary, the surgeon should tailor the operation to relieve all symptoms and not just symptoms of suspected uterine origin. In other words, many surgeons misguidedly conduct hysterectomies to ensure the patient no longer suffers from further spreading of endometriotic tissue. However, the endometriotic lesions that have already spread throughout the body will go unremoved.

When is it necessary to treat endometriosis?

The surgical choice for the treatment of endometriosis with a hysterectomy depends on many factors. These include the patient’s age, the severity of her symptoms, and whether she wants to have children. These are all key factors in decision-making.

A thorough history and physical exam are necessary to determine these factors, as well as gauge the areas that the disease may affect in the pelvis.

Diagnostic testing, such as ultrasound imaging and MRI, are also useful tools in determining whether a hysterectomy is necessary. This is strictly in instances of diffuse adenomyosis with anterior and posterior cul-de-sac obliteration.

Only in cases where women with endometriosis no longer wish to have children, and have already had conservative laparoscopic surgery, is a total hysterectomy with bilateral oophorectomy the definitive option. Depending on the expertise of the surgeon, ovarian conservation may also be an option.

What can I expect on the day of surgery?

Once you and your physician have come to an agreement that a hysterectomy is a right choice for you, you must prepare for the day of surgery. Any trip to the operating room can be intimidating. So, we like to inform our patients about what to expect before coming in for their hysterectomy.

• Light bowel preparation is necessary the day before surgery. This entails taking a stool softener in the form of magnesium citrate in order to empty the bowels. When full, the bowels have a tendency of sticking to the uterus, especially in cases of extensive endometriosis such as stage 4 endometriosis and frozen pelvis. Light bowel preparation the night before surgery can make the bowels much more accessible for your surgeon.
• We also advise a predominantly liquid-based light dinner the night before surgery, with no oral intake after midnight.
• Expect to be in the hospital overnight or go home the same day.
• Near scarless surgery to the abdomen with three to four incisions, each less than ⅕ of an inch (5 mm). Our technique for post-surgery suturing models that of plastic surgery.
• We make no sutures requiring a follow-up appointment.

What are common complications that can arise late after the surgery?

What are key surgical aspects to avoid when choosing a hysterectomy surgeon?

FAQ

Our approach

How does our treatment ensure minimal invasion?

As one of the pioneers in the field of proper hysterectomy, and with over three decades of experience, we have mastered our technique to ensure minimal invasion.

Our technique ensures minimal invasion, in great part due to our world-renowned expertise in the field. We do not resort to invasive techniques such as robotic surgery. By not using robots, we are able to perform quicker, less risky, and overall more productive surgeries. Our results are nearly scarless.

Why do we prefer vaginal over abdominal hysterectomy?

Another component of our hysterectomy technique that makes our approach so unique is our expertise in performing laparoscopically assisted vaginal hysterectomies (LAVH). Most surgeons are not able to do this, especially when it comes to cases of endometriosis. This is because great skill and experience are necessary to do this successfully and without complications.

Before the uterus can be removed, a vaginal hysterectomy requires a surgeon to separately detach the uterus from the ovaries, fallopian tubes, upper vagina, as well as all the blood vessels and connective tissue that support it. Even in cases of endometriosis and diffuse adenomyosis, we perform all hysterectomies vaginally if possible.

We do this by first excising all endometriosis lesions we can find throughout the pelvic and abdominal cavity. By performing laparoscopically assisted vaginal hysterectomies, we are able to see above the uterus anatomically. This gives us the ability to identify endometriosis lesions that we would not be able to see through a simple vaginal hysterectomy. Using this technique, we evaluate the peritoneum, cul-de-sac, and the uterus’s relationship with the ovaries and bowels.

The removal of the uterus through the vagina also ensures minimal invasion. When an abdominal hysterectomy is performed, a greater number of incisions that are larger in size must be made to remove the uterus through the abdomen. We have worked tirelessly to master the technique of vaginal hysterectomy so we can ensure minimal invasion.

How do we ensure that a patient’s symptoms disappear?

We firmly believe that whenever a hysterectomy is necessary in the case of endometriosis, thorough laparoscopic excision surgery should precede it.

Many women come to us following hysterectomies with persistent symptoms. If a patient has endometriosis, simply removing the uterus does not address the many other regions where endometriosis may remain. In fact, the patient will most likely continue to experience symptoms as the disease spreads and pain worsens.

We take the time in the operating room to ensure that we excise all lesions and signs of endometriosis, even before we begin to remove the uterus. When we go into surgery, our primary goal is to not only remove the uterus but also ensure we are not doing so in vain. Our primary focus is always ensuring our patients have their highest chance of symptom relief. Laparoscopic deep excision of endometriosis is the best way to do so, with a hysterectomy only if absolutely necessary.

How this can help us choose the right method?

This same conservative approach also determines what specific type of hysterectomy we think is right for you. We always look to preserve the ovaries if possible. There is a potential higher risk of cardiovascular issues and bone loss in premenopausal patients with prophylactic bilateral salpingo-oophorectomy. As a result, hysterectomy and bilateral salpingo-oophorectomy is our last option.

Nevertheless, this procedure can sometimes be necessary. However, even in those rare instances, we always have our patients’ approval, understanding, and consent. We always want our patients to know that they have a choice.

Patient story

Hysterectomy for advanced endometriosis (stage 4)

E.L was a patient in her early 40’s who quietly struggled with adenomyosis for nearly two years. After consulting with two other physicians, she underwent a successful supracervical hysterectomy treatment at Seckin Endometriosis Center. Learn about E.L’s story here.

You can read more stories of patients who received hysterectomies in our testimonial section.