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 lower abdomen and pelvis. This organ, essential to reproduction, sits behind the bladder and in front of the rectum. (1)

On each side of the uterus is a fallopian tube and 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 person no longer has menstrual periods and cannot become pregnant.

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

Hysterectomy is a common type of surgery, with about 600,000 performed each year in the United States. After cesarean section, it is the second most frequently performed surgical procedure. (3)

According to the Centers for Disease Control and Prevention (CDC), about one-third of women ages 50 and older in the United States have had a hysterectomy. Black women in this age group are more likely than white women to have had a hysterectomy, while Hispanic women are less likely.

Most of the time, a hysterectomy is performed to treat a health condition when alternative therapies, such as medication, hormone treatments, or less-invasive surgical procedures have been unsuccessful in completely alleviating symptoms such as bleeding and pain.

In some cases, a hysterectomy may be necessary to save a person’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, as noted by the American College of Obstetricians and Gynecologists. The uterus can be removed through an open incision in the lower abdomen, through the vagina, or using 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 person's choice of procedure is limited — for example, if they have a large uterus, a vaginal or laparoscopic procedure may not be an option.

An abdominal hysterectomy typically involves a hospital stay of at most two to three nights, according to Stanford Medicine. It may be recommended over less-invasive options if you have an enlarged uterus, large fibroids, endometriosis, or cancer, or if you need your ovaries and fallopian tubes removed.

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)

In a vaginal hysterectomy, the uterus is removed through the vagina and no abdominal incision is made, Stanford Medicine notes. Vaginal hysterectomy generally involves the least postsurgery pain and leaves no visible scarring, and is typically the preferred method for treating uterine prolapse (when the uterus falls down into the vagina due to weakened muscles and other pelvic tissues). But due to the size and location of the vagina, vaginal hysterectomy may not be an option for your procedure.

Learn More About Types and Methods of Hysterectomy

During the procedure, your surgeon makes a few small incisions in your lower abdomen. Then a laparoscope — a thin, tube that contains a video camera — is inserted in one of these incisions. The laparoscope allows the surgeon to see your pelvic organs, and surgical tools are inserted through the other incisions. The uterus can be removed in small pieces through the incisions, through a larger incision made in the abdomen, or through the vagina, Stanford Medicine notes.

Treatment Options That Aren’t Hysterectomy

Most hysterectomies are elective, which means you should have some time to explore and discuss other options to manage your pain or other symptoms.

With the exception of certain gynecological cancers or a rare emergency, such as uncontrollable bleeding after childbirth, there are alternatives to hysterectomy that can treat nearly every condition or symptom where surgical removal of the uterus may be considered. Treatment options may include medication, hormone treatments, or minimally invasive procedures.

Learn More About Alternatives to Hysterectomy

Ultimately, the root cause or origin of your symptoms will determine the solutions your doctor offers or recommends. For example, the growth of uterine fibroids, which are noncancerous tumors, may be slowed with medication. Pain from endometriosis may respond to the medications such as elagolix (Orilissa) or other therapies.

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

Conditions and Symptoms That May Warrant Hysterectomy

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

Fibroids are benign (noncancerous) tumors that grow in the wall of the uterus. They can be as small as an apple seed or as large as a grapefruit, according to the Office on Women’s Health. Because they often cause no symptoms, doctors sometimes detect fibroids incidentally during a pelvic exam or a prenatal ultrasound.

Signs and Symptoms of Uterine Fibroids

Fibroids don’t always cause symptoms. When they do, symptoms can 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

In endometriosis is a disease in which tissue similar to the lining of the uterus grows in other places in the body. 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.

Symptoms of endometriosis can include 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 from endometriosis. Minimally invasive procedures may be performed to remove diseased tissue, but lesions and pain often return within a year or two. (14) Sometimes after repeated surgical treatments to remove the disease, or instances where hormone 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 person’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. Hysterectomy may be recommended for this condition. (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 person may opt for a hysterectomy. (16)

Chronic Pelvic Pain

Chronic pelvic pain is pain in the pelvic area that lasts 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 for pelvic pain 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. This usually resolves after menopause. Doctors treat it the same way they treat endometriosis. Sometimes hormonal treatments help.

Hysterectomy may be recommended for adenomyosis when other treatments have failed to control the condition, the Mayo Clinic notes.

Is Hysterectomy a Treatment for Cancer?

Hysterectomies are routinely performed to treat cancer. Hysterectomy is the main treatment for endometrial cancer, which is the most common gynecologic cancer, according to the American Cancer Society. 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 prompt a doctor visit. Hysterectomy can often eliminate 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 advanced. (21)

Hysterectomy is also a common treatment for early-stage cervical cancers, according to the American Cancer Society. This type of cancer begins in the cells lining the cervix, the lower part of the uterus.

Only a fraction of the approximately 600,000 hysterectomies performed in the United States each year are for cancer treatment and 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 by alternative treatments, such as hormone 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 of 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 should avoid any heavy (over 20 pounds) lifting for six weeks after surgery. Generally, you should avoid vaginal intercourse, or putting anything in your vagina, for eight weeks after a hysterectomy. (23)

Learn More About Recovery After Hysterectomy

Despite the fact that hysterectomy is one of the most common surgeries 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

Get All the Facts About Hysterectomy

Consider getting a second opinion if your doctor recommends hysterectomy. It is a permanent, irreversible procedure, and in most cases, surgical removal of the uterus is elective rather than medically necessary.