Hysterectomy 101

Each year, more than 600,000 hysterectomies are performed in the United States, making it one of the most common women's surgeries—second only caesarean section. In fact, according to the U.S. Department of Health and Human Services, the procedure is so common that one in every three American women has had a hysterectomy by age 60.

Despite its prevalence, however, little is known about hysterectomy beyond the fact that the procedure makes it impossible for a woman to become pregnant. The reason for this is that a hysterectomy is the surgical removal of the uterus, the pear-shaped reproductive organ responsible for holding a fetus during pregnancy.

In some hysterectomies, other organs may be removed as well, especially if the patient has certain medical conditions, such as endometriosis or cancer, in which a hysterectomy may offer treatment. Other organs that may be removed include the cervix (the lower part of the uterus that opens into the vagina), the ovaries (glands on both sides of the uterus that release eggs for pregnancy), and the fallopian tubes (the passageways between the uterus and the ovaries).

Why Is a Hysterectomy Performed?

A hysterectomy may be indicated to relieve symptoms caused by several conditions, including:

  • Fibroids.
  • Uterine fibroids, benign tumors that develop in or attach themselves to the uterine wall, may grow as single tumors or in clusters. For many women with fibroids, symptoms are minimal and require no treatment. But for others, they can cause excessive menstrual bleeding, pelvic pain, and frequent urination. More hysterectomies are performed because of fibroids than any other problem of the uterus, according to the U.S. Department of Health and Human Services.

  • Uterine prolapse.
  • This condition happens when the pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then descends into the vaginal canal.

  • Endometriosis.
  • This is a condition in which endometrial tissue, the tissue that lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Symptoms can include painful menstrual periods, abnormal menstrual bleeding, and pain during or after sexual intercourse. When medication and surgery do not cure endometriosis, a hysterectomy is often performed.

  • Cancer.
  • If a patient has cancer of the uterus, cervix, or ovaries, a hysterectomy may be recommended as a possible treatment.

  • Chronic pelvic pain.
  • Surgery is sometimes an option for women who have chronic pelvic pain, which may be caused by several conditions. Often, other treatments for chronic pelvic pain are recommended first, leaving surgery as a last resort.

How Is a Hysterectomy Performed?

The type of hysterectomy surgery you have depends on four main factors: the reason for the surgery, the size of the uterus, its position in the stomach, and your overall health. The five most common types are:

  • Abdominal hysterectomy.
  • The doctor makes an incision in the stomach, and the uterus and cervix are removed. This type of surgery is common when cancer may be present, the uterus is extremely large, or the patient has endometriosis, in which the lining of the uterus grows outside of the uterus.

  • Vaginal hysterectomy.
  • The doctor removes the uterus through the vagina by making a small incision. This method is only used if there is no chance that cancer may be present in the uterus, cervix, or ovaries-or if the uterus is small enough to be removed vaginally.

  • Laparoscopically assisted vaginal hysterectomy (LAVH).
  • To perform this surgery, the doctor inserts a lighted tube called a laparoscope through small cuts in the stomach. This allows the doctor to have a clear view of the organs while inserting surgical tools to cut the tissue that holds the uterus in place. The uterus is then removed through the vagina.

  • Laparoscopic supracervical hysterectomy (LSH).
  • With LSH, the doctor inserts a scope and tools through small incisions in the stomach. The uterus is removed in small pieces, while the cervix is left in place. This surgery is only performed if the patient doesn't have cervical cancer.

  • Total laparoscopic hysterectomy (TLH).
  • For this type of surgery, the doctor inserts a scope and tools through several small incisions in the stomach. The uterus and cervix are then removed in small pieces through one of the incisions.

Are There Alternatives to a Hysterectomy?

It's important to remember that a hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, be sure ask your doctor about alternatives to this surgery.

In the case of cancer, hysterectomy might be the only option. But there may be alternative treatments for conditions such as fibroids, endometriosis, and uterine prolapse. These options may include medications, endometrial ablation (the use of electricity, heat, or cold to destroy the lining of the uterus), or uterine artery embolization (a procedure that involves blocking the blood supply to fibroids, which can reduce pain and heavy bleeding).