Hysterectomy

A hysterectomy is surgical removal of a woman’s uterus. Uterus is commonly known as the “womb”, where a baby grows during a pregnancy. It is the second most common surgery among women in the United States.

A hysterectomy may treat conditions other than cancer, including:

• Uterine fibroids - non-cancerous, muscular tumors that grow in the wall of the uterus and can cause pain, pressure and abnormal bleeding.
• Endometriosis -occurs when the tissue that lines the uterus grows outside the uterus and on other organs and causes pain and abnormal bleeding.
• Prolapse of the uterus- occurs when the uterus slips down from its usual place into the vagina and can cause pain, pressure, bulge and incontinence.
• Adenomyosis - when the tissue that lines the uterus grows inside the walls of the uterus and causes pain and abnormal bleeding.
• Chronic pelvic pain - may be treated with a hysterectomy, particularly if it is clear the pain comes from the uterus.
• Abnormal vaginal bleeding - may be caused by multiple factors, including changes in hormone levels, infection, cancer or fibroids.

A hysterectomy may be used to treat endometrial, cervical, ovarian and uterine cancers. The type of hysterectomy performed depends on the type of cancer, as well as its extent. The procedure may involve removing the ovaries and fallopian tubes in a surgery called a salpingo-oophorectomy. If a patient hasn't yet reached menopause, a hysterectomy that removes the ovaries will cause her menstrual periods to stop and put her into surgical menopause. Ask the care team about taking estrogen after the surgery to help lower the risk of heart disease and osteoporosis, and relieve menopausal symptoms.

Types of hysterectomy

Different types of hysterectomy may be performed, depending on each patient's individual situation. Options include:

• Supra-cervical (layman terminology for this is “partial hysterectomy”) hysterectomy: The upper part of the uterus is removed, and the cervix is left intact. This type of hysterectomy is also called subtotal or supracervical.
• Total hysterectomy: The entire uterus and the cervix are removed.
• Radical hysterectomy: The entire uterus, the tissue on both sides of the cervix and the upper part of the vagina are removed. This type of surgery is performed mainly to treat cancer.
• Total hysterectomy with bilateral salpingo-oophorectomy: The entire uterus and the cervix are removed, as well as both ovaries and fallopian tubes. This procedure is similar to a unilateral salpingo-oophorectomy, but in the latter procedure, the ovary and fallopian tube on only one side are removed.

Surgeons may choose from a number of techniques to perform a hysterectomy, including:

• Abdominal surgery: The surgeon makes a 5- to 7-inch incision in the lower part of the belly. The incision, or cut, may be placed up and down or across the belly.
• Vaginal surgery: To perform the procedure, the surgeon makes an incision in the vagina near the cervix so he or she can access the uterus. The surgeon detaches the uterus and cervix from blood vessels and connective tissue, in addition to the ovaries, fallopian tubes and the upper vagina, and removes the uterus through the vagina.
• Laparoscopic surgery: The surgeon makes three or four small incisions in the belly and inserts surgical tools and a special camera called a laparoscope inside the body. The surgeon operates while watching the video from the laparoscope on high-resolution monitors in the operating room. The surgeon removes the uterus through the vagina, using an incision in the vagina to detach the uterus from the vagina.
• Robotic-assisted surgery: Similar to a laparoscopic hysterectomy, with this procedure, the surgeon inserts a surgical tool and a laparoscope through small incisions in the belly, then then uses specialized robotic technology to perform the surgery.

Hysterectomy for cancer

Hysterectomy for endometrial or uterine cancer

Removal of the uterus and cervix is the most common treatment for endometrial cancer. Sometimes the removal of fallopian tubes with or without ovaries and lymph nodes is also necessary. This may be done with an abdominal hysterectomy, a vaginal hysterectomy, a laparoscopic hysterectomy (in which the organs are removed through the vagina laparoscopically, with tiny abdominal incisions made for the camera and instruments to pass through) or robotic-assisted surgery (in which a laparoscopic hysterectomy is performed with the assistance of tools with robotic arms that allow for more precision).

A total abdominal hysterectomy involves the removal of these organs through an abdominal incision, whereas in a vaginal hysterectomy, the cervix and uterus are removed through the vagina. In cases where cancer has spread outside of the cervix, a radical hysterectomy to remove the upper portion of the vagina and the tissues near the uterus (the parametrium and uterosacral ligaments) may be performed.

Hysterectomy for cervical cancer

A simple hysterectomy to remove the uterus and cervix may be used to treat severe cases of cervical intraepithelial neoplasia (abnormal cervical cells), some early cervical cancers or invasive cervical cancer.

Hysterectomy for ovarian cancer

If ovarian cancer has spread, most times hysterectomy is performed along with removal of tubes and ovaries. Other tissue like omentum, lymph nodes and peritoneal biopsies may also be removed. These surgeries may be called “debulking."

Recovery from hysterectomy

The exact length of recovery from a hysterectomy depends on which type of procedure the patient has undergone, but it generally lasts about six weeks, according to the American Cancer Society.

• Abdominal hysterectomy: The patient will need to stay in the hospital for a minimum of two days after an abdominal hysterectomy. Thereafter, expect to spend another six to eight weeks recovering at home.
• Radical hysterectomy: The patient's hospital stay after this more-invasive surgery may be approximately three to seven days.
• Laparoscopically assisted vaginal hysterectomy or robotic-assisted hysterectomy: Because these procedures are much less invasive than abdominal and radical hysterectomies, the hospital stay may last one to two days. At home, recovery may take about two to three weeks however the internal healing takes the same time of six-eight weeks. Therefore there will be some restrictions for that time period.

Complications and side effects

It’s normal to have side effects after surgery, such as pain and fatigue, but these are short-term.

The patient may also experience some nausea, and it may be difficult to urinate or have a bowel movement immediately after surgery.

The patient will gradually return to a normal diet.

If the patient's ovaries were removed, she may experience menopausal symptoms, such as hot flashes, night sweats and vaginal dryness. Discuss any side effects with the provider and the care team so that they can suggest ways to manage them.

Following a hysterectomy, a woman will no longer have periods and cannot get pregnant (carry a child). Having a hysterectomy may result in changes to a woman's body and may affect how she feels about herself. It’s important to discuss potential changes with the doctor or nurse, as well as trusted family members and friends, before the surgery.

The following complications are rare but serious:

• Excessive bleeding and/or blood clots
• Damage to the ureter during surgery
• Damage to the bladder or bowel, causing infection, incontinence or frequent urination
• Vaginal problems, such as prolonged wound healing or vaginal prolapse
• Ovarian failure due to decreased blood supply
• Wound or urinary tract infection
• Allergic reaction to anesthesia

If the patient's lymph nodes are removed as part of the surgery, she may experience a side effect called lymphedema. This occurs when lymph fluid builds up in the soft body tissues, resulting in swelling.

Learn more about lymphedema treatment for gynecologic cancers.

Cancer after hysterectomy

It may still be possible to develop gynecologic cancer following a hysterectomy, but the risk depends on which procedure was performed. Women who undergo these procedures should continue to follow the care team's recommendation on screenings.

If a woman has a partial or total hysterectomy but her ovaries remain in place, she may still face the risk of developing ovarian cancer.

If both of the patient's ovaries were removed, she's still at risk of developing primary peritoneal cancer (PPC), a rare cancer that affects the peritoneum, a thin layer of tissue that covers the abdominal organs.

Symptoms of PPC include:

• Bloating
• Nausea or vomiting
• Bowel habit changes
• Feeling full after eating very little

Women without ovaries may continue to be at risk of developing ovarian or fallopian tube cancer, although the risk is low.

If the patient didn't have her cervix removed during the hysterectomy, she may still be at risk of developing cervical cancer.

Women who've undergone a hysterectomy should continue to be evaluated for vaginal cancer, which is rare but may still occur following hysterectomy.