The most common reason for a hysterectomy is fibroid tumors growing in the muscle of the uterus, which can sometimes cause heavy bleeding and pain. More hysterectomies are done because of fibroids than for any other problem of the uterus. Endometriosis, which can cause painful menstrual periods, abnormal vaginal bleeding, and sometimes loss of fertility (ability to get pregnant), is the second leading reason for hysterectomies. Uterine prolapse, a condition in which the uterus moves from its usual place down into the vagina, accounts for about 16% of all hysterectomies. Cancers affecting the pelvic organs account for about 10% of all hysterectomies. Other reasons why it may be necessary to have a hysterectomy include chronic pelvic pain, heavy bleeding during or between periods, and chronic pelvic inflammatory disease.

For some conditions of your uterus and ovaries, a hysterectomy is the only treatment option. Read more about fibroids; endometriosis, uterine prolapse, uterine, endometrial, and cervical cancer, abnormal uterine bleeding, and your treatment options for these conditions.

A hysterectomy is the surgical removal of the uterus, or womb. It is the second most frequently performed surgery among women, after cesarean section (C-section). Depending on the type of hysterectomy performed and the reason it’s being done, removal of the cervix, ovaries, and fallopian tubes is sometimes performed during the same surgery.

Learn more about hysterectomy.

While all hysterectomies remove a woman’s uterus, or womb, there are different types of hysterectomies:

• A complete or total hysterectomy involves the removal of the uterus and the cervix.

• A partial or supracervical hysterectomy involves the removal of the upper part of the uterus, but not the cervix.

• A radical hysterectomy involves removal of the cervix, the uterus, the upper part of the vagina, and supporting tissues, including the lymph nodes. This type of hysterectomy is usually performed when cervical cancer is present.

• A total hysterectomy and bilateral salpingo-oophorectomy involves a total hysterectomy plus the removal of the ovaries and fallopian tubes, which brings on surgical menopause. If you require this type of surgery, it’s important to talk to your doctor about symptoms of menopause.

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There are two main techniques used to perform hysterectomies:

• Open technique

  A total abdominal hysterectomy (TAH) is a complete hysterectomy performed through an incision of approximately five inches in length in the abdominal muscle. TAH is not considered a type of MIP. After the incision is made, the surgeon cuts through the muscle wall and other connective tissues to reach the uterus.

• Minimally invasive techniques

  A vaginal hysterectomy is performed through an incision made at the top of the vagina. Through the incision, all connections between the uterus and the body are cut and tied off. Then the uterus is removed through the vagina.

  A laparoscopic hysterectomy is performed through small dime-sized incisions made in the abdomen to create passageways for specialized surgical instruments used to perform the procedure. The uterus is detached while the doctor is viewing the area through a laparoscope (a miniature camera). The image is viewed by the surgeon on a video monitor. After the uterus is detached, it is removed vaginally through a small incision.

Learn more abut open surgery vs. MIP for hysterectomy.

While it is considered one organ, the uterus is made up of different parts:

• The ovaries are the organs that contain and produce eggs. Working with the brain and the central nervous system, the ovaries also control your hormonal cycle. They play a part in the release of estrogen, which sparks the start of the menstrual cycle and the release of one egg per month until menopause.

• The fallopian tubes are the tubes that eggs travel through as they move from the ovaries to the uterus.

• The fundus is the top of the uterus.

• The body of the uterus is where the fertilized egg is normally implanted and nourished as it grows during pregnancy.

• The endometrium is the mucous membrane that lines the uterus and is shed during menstruation.

• The myometrium is the muscular wall that forms the main mass of the uterus.

• The cervix, which narrows towards the bottom, is the lower portion of the uterus and connects the uterus to the vagina.

• The vagina, or birth canal, is the passage from the uterus to the genital area. The vagina is made of muscle that can expand to allow the baby to pass through during birth.

Learn more about the anatomy of the uterus.

Depending on the type of hysterectomy, the uterus, the cervix, the upper part of the vagina, the lymph nodes, the ovaries, and the fallopian tubes, and the tissues supporting all of these organs, may be removed.

Learn more about the anatomy of the uterus.

The decision about removal of the ovaries (oophorectomy) during a hysterectomy is one that should be discussed with your doctor. Factors that will influence the decision include the type of hysterectomy being performed and the disease being treated. However, the decision about removal of the ovaries should be a separate and distinct one from the decision about removal of the uterus.

Learn more about hysterectomy.

After a hysterectomy you will no longer menstruate or be able to conceive, but you will still be able to engage in sexual activities.

Learn more about hysterectomy.

Different women experience sexuality differently. Many women get pleasure from stimulation of the clitoris, other women by vaginal stimulation, and still others by a combination of the two. Some women may have pleasurable uterine contractions with orgasm, and others may feel that pressure against the cervix during intercourse is important to their sexual experience. For some women, a hysterectomy may change or eliminate these sensations. For other women, hysterectomy will not affect their sexual enjoyment.

However, if your uterus is causing you to have pain with intercourse, a hysterectomy may relieve that pain and make intercourse more pleasurable. One study found that following removal of the uterus for symptoms that were significantly bothersome to the patient, 75% of women noted that sexual enjoyment was better, while only 10% felt it was worse, than before surgery. ⁴¹ Another study found that the best predictors of sexuality after hysterectomy were the frequency of desire, intercourse, and orgasm prior to the surgery, as well as the woman’s attitude towards her partner. ⁴²

Learn more about hysterectomy.

While all operations have risks, serious complications from a hysterectomy are rare. The risk for serious complications depends on the reason surgery is needed, your medical condition and age, and the experience of the surgeon and anesthesiologist. 

Get more details about the risks and complications of hysterectomy.

Many women feel that MIP is a better option for them than TAH because MIP offers a number of significant benefits, including:

• Less recovery time

• Less time in the hospital

• Less scarring

• Less pain

Today, there are several kinds of MIP for hysterectomy to consider. The appropriate surgical option may depend on many factors, including the condition being treated. Learn more about the benefits of MIP for hysterectomy.