Hysterectomy

Medical Author: Suzanne R Trupin, MD
Medical Editor: Melissa Conrad Stöppler, MD

• What is a hysterectomy?
• How common is hysterectomy?
• Why is a hysterectomy performed?
• What tests or treatments are performed prior to a hysterectomy?
• How is a hysterectomy performed?
• What are the types of hysterectomies
  • Total abdominal hysterectomy
  • Vaginal hysterectomy
  • Laparoscopy-assisted vaginal hysterectomy
  • Supracervical hysterectomy
  • Laparoscopic supra cervical hysterectomy
  • Radical hysterectomy
  • Oophorectomy and salpingo-oophorectomy (removal of the ovaries and/or Fallopian tubes)
  • Patient Discussions: Hysterectomy - Describe Your Experience
• What are complications of a hysterectomy?
• What are the alternatives to a hysterectomy?
• Should women who have had a hysterectomy continue to have PAP smears?
• Related hysterectomy articles:
  Hysterectomy - on WebMD

What is a hysterectomy?

A hysterectomy is a surgical procedure whereby the uterus (womb) is removed. Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States.

How common is hysterectomy?

Approximately 300 out of every 100,000 women will undergo a hysterectomy.

Why is a hysterectomy performed?

The most common reason hysterectomy is performed is for uterine fibroids The next most common reasons are:

• abnormal uterine bleeding (vaginal bleeding),
  
  
• cervical dysplasia (pre-cancerous conditions of the cervix),
  
  
• endometriosis, and uterine prolapse (including pelvic relaxation).

Only 10% of hysterectomy is performed for cancer. This article will primarily focus on the use of hysterectomy for non-cancerous, non-emergency reasons, which can involve even more challenging decisions for women and their doctors.

Uterine fibroids (also known as uterine leiomyomata) are by far the most common reason a hysterectomy is performed. Uterine fibroids are benign growths of the uterus, the cause of which is unknown. Although the vast majority are benign, meaning they do not cause or turn into cancer, uterine fibroids can cause medical problems. Indications for hysterectomy in cases of uterine fibroids are excessive size (usually greater than the size of an eight month pregnancy), pressure or pain, and/or bleeding severe enough to produce anemia. Pelvic relaxation is another condition that can require treatment with a hysterectomy. In this condition, a woman experiences a loosening of the support muscles and tissues in the pelvic area. Mild relaxation can cause first degree prolapse, in which the cervix (the uterine opening) is about halfway down into the vagina. In second degree prolapse, the cervix or leading edge of the uterus has moved to the vaginal opening, and in third degree prolapse the cervix and uterus protrude past the vaginal opening. Second and third degree uterine prolapse must be treated with hysterectomy. A loosening, vaginal wall weakness such as a cystocele, rectocele, or urethrocele, can lead to symptoms such as urinary incontinence (unintentional loss of urine), pelvic heaviness, and impaired sexual performance. The urine loss tends to be aggravated by sneezing, coughing, or laughing. Childbearing is probably involved in increasing the risk for pelvic relaxation, though the exact reasons for this remain unclear. Avoidance of vaginal birth and having a caesarean section doesn't eliminate the risk of developing pelvic relaxation.

A hysterectomy is also performed to treat uterine cancer or very severe pre-cancers (called dysplasia, carcinoma in situ, or CIN III, or microinvasive carcinoma of the cervix). A hysterectomy for endometrial cancer (uterine lining cancer) has an obvious purpose, that of removal of the cancer from the body. This procedure is the foundation of treatment for cancer of the uterus.

Next: What tests or treatments are performed prior to a hysterectomy? »

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