What Is a Hysterectomy? 

Learn why patients may benefit from a hysterectomy and how surgical advancements have improved the procedure. 

You probably know someone who has had a hysterectomy. Statistics show more than 14% of women in the United States have undergone the procedure, and it’s the second most common surgery performed on women after cesarean sections, according to the U.S. Department of Health and Human Services. 

There are three types of hysterectomy surgery: 

• A total hysterectomy involves removing the patient’s uterus and cervix.  

• A partial hysterectomy, also known as a supracervical hysterectomy, removes only the uterus.  

• Patients diagnosed with uterine, cervical or ovarian cancer may choose a radical hysterectomy to remove the uterus, cervix, the tissue alongside the cervix, the upper part of the vagina, and sometimes the ovaries and fallopian tubes as well. 

“When patients are considering hysterectomy, the majority have tried less-invasive interventions and are done with childbearing,” says Brittney Alyce Robinson, MD, an obstetrician and gynecologist treating patients at USC Verdugo Hills Hospital, part of Keck Medicine of USC.  

What are the main reasons for a hysterectomy? 

“One of the most common reasons for a hysterectomy is abnormal uterine bleeding,” Dr. Robinson explains. Heavy bleeding from conditions such as uterine fibroids can cause patients to become anemic, which can severely impact daily life and even lead to serious complications like heart problems and organ damage if untreated. 

A uterine prolapse, which happens when muscle weakness around the uterus causes the uterus to sag into the vagina, is another primary reason for a hysterectomy. The risk of a uterine prolapse increases with age and is more common after menopause. Mothers who have had multiple pregnancies are also more likely to experience uterine prolapse. 

Patients may also consider a hysterectomy as part of cancer treatment. Cancer that is limited to the cervix may be cured with a total hysterectomy. For ovarian cancer, patients may choose a radical hysterectomy that includes removing the ovaries and fallopian tubes. 

Dr. Robinson emphasizes, however, that a hysterectomy is a major surgery and should only be considered if less-invasive options are unsuccessful. “For younger patients who want to have children in the future, I would not counsel them toward hysterectomy,” she says. 

To address abnormal bleeding and pain, Dr. Robinson says she starts with nonsurgical options including medications, lifestyle modifications and exercises such as pelvic floor physical therapy. 

How is a hysterectomy surgery performed? 

“The gold standard or the preferred approach is a vaginal hysterectomy because it has the best outcomes for the patient,” Dr. Robinson says. 

Dr. Robinson explains that she performs a procedure called vaginal natural orifice transluminal endoscopic surgery, or vNOTES. It allows her to perform a vaginal hysterectomy laparoscopically via an “incision-less” surgery that is completed vaginally and leaves no external scarring for the patient. 

Another option is an abdominal hysterectomy, which can also be performed using laparoscopic instruments. The doctor creates tiny incisions around the belly button and lower pelvis to remove the uterus and other organs.  

Laparoscopic and robotic hysterectomies, whether performed through the vagina or abdomen, are minimally invasive, and patients can typically go home the same day. Dr. Robinson advises patients to take it easy for about six weeks after a hysterectomy. Patients can walk and take the stairs, but they should avoid heavy lifting and sexual activity while the area heals.  

An open hysterectomy may be required when surgery involves a large uterus, large fibroids or large pelvic masses, or if there is increased risk of running into surgical difficulty when trying to perform minimally invasive techniques. Surgeons may also recommend an open procedure if the patient has cancer, as this method allows the doctor to more easily check to see if the disease has spread. Patients can expect to spend a couple of days in the hospital after undergoing an open hysterectomy. 

What to expect after a hysterectomy 

Hysterectomy side effects depend on the type of procedure performed.  

Hysterectomy scar 

With a vaginal hysterectomy, patients avoid visible scarring. A laparoscopic abdominal hysterectomy results in minimal scarring since the incisions are small. A scar from an open hysterectomy, however, can resemble a horizontal, low-transverse scar, similar to a cesarean scar. In some cases, however, a vertical incision is necessary and results in a vertical scar. 

Sex after hysterectomy 

“Patients are able to maintain sexual function after a hysterectomy and it will not affect their ability to achieve orgasm,” Dr. Robinson says. However, she says patients should avoid vaginal sexual activity until their doctor verifies the area has healed properly.  

Bleeding after hysterectomy 

Since a hysterectomy removes the uterus, patients will stop having menstrual periods and cannot become pregnant. However, a total or partial hysterectomy does not automatically trigger menopause, and hot flashes or symptoms of menopause may be triggered by removal of the ovaries if the patient has not already completed menopause.  

If patients are struggling with chronic symptoms that aren’t resolved with less-invasive options, Dr. Robinson encourages them to speak with a specialist and get a second opinion about whether a hysterectomy could help.  

“Overall, hysterectomy can be very effective to treat certain conditions,” Dr. Robinson says. “Most patients have significant improvement in their quality of life after hysterectomy.” 

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