What is a hysterectomy? Why is it done?

Your uterus is a complex organ. It usually measures just 3–4 inches across, but if you’re pregnant, the muscular walls grow and stretch to over a foot tall. It develops and sheds a thick lining on a monthly(ish) basis. It provides nourishment for a growing fetus. 

The complex nature of the uterus and all of its functions, however, means that there’s a lot of room for discomfort, pain, or danger when things go wrong. Fibroids and endometriosis are a few examples of medical conditions a hysterectomy can help. 

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A hysterectomy is a common type of surgery in which the uterus is removed. About 600,000 people in the United States have a hysterectomy every year, and about 1 in 9 has one in their lifetime (Wu, 2007; Wright, 2013).  

There are many reasons why you would consider a hysterectomy. Healthcare providers typically divide the reasons for getting one into benign conditions (meaning conditions unrelated to cancer) and malignant or cancerous conditions. 

Non-cancerous conditions are the most common reasons for getting a hysterectomy and include the health conditions below (Donnez, 2016). 

Uterine fibroids 

Fibroids are benign growths found in the uterus. The good news is one small fibroid isn’t likely to cause problems, and it may even disappear on its own. But if your uterine fibroids are large and painful or cause heavy bleeding, treatment may be needed.

A healthcare provider might recommend birth control pills (oral contraceptives), an intrauterine device, or a vaginal hormone ring. If these don’t alleviate symptoms, a hysterectomy is an option. 

Endometriosis

With endometriosis, tissues that line the inside of your uterus grow outside of it. It invades other organs like your ovaries, intestines, and bladder. Endometriosis can cause severe chronic pelvic pain and sometimes even infertility. 

Endometriosis symptoms may improve when you take anti-inflammatory medications like ibuprofen. The next step is usually hormone therapy. If those standard treatments don’t help, a medical expert may be able to remove some of the abnormal tissue, depending on its location. A hysterectomy is a later option if no other alternatives are working.  

Adenomyosis

Adenomyosis is another condition where the uterine lining ends up in a place it shouldn’t be. Instead of extending out of the uterus to invade other organs like endometriosis, tissues penetrate deeper into the surrounding muscle of the uterus wall. This can cause an enlarged uterus, bleeding, and pain. 

Adenomyosis may improve with hormone therapy. However, since the unhealthy tissue is so deep inside the uterine muscle, it can’t be removed surgically. If medications don’t help, a hysterectomy is often the next step.  

Abnormal uterine bleeding 

Some people bleed heavily during their menstrual cycle or experience abnormal bleeding between cycles. This can lead to severe anemia. A hysterectomy isn’t usually the first choice of treatment for this––especially if you are considering pregnancy in the future. Medication like birth control pills can relieve heavy bleeding without needing surgery. 

Uterine prolapse

There are ligaments that anchor the uterus securely in the pelvis that can get overstretched. This is called a uterine prolapse and is common in people who’ve had multiple pregnancies. It’s also sometimes a normal change that comes with age. 

If your uterus is prolapsed, it sits lower in your pelvis. Sometimes it protrudes out of the vagina, especially when straining to lift something heavy or during bowel movements. Besides being painful, a uterine prolapse can cause discomfort during sex or difficulty going to the bathroom. 

For mild prolapses, you can try kegel exercises, a technique easy to do at home that makes your pelvic floor stronger. If this isn’t effective, a special device called a pessary may be recommended to hold the uterus in place. There are also surgical procedures to attach the uterus back in its correct position––or a hysterectomy to remove it altogether.  

Some types of cancer––like cervical, uterine, and ovarian cancer––may require a hysterectomy. If you’ve been diagnosed with cancer, your healthcare provider will discuss treatment options with you and go over why a hysterectomy might help.  

If you’re having a hysterectomy to treat cancer but want to preserve your eggs, it may be possible to leave the ovaries in place. If not, you may be able to retrieve your eggs (or even ovarian tissue) and freeze them before the procedure to protect them from damage (Donnez, 2015).  

There are three types of hysterectomies. What procedure is performed depends on your specific needs: 

• Partial hysterectomy: In this procedure, only the upper part of the uterus is removed and the cervix is left in place. A partial hysterectomy is also called a subtotal or supracervical hysterectomy. Some people experience side effects like abnormal vaginal bleeding or pain during sex after the procedure (van der Stege, 1999).

• Total hysterectomy: In a total hysterectomy, the whole uterus (including the cervix) is removed. This is the most common type of hysterectomy performed. After a total hysterectomy, you typically spend more days in the hospital than you would after a partial hysterectomy since it’s a more complicated procedure. However, some studies suggest you’ll have a lower risk of experiencing side effects in the future (Gimbel, 2007; Lethaby, 2012). 

• Radical hysterectomy: As the name suggests, a radical hysterectomy is the most extensive procedure. It involves removing the uterus, cervix, and part of the vagina. Depending on the underlying problem, it might be paired with a procedure called a bilateral salpingo-oophorectomy, which is when both ovaries and fallopian tubes are taken out. This type of surgery is reserved for the treatment of advanced cervical cancer, and endometrial or ovarian cancer that’s spread to the cervix. 

The uterus can be removed through a large incision in the abdomen (called a laparotomy or abdominal hysterectomy), through the vagina (a vaginal hysterectomy), or via small incisions in the belly button (laparoscopic hysterectomy). The route your healthcare provider chooses is based on how urgent the procedure is, the reason for it, and your personal medical history. 

Many issues following a hysterectomy are related to structures that surround the uterus. Some of the most common complications include:

• Injury: The urethra, bladder, or digestive tract can all be injured during a hysterectomy. Injuries can lead to a serious complication called a fistula, which is when an abnormal connection develops between two organs.

• Infection: Infections are often seen after a hysterectomy, especially urinary tract and incision infections (Clarke-Pearson, 2013).  

• Urinary incontinence: There’s an increased risk of urinary incontinence (loss of control over urination) after vaginal or laparoscopic procedures (Harendarczyk, 2020). 

It can take up to 6–8 weeks to fully recover from a hysterectomy, although it depends on what type you had. For example, you might heal faster after a vaginal or laparoscopic procedure where the incisions are small compared to a more extensive abdominal hysterectomy. 

Your healthcare provider will advise how long you should rest for and what to avoid (like lifting things). In general, don’t have vaginal sex or insert anything (like a tampon) into your vagina for six weeks after the procedure (ACOG, 2021). 

If you haven’t reached menopause yet and have had your whole uterus and cervix removed, you don’t get your period anymore. If you only had a partial hysterectomy, there is a chance you’ll have occasional spotting. 

Regardless of the procedure type, you may not be able to carry a pregnancy. Researchers and healthcare professionals are continuing to investigate procedures like uterus transplants, which aren’t widely available yet (de Graca, 2021). 

Your ovaries make a hormone called estrogen. Estrogen stimulates your body to produce the mucus that lubricates your vagina. If your ovaries are removed during a hysterectomy, you’re at risk for vaginal dryness. Your healthcare provider may be able to help you find a solution, such as hormone creams or pills. 

In general, studies demonstrate that having a hysterectomy can have positive aspects on quality of life. It can relieve disruptive symptoms like pain and heavy bleeding. If you need a hysterectomy, your healthcare provider can also help advise you about options for preserving fertility and managing possible side effects. 

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Current version

February 23, 2022

Written by

Gina Allegretti, MD

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.