Hysterectomy

What Is It?

A hysterectomy is the surgical removal of the uterus. Depending on the type of hysterectomy, additional pelvic organs or tissues also may be removed. The types of hysterectomy include:

• Subtotal, supracervical or partial hysterectomy — The uterus is removed, but not the cervix.
• Total or complete hysterectomy — Both the uterus and the cervix are removed. About 50 percent of all hysterectomies are total hysterectomies, and this procedure is the most common form of hysterectomy performed in women older than age 45.
• Total hysterectomy plus unilateral salpingo-oophorectomy — This procedure removes the uterus, cervix, one ovary and one fallopian tube, while one ovary and one fallopian tube are left in place. After surgery, the remaining ovary should produce adequate levels of female hormones, if the woman has not reached menopause.
• Total hysterectomy plus bilateral salpingo-oophorectomy — This is the removal of the uterus, cervix, and both fallopian tubes and ovaries. Removing both ovaries will cause a "surgical menopause" in a woman who has not reached menopause because the production of female hormone stops when the ovaries are removed.
• Radical hysterectomy — This procedure removes the uterus, cervix, both ovaries, both fallopian tubes and nearby lymph nodes in the pelvis. This procedure is only done in some women who have gynecological cancer. Since both ovaries have been removed, levels of female hormones drop dramatically after surgery, and hormone supplements may be needed.

Hysterectomies also can be done with different types of surgical incisions (surgical cuts). About 75 percent of all hysterectomies are abdominal hysterectomies, in which the uterus is removed through a horizontal or vertical incision in the lower abdomen. The rest are vaginal hysterectomies, in which the uterus is removed through a vaginal incision.

In one form of vaginal hysterectomy, called a laparoscopically assisted vaginal hysterectomy (LAVH), the uterus is removed through the vagina, but the surgeon also makes several small incisions in the abdomen. These incisions allow the surgeon to insert a laparoscope, a telescopelike instrument with a camera for viewing inside the abdomen. Through the laparoscope, the surgeon can inspect the pelvic organs and insert small instruments to help remove the uterus.

Hysterectomy is a very common surgical procedure in the United States, especially in middle-aged women between 40 and 50. However, the popularity of the procedure has declined steadily since the late 1980s in part because more and more women have been opting for less extreme surgical procedures when possible. Still, by age 60, about 25 percent of all American women have had a hysterectomy.

What It's Used For