Are you considering a hysterectomy? It’s a decision you certainly don’t take lightly so you likely have many questions, like: Will you lose your ovaries or be able to get pregnant? Or will a hysterectomy cause you to start menopause?
While it is the second most common surgical procedure for people of reproductive age, just after a Cesarean section, there remain stigmas and myths about hysterectomies. The truth is this go-to surgical option has come a long way — it’s quicker, safer and far less invasive.
Read on to learn the facts about hysterectomies, your different surgical options and what to expect post-surgery.
What is a hysterectomy?
A hysterectomy is a surgery to remove part of or all of a person’s uterus used to treat a serious or advanced gynecological condition.
“Most commonly it’s used to treat abnormal or heavy or irregular vaginal bleeding or pelvic pain caused by uterine fibroids, adenomyosis or endometriosis,” said Nichole Mahnert, MD, an OBGYN with Banner Health in Arizona.
In addition, a hysterectomy is also one of the most effective ways to treat gynecological cancer, such as cervical cancer or uterine cancers, and pelvic or uterine prolapse.
Like any major operation, a hysterectomy is usually the last resort for treating conditions or as a preventive measure.
“We always try the least invasive approach first – treatments such as medications, physical therapy and other less invasive procedures are done before performing a hysterectomy,” Dr. Mahnert said.
What are the different kinds of hysterectomies?
Unlike what you may have heard, a hysterectomy isn’t a one-size-fits-all approach. All hysterectomies remove some or all of the uterus and possibly additional parts of your reproductive system. But not all of them are created equal.
“The medical reasons for your hysterectomy will indicate which type you receive,” Dr. Mahnert said.
There are three different kinds of hysterectomy surgeries, including:
- Total hysterectomy: This procedure removes the entire uterus and cervix but not your ovaries.
- Partial hysterectomy: Also known as a subtotal hysterectomy or supracervical hysterectomy, this procedure removes the upper part of the uterus and leaves the cervix in place.
- Radical hysterectomy: This procedure is typically only performed for cervical cancer. It removes your uterus and all your reproductive organs as well as the upper vagina, some lymph nodes and nearby tissues.
Depending on your diagnosis and the reason for the hysterectomy, one or both of your ovaries as well as your fallopian tubes may also be removed. This is called a hysterectomy with oophorectomy.
There are three types of oophorectomies:
- Unilateral oophorectomy – one of your ovaries removed
- Bilateral oophorectomy – both of your ovaries removed
- Bilateral salpingo-oophorectomy - both fallopian tubes and ovaries are removed
Your fallopian tubes may be removed because they don’t serve a purpose after the uterus is removed and removal can help prevent ovarian cancer.
Can I get pregnant after a hysterectomy?
Since the uterus is a critical organ where a baby grows and develops, and a hysterectomy poses the risk of removing the uterus, the surgery makes it impossible to carry a pregnancy.
While it’s not possible to get pregnant or bear children naturally after a hysterectomy, there are still ways of having your own biological children. Thanks to advances in medical science, it’s possible to have a baby through egg freezing and in vitro fertilization (IVF) surrogacy.
“If you desire to have children, this is an important discussion to have with your health care provider and/or a fertility specialist,” Dr. Mahnert said.
How is a hysterectomy performed?
In the past, getting a hysterectomy involved major surgery and a long recovery time. Today, there are many types of hysterectomy surgeries, many involving minimally-invasive techniques to minimize your stay in the hospital and recovery.
These surgical procedures include:
- A laparoscopic hysterectomy is a minimally-invasive procedure where your surgeon makes small incisions that allow tiny cameras and surgical instruments to be inserted into the abdomen to remove organs and tissue.
- A robotic hysterectomy uses a laparoscopic approach but with the aid of robotic arms and a computer station for your surgeon to control the instruments.
- A vaginal hysterectomy is where your surgeon removes your uterus through a small cut in your vagina.
- An open abdominal hysterectomy, also known as an open abdominal surgery, uses a single incision along your bikini line or a vertical incision to give your surgeon a good view of female reproductive organs.
Different factors, including diagnosis as well as the surgeon’s preference and area of expertise, will help determine which type of hysterectomy is performed.
“Typically, the first choice is vaginal hysterectomy, but if someone’s uterus is too large, they have had prior surgeries or we suspect endometriosis, then laparoscopic or robotic may be the route,” she said. “An abdominal surgery only happens when the uterus is very large or there is a concern for cancer.”
How can I prepare for a hysterectomy?
Preparing for your hysterectomy begins with a discussion with your surgical team about a week or so before the procedure. During this appointment, you’ll discuss some of the following:
- Medications you’re currently taking
- Instructions on what you can and cannot eat prior to surgery
- Potential complications and recovery time
- Lifestyle habits to adopt prior to surgery (e.g., smoking cessation)
Dr. Mahnert shared these additional tips to prepare for surgery:
- Eat more fruits and vegetables
- Stay hydrated
- Limit processed foods
- Manage stress levels
- Avoid smoking
[For additional tips, read “Take These 4 Steps Before Undergoing Elective Surgery.”]
What does recovery from a hysterectomy look like?
Your recovery will depend somewhat on the type of hysterectomy that was performed. Typically, recovery time for a vaginal hysterectomy or laparoscopic hysterectomy can take two to six weeks, while an open abdominal surgery can take four to eight weeks.
“Usually recovery is about four weeks, but some can take two weeks and others six weeks,” Dr. Mahnert said. “Keep in mind that recovery isn’t just a physical process — it’s an emotional one as well. Every person processes it in their own way.”
You may be relieved to have your symptoms gone, but you may also mourn the loss of your fertility. Talk with your health care provider about what to expect post-surgery, including any physical and emotional effects.
It’s important to lean on your support systems like friends and family and seek support from a licensed behavioral health specialist who focuses on fertility if you need it.
Will a hysterectomy cause me to go into early menopause?
This is a common question many people ask when facing an upcoming hysterectomy. The answer, however, isn’t a simple yes or no.
If you have a total hysterectomy, you’ll experience premature menopause, which will mark the end of your menstrual cycle and the beginning of menopause symptoms. You may be offered hormone replacement therapy to replace some of the hormones your ovaries used to produce or relieve any symptoms you may have.
If a hysterectomy leaves one or both of your ovaries in place, there’s a chance that you’ll experience menopause sooner than you would have if you didn’t have the surgery.
If you’ve already entered menopause, the difference may not be drastically different, however, the surgery can result in a weakened pelvic floor.
A hysterectomy is a common gynecological surgery to remove the uterus (part of or all of it). There are many reasons you may have a hysterectomy and several ways it can be performed.
If you have additional questions or concerns about a hysterectomy, talk to your health care provider or find a Banner Health specialist at bannerhealth.com.