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Hysterectomy

If you suffer from fibroids, your doctor may recommend a hysterectomy. This procedure involves removing the uterus so that new fibroids cannot grow. It can be performed several different ways depending on the size of the uterus and other factors.

It is important to note that the ovaries are not necessarily removed during a hysterectomy. They may be removed if they look abnormal or if the patient wants to decrease her chance of developing ovarian cancer later in life. In general, if a woman is in menopause or close to menopause, then the ovaries are removed at the time of the hysterectomy.

Removal of the ovaries in a pre-menopausal woman can lead to hot flashes, vaginal dryness and other symptoms.

Vaginal Hysterectomy

To be eligible for a vaginal hysterectomy, your uterus must be a certain size and not too large. A vaginal hysterectomy is performed by removing the uterus through the vagina rather than through an incision on the abdomen.

You will likely be asleep during the procedure and spend two nights in the hospital. After the procedure, you will experience significant pain for 24 hours and mild pain for 10 days. Full recovery usually takes four weeks. You will not have any scars on your skin.

Risks

Complications from surgery may include bleeding, infections and injury to the intestines or bladder.

Abdominal Hysterectomy

An abdominal hysterectomy involves removing the uterus through a horizontal incision on the lower abdomen, known as "a bikini cut." If the uterus is very large or if there is a scar from an earlier operation, it may be necessary to make a vertical incision on the lower abdomen.

There are different kinds of abdominal hysterectomies:

• Total abdominal hysterectomy involves removing the uterus and the cervix, which is the lowest part of the uterus. Women who have had abnormal pap smears or cervical dysplasia are usually encouraged to have their cervix removed at the time of hysterectomy.
• Subtotal or supra-cervical hysterectomy involves removing only the upper part of the uterus. In some cases, women who retain their cervix have less bladder leakage and vaginal relaxation later in life. However, these outcomes have not been scientifically proven. Women who have had a supra-cervical hysterectomy will continue to need periodic pap smears. In addition, some women will have monthly spotting or light bleeding if endometrial glands are still embedded in the cervical tissue. An abdominal hysterectomy requires general anesthesia and three days in the hospital. Recovery usually takes six weeks. Some women experience a complication from surgery that requires a longer recovery time. After surgery, you will have a four-inch horizontal scar near the pubic hair or "bikini" line.

Risks

Like any surgical procedure, an abdominal hysterectomy does have some risks, though rare. About five percent of women develop an infection after surgery that is treated with antibiotics in the hospital for as many as five days. About five percent of women develop a wound infection that is treated at home but requires frequent visits to the doctor's office for up to six weeks.

Other complications include bleeding, infection and injury to the intestines or bladder.

Laparoscopic Hysterectomy

Laparoscopic hysterectomy is a new procedure in which the uterus is removed through very small incisions on the lower abdomen. The cervix, or lower portion of the uterus, remains in place. Women with large fibroids may not be candidates. If the uterus is large then an abdominal hysterectomy may be necessary.

Laparoscopy is performed in the operating room with the patient asleep. During the procedure, four one-centimeter incisions are made in the lower abdomen: one at the navel (belly button) and one below the "bikini" line (near the pubic hair) and one near each hip. The abdominal cavity is filled with carbon dioxide gas. A thin, lighted telescope -- called a laparoscope -- is placed through an incision, allowing doctors to see the ovaries, fallopian tubes and uterus. Long instruments, inserted through other incisions, are used to remove the uterus. A special instrument is used to cut the uterus into smaller segments for removal through the small incisions. At the end of the procedure, the gas is released and the skin incisions are closed. Sometimes during the operation, it is necessary to switch from a laparoscopic hysterectomy to an abdominal hysterectomy. After the procedure, you will have small scars on your skin.

You will spend one night in the hospital and recovery takes 2-4 weeks.

Risks

Complications may include injuries to internal organs and bleeding.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.