hysterectomy

A hysterectomy is the surgical removal of the uterus. In some cases the cervix is removed as well; ovaries and fallopian tubes may be taken out depending on the indication. Surgeries may be performed through the abdomen, through the vagina, or with minimally invasive methods such as laparoscopy or robotic assistance. Hysterectomies are categorized by extent: total (uterus and cervix removed), subtotal or partial (uterus removed while the cervix is left intact), and radical (uterus with surrounding tissues, part of the vagina, and sometimes lymph nodes, usually for cancer). When ovaries and fallopian tubes are removed, the procedure is often called a hysterectomy with salpingo-oophorectomy.

Indications include abnormal uterine bleeding unresponsive to other treatments, fibroids, adenomyosis, endometriosis, chronic pelvic pain, pelvic organ prolapse, and gynecologic cancers or high cancer risk where removal is advised.

Procedure and recovery: The operation is performed under general anesthesia. The uterus and related structures are removed; the specimen is examined by pathology. Removing the uterus ends menstruation and pregnancy potential. If ovaries are removed, menopause may occur abruptly in premenopausal women. Recovery varies by approach: open abdominal surgery typically requires longer hospital stay and recovery than vaginal or minimally invasive techniques, which often enable earlier discharge and quicker return to usual activities.

Risks and long-term effects: Possible complications include bleeding, infection, injury to the bladder, ureters, or bowel, blood clots, and reactions to anesthesia. Long-term effects may include hormonal changes if the ovaries are removed, hot flashes, sexual function changes, vaginal dryness, and an increased risk of osteoporosis or cardiovascular changes in some women. Fertility is not restored by this operation.

Alternatives and considerations: For some conditions, uterus-preserving options such as myomectomy, endometrial ablation, or medical therapies may be appropriate. The choice depends on the condition, age, fertility desires, health, and surgeon expertise.