Hysterectomy
A definitive surgical option for conditions like fibroids, abnormal bleeding, prolapse, and adenomyosis—tailored by approach (vaginal, laparoscopic/robotic, or abdominal) and whether the cervix and ovaries are preserved.
Hysterectomy removes the uterus and ends menstrual periods and fertility. It may be recommended for symptomatic fibroids, abnormal uterine bleeding, adenomyosis, pelvic organ prolapse, some cases of endometriosis, and other benign conditions after conservative options are considered. Approaches include vaginal, total laparoscopic (TLH), laparoscopic-assisted vaginal (LAVH), robotic, or total abdominal (TAH). The cervix may be removed (total hysterectomy) or preserved (supracervical/subtotal) when appropriate. Ovaries can be preserved or removed (oophorectomy) based on age, risk, and goals.
Fast Facts About Hysterectomy
Definitive treatment that ends periods and fertility
Multiple approaches: vaginal, laparoscopic/robotic, or abdominal
Cervix may be removed (total) or preserved (supracervical/subtotal)
Ovaries can be preserved; removing both before menopause causes surgical menopause
Typical recovery: ~1–2 weeks to light activity for minimally invasive/vaginal; 4–6 weeks for abdominal
Who It May Help
- Heavy, painful, or prolonged bleeding not controlled with other treatments
- Uterine fibroids causing bleeding, pain, pressure, or anemia
- Adenomyosis with refractory pain/bleeding
- Pelvic organ prolapse affecting bladder/bowel/sexual function
- Select cases of endometriosis or chronic pelvic pain after other options
- Precancerous uterine conditions when definitive management is preferred (benign pathway; cancer care is individualized)
How It Works
Under anesthesia, the uterus is detached from surrounding ligaments and blood supply and removed via the vagina, small laparoscopic/robotic ports, or a lower abdominal incision. If the cervix is removed (total), the top of the vagina is closed (vaginal cuff). If the cervix is preserved (supracervical), the uterine body is removed above the cervix. Fallopian tubes are commonly removed (salpingectomy) to lower certain ovarian cancer risks; ovaries are preserved or removed based on age, symptoms, and risk profile. Incisions are closed with dissolvable sutures or skin adhesive.
Candidacy & Alternatives
Good candidates have symptoms or diagnoses where definitive treatment aligns with goals and less invasive options have been considered. Alternatives include medical therapy (e.g., LNG-IUD, hormonal methods, tranexamic acid, GnRH agents), targeted procedures (hysteroscopic myomectomy or polypectomy), uterine artery embolization, endometrial ablation (for bleeding; not for future pregnancy), pelvic floor therapy and pessary for prolapse, and myomectomy for uterus-preserving fibroid care. We personalize recommendations to your anatomy, future fertility, and recovery preferences.
Approach Options at a Glance
Vaginal / TLH / Robotic
- No or small external incisions; often outpatient
- Less pain and faster return to activity (days–2 weeks)
- Good visualization for concurrent procedures
- Common for fibroids, bleeding disorders, and many prolapse cases
LAVH (Hybrid)
- Laparoscopic assistance with vaginal removal
- Useful when additional visualization is needed
- Recovery similar to minimally invasive approaches
- Flexible for varied anatomy
Abdominal (TAH)
- Lower abdominal incision
- Preferred for very large uteri, extensive adhesions, or complex anatomy
- Longer hospital stay and recovery (4–6 weeks)
- Allows broad access for extensive reconstruction
What to Expect
Most minimally invasive or vaginal cases are same-day or 23-hour stays; abdominal cases may stay longer. Expect abdominal/pelvic soreness and fatigue for several days. Light spotting is common. Walking is encouraged; avoid heavy lifting until cleared. Many return to desk work in ~1–2 weeks after minimally invasive/vaginal surgery and ~4–6 weeks after abdominal. Pelvic rest (no intercourse, tampons, swimming/hot tubs) is typically advised for 6–8 weeks or until the cuff/incisions are healed.
Safety & Considerations
Common effects include pain, fatigue, bloating, constipation, and light bleeding. Uncommon risks include infection, bleeding/transfusion, blood clots, injury to bladder/ureters/bowel, hernia at incision sites, or need to convert to an open approach. Removing both ovaries before menopause causes immediate surgical menopause; we review symptom management and long-term health planning. If the cervix is retained, periodic cervical screening may still be recommended depending on history.
Before Your Visit
- ✓Share recent imaging (ultrasound/MRI), biopsies, and prior op notes
- ✓Discuss goals: cervix/ovary preservation, prolapse repair, or salpingectomy
- ✓Optimize anemia and review medications (including anticoagulants/supplements)
- ✓Follow anesthesia fasting and ride-home plans
- ✓Prepare home recovery: stool softener, protein-rich snacks, and incision care supplies
Frequently Asked Questions
1Will my ovaries be removed?
Not necessarily. Many patients keep one or both ovaries to maintain hormones before menopause. We individualize removal based on age, risks, symptoms, and personal preference.
2What is the difference between total and supracervical hysterectomy?
Total removes the uterus and cervix; supracervical removes the uterine body while the cervix remains. If the cervix stays, you may still need cervical screening per your history.
3How long is recovery?
Light activity often resumes within 1–2 weeks after minimally invasive/vaginal approaches and 4–6 weeks after abdominal surgery. Heavy lifting and intercourse wait until cleared.
4Will I go into menopause?
Periods stop because the uterus is removed. If both ovaries are removed before menopause, surgical menopause occurs immediately. If ovaries are preserved, hormones generally continue.
5Will sex feel different afterward?
Most people resume comfortable sexual activity after healing. If a vaginal cuff is created, we allow time for full healing and may recommend pelvic floor therapy if tension or pain occurs.
6Do I need Pap smears after hysterectomy?
If the cervix is removed for benign reasons and you have no significant history of cervical disease, routine cervical screening may no longer be needed. If the cervix remains—or if you have a history of high-grade changes—screening guidance differs.
Considering Hysterectomy for Lasting Relief?
We’ll confirm that a hysterectomy aligns with your goals, select the safest approach, and plan recovery—clarifying choices about the cervix, tubes, and ovaries along the way.
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