What it a hysterectomy?
A hysterectomy is a procedure to remove the uterus (1). The word hysterectomy has two parts: hyster-, meaning uterus, and ectomy-, meaning removal.
Not all hysterectomy procedures are the same. There are four main types of hysterectomy procedures: 1. A total hysterectomy is the removal of the uterus and cervix. 2. A partial (subcervical) hysterectomy is the removal of just the uterus, leaving the cervix in place. 3. A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, and ovaries. Salpingo- refers to the fallopian tubes, and oopho- refers to the ovaries. 4. A radical hysterectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, part of the vagina, and other tissue surrounding the uterus (1,2).
Hysterectomies are permanent. A person who has had a hysterectomy can no longer have children (i.e. it causes sterility). Hysterectomies also permanently stop menstrual bleeding, but the hormonal fluctuations of the menstrual cycle will still happen unless a person has had their ovaries removed (1,2).
Reasons for the procedure
A person may choose to have a hysterectomy to treat a reproductive disorder or condition (1-3). Having a hysterectomy is considered major surgery, and coming to this decision should not be taken lightly. Healthcare providers will often try less-invasive alternative therapies and treatments first before a hysterectomy is recommended (2,3).
A hysterectomy is sometimes performed to treat a prolapsed uterus, endometriosis, uterine fibroids, or other bleeding and pain disorders in the lower reproductive system (1-3). They are also performed to treat or prevent reproductive cancers, such as uterine or cervical cancer (1,2). The removal of both ovaries and fallopian tubes during a hysterectomy is sometimes recommended for people with or at high risk of breast cancer (1) or ovarian cancer, as the reproductive hormones released by the ovaries impact cancer risk (4-6). More research is needed in this area.
Transgender men and nonbinary people who were born with a uterus may choose to undergo a hysterectomy with the removal of ovaries and fallopian tubes, as part of gender affirmation surgery (7,8). A total hysterectomy with bilateral salpingo-oophorectomy may be recommended before surgery to construct a penis (7).
Emergency hysterectomies, which usually aren’t chosen, are done to stop life-threatening bleeding during or soon after the delivery of a baby (9). An emergency hysterectomy is typically either a partial hysterectomy or total hysterectomy (9).
Hysterectomies are surgeries and therefore come with risks. Possible complications include infection, hemorrhage, accidental injury to other body parts during the procedure (including the bladder or bowels), and adverse reactions to anesthesia (1,2). Hysterectomies are very effective at treating a variety of disorders and conditions, but it’s important to understand what the alternatives to surgery are, and the risks associated with the procedure.
Reproductive health after the procedure
All types of hysterectomies permanently stop menstrual bleeding. Despite this, people who have not had their ovaries removed will continue to produce reproductive hormones and have hormonal menstrual cycles without periods.
A person who has had both ovaries removed with their hysterectomy will go through surgically-induced menopause (1,2). They will not experience hormonal menstrual cycles or periods. Some healthcare providers may then recommend hormone therapy to help prevent osteoporosis and/or other side effects of menopause (1,2).
People who have had a hysterectomy can no longer carry a pregnancy, as the uterus is the only place in the body where fertilized eggs can develop. Although a person with ovaries could, in theory, experience an ectopic pregnancy (where a fertilized egg begins to develop in the fallopian tube or another part of the reproductive tract), the chance of this is almost zero (10). If you experience extreme abdominal pain or bleeding after your hysterectomy, speak with your healthcare provider immediately.
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