At a glance
- What the surgery does
- Removes the uterus, sometimes with the cervix, fallopian tubes or ovaries.
- Why people consider it
- Fibroids, heavy bleeding, pain from endometriosis or adenomyosis, prolapse, or cancer and pre-cancer.
- The main choices
- For non-cancer conditions, alternatives such as a hormonal IUD, medicines or myomectomy.[4][5][7] If surgery, what gets removed, and the approach: vaginal is fastest when possible.[1]
- What recovery involves
- Often home the same or next day after vaginal or laparoscopic surgery, about two weeks before desk work, and around six weeks before sex.
- What to ask your surgeon
- What alternatives could work, exactly what will be removed and why, and whether the operation can be done vaginally.
The short version
- For heavy periods, a hormonal IUD gave similar quality of life to hysterectomy at five years in a Finnish trial, at lower cost, though 42% of women in the IUD group eventually had a hysterectomy.[4]
- For fibroids, medicines, myomectomy (removing just the fibroids) and uterine artery embolization can all avoid hysterectomy for some women.[5][7][15]
- When it's possible, vaginal hysterectomy has the fastest recovery. Laparoscopic surgery is the next best when it isn't. Robotic surgery hasn't shown a benefit over standard laparoscopy for non-cancer conditions.[1][2]
- Removing healthy ovaries before menopause has long-term trade-offs, including higher overall death and heart disease risk in a large US study.[3] Removing the fallopian tubes, though, may lower ovarian cancer risk without those trade-offs.[8][14]
- Keeping the cervix (subtotal hysterectomy) didn't improve sexual, bladder or bowel function compared with removing it.[6][12]
Why hysterectomy is done
Common reasons include fibroids (non-cancerous growths in the uterus), heavy or abnormal bleeding, endometriosis or adenomyosis causing pain, pelvic organ prolapse, and cancer or pre-cancer of the uterus, cervix or ovaries.[10][11][13]
For cancer, hysterectomy is often a key part of treatment and the decisions are different. This guide focuses on hysterectomy for non-cancer conditions, where you usually have more time and more choices.
After a hysterectomy you no longer have periods and can't become pregnant. If you might want children in the future, make sure every alternative has been discussed.
Alternatives to consider first
For many non-cancer conditions, hysterectomy is one option among several.
Heavy menstrual bleeding
In a Finnish trial of 236 women with heavy periods, those given a levonorgestrel-releasing IUD (a hormonal IUD) had similar quality of life and satisfaction to those who had hysterectomy after five years, at lower cost. Over that time, 42% of the IUD group chose to have a hysterectomy anyway.[4] Medicines and endometrial ablation (destroying the lining of the uterus) are other options.[13]
Fibroids
- Medicines. In two international trials, once-daily relugolix combination therapy cut heavy bleeding to a normal level in about 7 in 10 women with fibroids, compared with fewer than 2 in 10 on placebo, while protecting bone density.[7]
- Myomectomy removes fibroids and keeps the uterus. In the UK FEMME trial of 254 women, myomectomy gave somewhat better fibroid-related quality of life at two years than uterine artery embolization.[5]
- Uterine artery embolization, done by a radiologist through a small tube in the groin or wrist, cuts off the fibroids' blood supply. A Cochrane review found satisfaction was similar to surgery, with a shorter hospital stay and faster return to normal life, but a higher chance of needing more treatment within a few years.[15]
If you're told hysterectomy is the only option for a non-cancer problem, it's reasonable to ask why the alternatives won't work for you, or to get a second opinion.
What gets removed
"Hysterectomy" can mean different operations. Ask exactly which organs will be removed.
| Term | What's removed | What the evidence says |
|---|---|---|
| Total hysterectomy | Uterus and cervix | The most common type. |
| Subtotal (supracervical) | Uterus only, cervix left in place | In a Cochrane review of nine trials, keeping the cervix didn't improve sexual, bladder or bowel function, and some women continued to have light periods. You still need cervical screening.[6] A UK trial reached the same conclusion about sexual function.[12] |
| Salpingectomy | The fallopian tubes, often removed along with the uterus | Many ovarian cancers are thought to start in the tubes. ACOG says removing the tubes during hysterectomy can be considered to reduce ovarian cancer risk.[8] In a Swedish national study, removing the tubes was linked with a lower risk of ovarian cancer.[14] |
| Oophorectomy | One or both ovaries | In the US Nurses' Health Study of about 29,000 women having hysterectomy for non-cancer reasons, removing both ovaries lowered breast and ovarian cancer risk but was linked with higher overall death, heart disease and lung cancer over 24 years. In no age group was it linked with longer survival.[3] |
If your ovaries are removed before menopause, you'll go through menopause right away. Ask about hormone therapy and how it fits your own health history. If they're kept, you'll go through menopause at about the usual time.
How the surgery is done
| Approach | How it's done | What the evidence says |
|---|---|---|
| Vaginal | The uterus is removed through the vagina. No belly incisions. | A Cochrane review of 47 trials found vaginal hysterectomy gave a faster return to normal activities than abdominal surgery, about 9 to 10 days sooner, and recommended it when technically possible.[1] ACOG agrees.[2] |
| Laparoscopic | Small incisions in the belly and a camera. The uterus is removed through the vagina or in small pieces. | About two weeks faster return to normal activities than abdominal surgery, but a higher rate of bladder and ureter injuries in the trials.[1] |
| Robotic | Laparoscopic surgery done with a surgical robot. | No benefit shown over standard laparoscopy for non-cancer conditions in randomized trials, though the evidence is limited.[1] |
| Abdominal (open) | An incision across or down the lower belly. | The longest recovery. Still sometimes needed for a very large uterus, cancer, or extensive scarring.[1][2] |
Which approach is possible depends on the size of your uterus, prior surgeries, the reason for surgery, and very much on your surgeon's experience. The Cochrane authors note that the approach should be decided by you together with your surgeon.[1]
Morcellation
For a large uterus removed through small incisions, surgeons sometimes cut it into pieces (morcellation). The FDA warns that if there's an unsuspected uterine cancer, power morcellation can spread it, and recommends power morcellation only in appropriately selected women, and only with a tissue containment system.[9] Ask whether morcellation is planned and how it will be done.
What happens on surgery day
Hysterectomy is done under general anesthesia, sometimes with a spinal. Vaginal and laparoscopic hysterectomies usually take one to three hours, and many people go home the same day or the next day. Abdominal hysterectomy usually means a few days in hospital.
Before surgery you'll likely have a pregnancy test if relevant, and an up-to-date cervical screening result. Tell your team about any blood clot history, since pelvic surgery raises the risk.
Recovery
- First daysWalking soon after surgery helps prevent clots. Some vaginal spotting is normal. Pain is usually managed with tablets after the first day after laparoscopic or vaginal surgery.
- Weeks 1 to 2Short walks, light activity. Many people with desk jobs return to work around two weeks after laparoscopic or vaginal surgery. Avoid heavy lifting.
- Weeks 2 to 6Gradually build up activity. Most surgeons ask you to avoid sex and putting anything in the vagina until the top of the vagina has healed, often around six weeks.
- 6 weeks and beyondMost people are back to normal activity. After abdominal surgery, full recovery takes longer.[1][10]
Call your team for heavy bleeding, fever, foul-smelling discharge, worsening pain, calf swelling, or shortness of breath.
Risks and complications
- Bleeding and infection, including infection at the top of the vagina.
- Injury to the bladder, ureters or bowel, more common with laparoscopic than abdominal or vaginal surgery in the trials, though still uncommon.[1]
- Blood clots in the legs or lungs.
- Separation of the vaginal cuff, rare, more often after sex too soon.
- Early menopause if both ovaries are removed before menopause, with the long-term trade-offs described above.[3]
- Spread of an unsuspected cancer with uncontained power morcellation.[9]
Questions to ask your surgeon
- Why are you recommending hysterectomy, and what alternatives could work for me?
Why we ask: For non-cancer conditions there are usually other options, such as a hormonal IUD, medicines, ablation, myomectomy or embolization. Alternatives to consider first
- Exactly what will be removed: cervix, tubes, ovaries?
Why we ask: "Hysterectomy" can mean different operations, and the answer changes menopause timing and long-term health. What gets removed
- If you plan to remove my ovaries, why, and what are the long-term trade-offs for me?
Why we ask: Removing healthy ovaries before menopause was linked with higher overall death and heart disease risk in a large US study. What gets removed
- Can this be done vaginally? If not, why not?
Why we ask: Vaginal hysterectomy has the fastest recovery and is recommended when it's possible. How the surgery is done
- How many hysterectomies do you do with this approach each year?
Why we ask: Which approach is possible depends heavily on the surgeon's experience. How the surgery is done
- Will you need to morcellate the uterus, and if so, how?
Why we ask: The FDA recommends power morcellation only in appropriately selected women, and only with a tissue containment system. Morcellation
- Will I go home the same day, and how long until I can go back to work?
Why we ask: Many people go home the same or next day after vaginal or laparoscopic surgery. Abdominal surgery takes longer to recover from. Recovery
- If I go into menopause because of surgery, what are my options for symptoms?
Why we ask: Sudden surgical menopause can bring strong symptoms. Knowing the plan ahead helps.
Print this page or save it to your phone, and write down the answers during your visit.
Understanding your surgical technology options
The companies that make the implants and devices used in this surgery, compared side by side with FDA records and sources, plus recent research and FDA news explained for patients.
Recovery supplies
We list recovery supplies at every budget, from gel ice wraps to cold therapy machines, with what to look for in each.
- Comfort after belly surgery
- Bending and reaching aids
- Personal care
- Walking
Sources
- Aarts JWM, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;8:CD003677. https://doi.org/10.1002/14651858.CD003677.pub5
- ACOG Committee Opinion No. 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017;129:e155-9. https://pubmed.ncbi.nlm.nih.gov/28538495/
- Parker WH, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses' Health Study. Obstet Gynecol. 2009;113:1027-37. https://doi.org/10.1097/AOG.0b013e3181a11c64
- Hurskainen R, et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA. 2004;291:1456-63. https://doi.org/10.1001/jama.291.12.1456
- Manyonda I, et al. Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med. 2020;383:440-51. https://doi.org/10.1056/NEJMoa1914735
- Lethaby A, et al. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database Syst Rev. 2012;4:CD004993. https://doi.org/10.1002/14651858.CD004993.pub3
- Al-Hendy A, et al. Treatment of uterine fibroid symptoms with relugolix combination therapy. N Engl J Med. 2021;384:630-42. https://doi.org/10.1056/NEJMoa2008283
- ACOG Committee Opinion No. 774: Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. Obstet Gynecol. 2019;133:e279-84. https://pubmed.ncbi.nlm.nih.gov/30913199/
- US Food and Drug Administration. Power morcellation during gynecologic laparoscopic surgeries. https://www.fda.gov/medical-devices/surgery-devices/power-morcellation-during-gynecologic-laparoscopic-surgeries
- Office on Women's Health (US HHS). Hysterectomy. https://www.womenshealth.gov/a-z-topics/hysterectomy
- MedlinePlus (US National Library of Medicine). Hysterectomy. https://medlineplus.gov/hysterectomy.html
- Thakar R, et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347:1318-25. https://pubmed.ncbi.nlm.nih.gov/12397189/
- American College of Obstetricians and Gynecologists. Hysterectomy (patient FAQ). https://www.acog.org/womens-health/faqs/hysterectomy
- Falconer H, et al. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015;107:dju410. https://pubmed.ncbi.nlm.nih.gov/25628372/
- Gupta JK, et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014;12:CD005073. https://pubmed.ncbi.nlm.nih.gov/25541260/
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