There are a number of reasons why a woman may need to have a hysterectomy. These reasons fall into two broad categories--(1) hysterectomies that are absolutely necessary to save the life of the mother such as hysterectomies for cancer, overwhelming infection, and uncontrollable bleeding and (2) hysterectomies to improve the quality of life of a woman. This latter type of surgery may be done for disabling pelvic pain or flooding which results in lost time from work, the presence of benign tumors which cause discomfort from pressure on the bladder or rectum, or for pelvic weakness which results in urinary incontinence, falling out of pelvic structures, or problems with control of one's bowels. Unfortunately, sometimes the term "hysterectomy" is used incorrectly to mean removal or the ovaries as well as the uterus. Terms such as "complete hysterectomy" or "total hysterectomy" are confusing. While most physicians mean the complete removal of the uterus including the cervix but not the ovaries, many consumers interpret this to mean the removal of the uterus, tubes, and ovaries. The correct term for removal of the ovaries is "oophorectomy" or "ovariectomy" --with "bilateral" oophorectomy meaning that both of the ovaries were removed. When the ovaries are removed, "surgical menopause" results, creating an abrupt decline in ovarian hormones such as estrogen.  women who undergo surgical menopause can expect to have severe hot flashes immediately after surgery. If only one ovary has been removed, the remaining ovary may continue to produce a normal level of hormones, preventing immediate menopause. Occasionally, after a hysterectomy without removal of the uterus, a patient may experience menopausal -like symptoms for a month or two because of disruption of the blood supply to the pelvic. This normally corrects spontaneously after a while.

Following hysterectomy, a woman who wishes to take estrogen for menopause-related changes does not need to take another hormone -- progesterone or a progestin --to guard against an increased risk of uterine cancer that could result from estrogen alone. Therefore, menopause treatment following removal of the uterus is greatly simplified.

There are several forms of hysterectomy:

Radical hysterectomy --the operation for uterine or ovarian cancer. The uterus and the pelvic tissue and lymph glands to removed to attempt complete removal of the cancer. The ovaries may or may not be removed. This is generally performed by a gynecological oncologist.  Obviously, when this is needed it must be done.

Abdominal hysterectomy--this is the old fashion way of removing diseased tissue in the pelvis by cutting the abdomen open either by an up and down or a sideways incision. There still is a place for it in modern gynecology--for very large masses, suspected cancer or severe infection. Fortunately, for many women, this has been replaced by laparoscopic hysterectomy (see below).

The main advantage of abdominal hysterectomy is that everything can be clearly see and that any gynecological surgeon at almost any facility can perform this procedures with skill and safety. The main disadvantage is a painful abdominal incision, a longer hospital stay (typically 3-4 days), a large scar, and a longer convalescence (approx 6-8 weeks).

Vaginal hysterectomy--For many years this has been the preferable method of hysterectomy for the right candidate. It offers the advantage of surgical speed, low cost, a shorter hospital day (1-2 days) and an easier convalescence (4-6 weeks). Unfortunately many younger gynecological surgeons do not feel comfortable with this approach because of their lack of training.

Laparoscopic assisted vaginal hysterectomy --This procedure starts by making small incisions in the navel and abdomen and freeing up the upper attachments of the uterus or ovaries before completing the procedure as a vaginal hysterectomy.  Using this technique, perhaps 75-80% of abdominal hysterectomies can be converted to a vaginal approach. Typical hospital stays are 24-48 hours and convalescence can be as little as 2-4 weeks.

Laparoscopic supra-cervical hysterectomy--  In this variation, the procedure starts by making small incisions in the navel and abdomen and freeing up the upper attachments of the uterus or ovaries and them continuing to seal off the blood vessels down the side of the uterus to the level of the cervix.  An incision is then made across the cervix leaving it in place.  The uterus is cut into small pieces and removed through the umbilicus.  The theory behind this approach is that by not cutting the nerves and blood vessels to the cervix and upper vagina that the pelvic supports will not be disrupted and that there will be more feeling during sexual intercourse.  The risk is that you will continue to need routine Pap smears since you could still get cervical cancer.

Total laparoscopic hysterectomy--  This is a very new variation which incorporates all the advantages of advanced laparoscopic surgery.  It is done only by a few gynecologists in the USA at this time.  In this operation, the entire procedure is done through small incisions in the abdomen and the entire uterus, including the cervix, is removed through the navel.  The incision in the upper vagina is repaired through the miniature abdominal incisions.  This procedure can be done even when access to the uterus through the vagina is not possible because one has not had a vaginal birth.  With this approach, the abdominal hysterectomy is now an obsolete procedure except for very large uterine tumors and other rare difficult management problems.

All surgery has risks--the general risks include bleeding, transfusions, infection, loss of function of limbs, paralysis allergic reactions to drugs, blood clots, and even death. These complications can occur even if the surgeon never touches your body.

Specific complications of hysterectomy may include menopause, loss of the ability to bear children, more extensive surgery than originally planned, injuries to bowel, bladder, the urinary tract, and pelvic blood vessels, hernias, wound infections etc. etc. Before you consider surgery, be sure that you understand the problem that you have, the alternatives to surgery, the benefits to surgery, and what might happen if you choose not to do it. IF YOU HAVE ANY QUESTIONS OR ARE NOT SURE, GET A SECOND OPINION. If your surgeon does not offer you enough time to answer all of your questions to your satisfaction, find another surgeon you can relate to.