What is a hysterectomy?

A hysterectomy is a common procedure used to treat gynecologic cancers, like ovarian cancer, cervical cancer and endometrial cancer, and other health conditions impacting the uterus. But there are still many myths surrounding this type of surgery. And, if you need a hysterectomy, you may have anxiety or questions about long-term side effects, including the impact on your fertility.

We spoke with gynecologist oncologist Jolyn Taylor, M.D., about what patients planning for a hysterectomy should expect.

What is a hysterectomy?

A hysterectomy is a surgery to remove a patient’s uterus. There are a few types of hysterectomies:

• Total hysterectomy: Removal of the uterus and cervix
  
• Supracervical hysterectomy: Removal of the uterus only
• Simple hysterectomy: Removal of the uterus and cervix, but not the tissue adjacent to the cervix (called parametria) or the upper vagina. This is the most common type of hysterectomy.
• Radical hysterectomy: Removal of the uterus, cervix, upper part of the vagina and supporting tissues adjacent to the cervix called the parametria

Removal of a fallopian tube is known as a salpingectomy. Removal of an ovary is known as an oophorectomy. Removal of both a fallopian tube and an ovary is a salpingo-oophorectomy. Some patients may have both fallopian tubes and/or both ovaries removed. 

It is important to talk to your surgeon about whether your ovaries should be removed at the time of hysterectomy. This decision will be based on your age, the reason you are having the hysterectomy and other medical factors. All women, however, should have their fallopian tubes removed if they are undergoing hysterectomy. This has been shown to decrease the risk of ovarian cancer later, and fallopian tubes have no impact on ovarian or hormonal function.

Hysterectomies may be performed through either:

• open surgery, also called a laparotomy with one larger incision, or
  
• a minimally-invasive, laparoscopic or robotic hysterectomy performed through multiple smaller incisions

Patients should talk to their health care provider to see which type of procedure is right for them. Most cervical cancer patients should avoid a minimally invasive hysterectomy, as studies show this could increase the risk of recurrence.

Who needs a hysterectomy?

A hysterectomy is a part of the standard treatment for patients who have been diagnosed with cervical, endometrial or ovarian cancer. However, some women who wish to try to get pregnant in the future may have the option for conservative therapy that does not involve a hysterectomy. Some women may need a prophylactic hysterectomy to reduce their chances of developing cancer in the future if they have been diagnosed with some hereditary conditions.

Outside of cancer care, hysterectomies are performed to treat uterine fibroids, heavy vaginal bleeding, some uterine prolapse, endometriosis (when the tissue that lines the uterus grows outside of the uterus) or adenomyosis (when the tissue that lines the uterus grows inside the walls of the uterus where it doesn’t belong) that are unable to be controlled through non-surgical means.

Are there any risks?

Often, especially when used for cancer treatment, a hysterectomy is performed along with other procedures, so the risk is specific to each individual patient. It’s important that you talk to your doctor about your risks.

What should patients expect during a hysterectomy?

Patients receive general anesthesia before a hysterectomy. During the procedure, the surgeon will remove the uterus through an incision in the abdomen or the vagina. Surgery can last anywhere from one to three hours. It may take longer if the surgeon is doing additional procedures.

How long does it take to recover from a hysterectomy?

Historically, recovery from a hysterectomy was a difficult process, but thanks to efforts like MD Anderson’s Enhanced Recovery Program, patients who have a minimally invasive or open hysterectomy both recovery relatively rapidly. But the experience does vary depending on which type of procedure you have. Patients who have an open radical or simple hysterectomy can expect to be in the hospital one to four days. Patients who have a minimally invasive hysterectomy will be able to leave the hospital as early as the same day as the procedure.

Regardless of the type of hysterectomy, patients should expect to be up and walking around the same day as the surgery. Patients often experience discomfort at the incision site for about four weeks. Patients should refrain from any heavy lifting for six weeks and from being fully submerged in water, using tampons, having sex or placing anything in the vagina until their doctor says they’ve healed.

What type of long-term side effects should a patient expect?

Patients who have had a hysterectomy will not be able to become pregnant, so it’s best to consider the hysterectomy relative to your goals surrounding fertility. Outside of fertility, patients will not experience any long-term side effects. A common myth is that hysterectomies cause patients to experience early menopause, but this is not true as hormonal function comes from the ovaries.

Will a patient still have a period after a hysterectomy?

This is a really frequently asked question. No, a patient who has a hysterectomy will not menstruate. Despite this, a patient who has a hysterectomy will not go into menopause unless the ovaries are removed.

What advice do you have for a patient interested in preserving her fertility?

Any patient who has been told they need a hysterectomy can weigh need for hysterectomy with their reproductive goals with their care team or seek a second opinion. Cancer patients who need a hysterectomy but are interested in preserving their fertility should seek care at a center with an oncofertility program, like MD Anderson. Our oncofertility specialists don’t just treat people with gynecologic cancers. They treat anyone whose cancer may impact their fertility. They can help patients who are considering a hysterectomy weigh their options so they can make the best decision for themselves.

Does a hysterectomy affect sexual function?

No, a hysterectomy alone does not impact sexual function. Recovery from surgery and undergoing therapy for cancer, including possibly going into menopause, however, may impact sexual function. Some hormone therapies used to treat cancer may cause sexual side effects. Patients should share their side effects and concerns with their care team.

Overall, hysterectomies are a safe and effective option for treating several types of cancer, and many patients who have them continue to live normal lives after.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.