A hysterectomy is surgery to remove a woman's uterus or womb. The uterus is the place where a baby grows when a woman is pregnant. After a hysterectomy, you no longer have menstrual periods and can't become pregnant. Sometimes the surgery also removes the ovaries and fallopian tubes. If you have both ovaries taken out, you will enter menopause.

Your health care provider might recommend a hysterectomy if you have

• Fibroids
• Endometriosis that hasn't been cured by medicine or surgery
• Uterine prolapse - when the uterus drops into the vagina
• Cancer of the uterine, cervix, or ovaries
• Vaginal bleeding that persists despite treatment
• Chronic pelvic pain, as a last resort

Hysterectomy is a surgery to remove a woman's uterus (her womb). The whole uterus is usually removed. Your doctor also may remove your fallopian tubes and ovaries. Talk to your doctor before your surgery to discuss your options. For example, if both ovaries are removed, you will have symptoms of menopause. Ask your doctor about the risks and benefits of removing your ovaries. You may also be able to try an alternative to hysterectomy, such as medicine or another type of treatment, first.

Each year in the United States, nearly 500,000 women get hysterectomies. A hysterectomy is the second most common surgery among women in the United States. The most common surgery in women is childbirth by cesarean delivery (C-section).

You may need a hysterectomy if you have one of the following:

• Uterine fibroids. Uterine fibroids are noncancerous growths in the wall of the uterus. In some women they cause pain or heavy bleeding.
• Heavy or unusual vaginal bleeding. Changes in hormone levels, infection, cancer, or fibroids can cause heavy, prolonged bleeding.
• Uterine prolapse. This is when the uterus slips from its usual place down into the vagina. This is more common in women who had several vaginal births, but it can also happen after menopause or because of obesity. Prolapse can lead to urinary and bowel problems and pelvic pressure.
• Endometriosis. Endometriosis happens when the tissue that normally lines the uterus grows outside of the uterus on the ovaries where it doesn't belong. This can cause severe pain and bleeding between periods.
• Adenomyosis. In this condition the tissue that lines the uterus grows inside the walls of the uterus where it doesn't belong. The uterine walls thicken and cause severe pain and heavy bleeding.
• Cancer (or precancer) of the uterus, ovary, cervix, or endometrium (the lining of the uterus). Hysterectomy may be the best option if you have cancer in one of these areas. Other treatment options may include chemotherapy and radiation. Your doctor will talk with you about the type of cancer you have and how advanced it is.

Keep in mind that there may be alternative ways to treat your health problem without having a hysterectomy. Hysterectomy is a major surgery. Talk with your doctor about all of your treatment options.

Hysterectomy (pronounced hiss-tur-EK-toh-mee) is the removal of the uterus. It is the only certain cure for uterine fibroids. But it is not the only treatment option, and it is not the best treatment for every woman with fibroids.

If you want to keep your uterus and/or get pregnant in the future, talk to your doctor about other treatments before having a hysterectomy. If your fibroids are small or if you have minor or no symptoms of fibroids, medical treatments may be effective good option. Surgeries that remove the fibroids without removing the uterus are also possible treatment options.

Hysterectomy is major surgery. Sometimes a hysterectomy may be medically necessary, such as with prolonged heavy bleeding or certain types of cancer. But sometimes you can try other treatments first. These include:

1. Watchful waiting. You and your doctor may wish to wait if you have uterine fibroids, which tend to shrink after menopause.
2. Exercises. For uterine prolapse, you can try Kegel exercises (squeezing the pelvic floor muscles). Kegel exercises help restore tone to the muscles holding the uterus in place.
3. Medicine. Your doctor may give you medicine to help with endometriosis. Over-the-counter pain medicines taken during your period also may help with pain and bleeding. Hormonal birth control, such as the pill, shot, or vaginal ring, or a hormonal intrauterine device (IUD) may help with irregular or heavy vaginal bleeding or periods that last longer than usual.
4. Vaginal pessary (for uterine prolapse). A pessary is a rubber or plastic donut-shaped object, similar to a diaphragm used for birth control. The pessary is inserted into the vagina to hold the uterus in place. Uterine prolapse happens when the uterus drops or “falls out” because it loses support after childbirth or pelvic surgery.
5. Surgery. You and your doctor may choose to try a surgery that involves smaller or fewer cuts than hysterectomy. The smaller cuts may help you heal faster with less scarring. Depending on your symptoms, these options may include:
   • Surgery to treat endometriosis. Laparoscopic surgery uses a thin, lighted tube with a small camera. The doctor puts the camera and surgery tools into your pelvic area through very small cuts. This surgery can remove scar tissue or growths from endometriosis without harming the surrounding healthy organs such as ovaries. You may still get pregnant after this surgery.
   • Surgery to help stop heavy or long-term vaginal bleeding.
     • Dilation and curettage (D&C) removes the lining of the uterus that builds up every month before your period. Often, a hysteroscopy is done at the same time. Your doctor inserts the hysteroscope (a thin telescope) into your uterus to see the inside of the uterine cavity. D&C may also remove noncancerous growths or polyps from the uterus. After the D&C, a new uterine lining will build up during your next menstrual cycle as usual. You may still get pregnant after this surgery.
     • Endometrial ablation destroys the lining of the uterus permanently. Depending on the size and condition of your uterus, your doctor may use tools that freeze, heat, or use microwave energy to destroy the uterine lining. This surgery should not be used if you still want to become pregnant or if you have gone through menopause.
   • Surgery to remove uterine fibroids without removing the uterus. This is called a myomectomy. Depending on the location of your fibroids, the myomectomy can be done through the pelvic area or through the vagina and cervix. You may be able to get pregnant after this surgery. If your doctor recommends this surgery, ask your doctor if a power morecellator will be used. The FDA has warned against the use of power morcellators for most women.
   • Surgery to shrink fibroids without removing the uterus. This is called myolysis. The surgeon heats the fibroids, which causes them to shrink and die. Myolysis may be done laparoscopically (through very small cuts in the pelvic area). You may still get pregnant after myolysis.
6. Treatments to shrink fibroids without surgery. These treatments include uterine artery embolization (UAE) and magnetic resonance (MR)-guided focused ultrasound (MR[f] US). UAE puts tiny plastic or gel particles into the vessels supplying blood to the fibroid. Once the blood supply is blocked, the fibroid shrinks and dies. MR(f)US sends ultrasound waves to the fibroids that heat and shrink the fibroids. After UAE or MR(f)US, you will not be able to get pregnant.

• A total hysterectomy removes all of the uterus, including the cervix. The ovaries and the fallopian tubes may or may not be removed. This is the most common type of hysterectomy.
• A partial, also called subtotal or supracervical, hysterectomy removes just the upper part of the uterus. The cervix is left in place. The ovaries may or may not be removed.
• A radical hysterectomy removes all of the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina. A radical hysterectomy is most often used to treat certain types of cancer, such as cervical cancer. The fallopian tubes and the ovaries may or may not be removed.

A hysterectomy can be done in several different ways. It will depend on your health history and the reason for your surgery. Talk to your doctor about the different options:

• Abdominal hysterectomy. Your doctor makes a cut, usually in your lower abdomen.
• Vaginal hysterectomy. This is done through a small cut in the vagina.
• Laparoscopic hysterectomy. A laparoscope is an instrument with a thin, lighted tube and a small camera that allows your doctor to see your pelvic organs. Laparoscopic surgery is when the doctor makes very small cuts to put the laparoscope and surgical tools inside of you. During a laparoscopic hysterectomy the uterus is removed through the small cuts made in either your abdomen or your vagina.
• Robotic surgery. Your doctor guides a robotic arm to do the surgery through small cuts in your lower abdomen, like a laparoscopic hysterectomy.

Uterine sarcoma (a type of cancer) is more common in women undergoing surgery for uterine fibroids (noncancerous growths in a woman's uterus) than previously thought, and it can be hard to distinguish between a uterine sarcoma and a uterine fibroid prior to surgery with available tests. When laparoscopic power morcellators are used for myomectomy or hysterectomy in women with presumed uterine fibroids that are actually uterine sarcomas, the surgical procedure poses a risk of spreading cancerous tissue beyond the uterus, worsening a woman's chance of long-term survival.

The FDA estimates that a hidden uterine sarcoma may be present in approximately 1 in 225 to 1 in 580 women undergoing surgery for uterine fibroids based on recent publications. The FDA also estimates that a leiomyosarcoma (a specific type of uterine sarcoma) may be present in approximately 1 in 495 to 1 in 1100 women undergoing surgery for uterine fibroids based on recent studies. Prior to 2014, the clinical community estimated uterine sarcomas to be present much less frequently, in as few as 1 in 10,000 women undergoing surgery for uterine fibroids.

Several studies show that using a laparoscopic power morcellator during gynecologic surgery in women with hidden uterine sarcomas is associated with lowering their chances of long-term survival without cancer. While these studies have limitations, women who have had fibroid surgery with a laparoscopic power morcellator later found to have a hidden uterine sarcoma, have lower disease-free survival (less time without any sign or symptom of cancer after surgery), when compared to women who were treated with manual morcellation or without morcellation. In addition, there is data to suggest an increase in rate of occult sarcoma for women undergoing surgery for presumed fibroids.

Uterine sarcomas and uterine fibroids may have similar signs and symptoms. At this time, there is no reliable method for predicting or testing whether a woman with fibroids may have a uterine sarcoma.

The FDA recommends health care providers share this information with patients and warns against using laparoscopic power morcellators in gynecologic surgeries to treat patients with suspected or confirmed cancer, and in women over age 50 having a myomectomy or hysterectomy for uterine fibroids.

Health care providers and informed patients can work together to choose the best treatment approach based on known risk factors for uterine sarcoma (e.g., age, exposure to pelvic radiation therapy, prior use of the drug Tamoxifen, and race). For some patients, the benefits of minimally invasive surgery with a laparoscopic power morcellator may outweigh the risks. These patients may include some younger women who wish to maintain their fertility.

Whether your ovaries are removed during the hysterectomy may depend on the reason for your hysterectomy.

Ovaries may be removed during hysterectomy to lower the risk for ovarian cancer. However, women who have not yet gone through menopause also lose the protection of estrogen, which helps protect women from conditions such as heart disease and osteoporosis.

Recent studies suggest that removing only the fallopian tubes but keeping the ovaries may help lower the risk for the most common type of ovarian cancer, which is believed to start in the fallopian tubes.

The decision to keep or remove your ovaries is one you can make after talking about the risks and benefits with your doctor.

All women who have a hysterectomy will stop getting their period. Whether you will have other symptoms of menopause after a hysterectomy depends on whether your doctor removes your ovaries during the surgery.

If you keep your ovariesduring the hysterectomy, you should not have other menopausal symptoms right away. But you may have symptoms a few years younger than the average age for menopause (52 years).

Because your uterus is removed, you no longer have periods and cannot get pregnant. But your ovaries might still make hormones, so you might not have other signs of menopause. You may have hot flashes, a symptom of menopause, because the surgery may have blocked blood flow to the ovaries. This can prevent the ovaries from releasing estrogen.

If both ovaries are removed during the hysterectomy, you will no longer have periods and you may have other menopausal symptoms right away. Because your hormone levels drop quickly without ovaries, your symptoms may be stronger than with natural menopause. Ask your doctor about ways to manage your symptoms.

Recovering from a hysterectomy takes time. Most women stay in the hospital one to two days after surgery. Some doctors may send you home the same day of your surgery. Some women stay in the hospital longer, often when the hysterectomy is done because of cancer.

Your doctor will likely have you get up and move around as soon as possible after your hysterectomy. This includes going to the bathroom on your own. However, you may have to pee through a thin tube called a catheter for one or two days after your surgery.

The time it takes for you to return to normal activities depends on the type of surgery:

• Abdominal surgery can take from four to six weeks to recover.
• Vaginal, laparoscopic, or robotic surgery can take from three to four weeks to recover.

You should get plenty of rest and not lift heavy objects for four to six weeks after surgery. At that time, you should be able to take tub baths and resume sexual intercourse. How long it takes for you to recover will depend on your surgery and your health before the surgery. Talk to your doctor.

Hysterectomy is a major surgery, so recovery can take a few weeks. But for most women, the biggest change is a better quality of life. You should have relief from the symptoms that made the surgery necessary.

Other changes that you may experience after a hysterectomy include:

• Menopause. You will no longer have periods. If your ovaries are removed during the hysterectomy, you may have other menopause symptoms.
• Change in sexual feelings. Some women have vaginal dryness or less interest in sex after a hysterectomy, especially if the ovaries are removed.
• Increased risk for other health problems. If both ovaries are removed, this may put you at higher risk for certain conditions such as: bone loss, heart disease, and urinary incontinence (leaking of urine). Talk to your doctor about how to prevent these problems.
• Sense of loss. Some women may feel grief or depression over the loss of fertility or the change in their bodies. Talk to your doctor if you have symptoms of depression, including feelings of sadness, a loss of interest in food or things you once enjoyed, or less energy, that last longer than a few weeks after your surgery.

It might. If you had a good sex life before your hysterectomy, you should be able to return to it without any problems after recovery. Many women report a better sex life after hysterectomy because of relief from pain or heavy vaginal bleeding.

If your hysterectomy causes you to have symptoms of menopause, you may experience vaginal dryness or a lack of interest in sex. Using a water-based lubricant can help with dryness. Talk to your partner and try to allow more time to get aroused during sex.

Maybe. You will still need regular Pap tests (or Pap smear) to screen for cervical cancer if you:

• Did not have your cervix removed
• Had a hysterectomy because of cancer or precancer

Ask your doctor what is best for you and how often you should have Pap tests.