Hysterectomy (surgical removal of the womb)
A hysterectomy is surgery to completely or partially remove the womb (uterus). This is done to relieve symptoms caused by medical conditions affecting the womb. It is a major surgical procedure that is associated with risks and side effects. So it is usually only considered if other treatments aren’t effective enough. If a woman has uterine or ovarian cancer, though, a hysterectomy may be necessary in order to remove the tumor.
For what reasons is a hysterectomy performed?
The most common reasons for having a hysterectomy include:
- Pelvic organ prolapse
- Very heavy or painful periods
- Uterine (womb), cervical or ovarian cancer
Only rarely does the womb need to be removed immediately. That may need to be done to avoid serious complications due to things like serious injuries, severe infections or uncontrollable bleeding during childbirth.
What types of hysterectomy are there?
There are three types of hysterectomy based on which organs and tissue are removed:
- Partial (supracervical) hysterectomy: The main body of the womb is removed. The cervix, fallopian tubes and ovaries remain in place.
- Total (complete) hysterectomy: The womb and the cervix are removed. The fallopian tubes and ovaries remain in place.
- Radical hysterectomy: A radical hysterectomy involves removing the womb and cervix, the nearby part of the vagina and parts of the supporting tissues – and sometimes also the fallopian tubes, ovaries and pelvic lymph nodes.
Types of hysterectomy
What does the procedure involve?
Hysterectomies can be carried out in different ways:
- Vaginal hysterectomy: The womb is removed through the vagina. The surgeon doesn’t need to make any incisions (cuts) in the belly.
- Laparoscopy (keyhole surgery): The surgeon makes small incisions in the belly and inserts thin tubes with a camera and surgical instruments attached to them. The womb is cut into smaller pieces in the abdominal cavity, and the removed tissue is sucked out.
- Abdominal hysterectomy: The womb is removed through an incision across the belly.
Hysterectomies are usually carried out through the vagina or keyhole surgery because they are less invasive than abdominal surgery. If possible, a vaginal hysterectomy is often preferred. It can also be combined with laparoscopy.
The type of procedure that is considered depends on the medical condition and factors such as the woman’s overall health, age and weight. The procedure is done in a hospital because a hysterectomy is a major operation. It’s usually possible to leave the hospital within one week. Depending on the scope of the procedure, it can take 3 to 6 weeks to start pursuing normal, everyday activities again.
When is a hysterectomy a good idea?
The removal of the womb is one of the most common gynecological procedures, but it's not always necessary. The exact medical condition and the woman’s individual situation will determine how suitable it is. The womb often needs to be removed in women who have uterine or ovarian cancer, to improve the chances of recovery. Symptoms caused by a large number of fibroids can sometimes only be relieved through a hysterectomy. sehr viele lassen sich manchmal nur durch diese Operation lindern.
The symptoms of many other problems can be relieved through other treatments, such as medication or less invasive surgical procedures that do not involve removing the womb. It might also be a good idea to wait until menopause because some symptoms will then improve on their own.
So it's generally a good idea to think carefully about the pros and cons of the different treatment options before making a decision. If you’re not sure, it might help to get a second opinion from a different doctor.
What are the possible risks and complications of a hysterectomy?
As with all surgical procedures, a hysterectomy may cause injury to blood vessels, nerves or organs, and may result in infections or wound-healing problems. About 5 out of 100 women have these kinds of complications. In the first few days after surgery, women may experience temporary pain, constipation or trouble emptying their bladder. Also, as with any surgery involving the abdominal cavity, scar tissue may form and cause different parts of abdominal tissue to stick to each other. Known as an adhesion, this can lead to pain or digestive problems.
After having a hysterectomy, it's no longer possible to have children. Menstrual periods stop as well. But if the cervix and the ovaries are left intact, mild bleeding may still occur.
If the ovaries are also removed, menopause starts right after the operation. This may cause problems like hot flashes, mood swings and vaginal dryness.
How the removal of the womb affects the woman's sex life will depend on what sort of symptoms she had before the procedure. It may improve if pain was a problem before, for instance. But some women experience a decrease in sexual pleasure.
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Indikation und Methodik der Hysterektomie bei benignen Erkrankungen (S3-Leitlinie). AWMF-Registernr.: 015-070. 04.2015.
Kives S, Lefebvre G. Supracervical hysterectomy. J Obstet Gynaecol Can 2010; 32(1): 62-68.
Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database Syst Rev 2012; (4): CD004993.
Robert Koch-Institut (RKI). Hysterektomie. February 06, 2014. (GBE kompakt: Zahlen und Trends aus der Gesundheitsberichterstattung des Bundes).
U.S. Department of Health and Human Services. Hysterectomy February 15, 2018. (Office on Women's Health).
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