Hysterectomy

A hysterectomy is the surgical removal of the uterus. It is the second most common surgery among women in the US, with approximately 600,000 performed annually. Types include total hysterectomy (uterus and cervix), subtotal/partial (uterus only), and radical (uterus, cervix, upper vagina, and surrounding tissue).

Common reasons include uterine fibroids, endometriosis, abnormal uterine bleeding, uterine prolapse, adenomyosis, chronic pelvic pain, and gynecologic cancers (uterine, cervical, ovarian). It is typically considered after other treatments have failed.

Pre-operative testing includes blood work, Pap smear, endometrial biopsy, and imaging. Stop blood thinners and certain supplements. You may need to do a bowel prep. Arrange for 2-6 weeks of help at home during recovery.

Approaches include vaginal (through the vagina, no visible scars), laparoscopic/robotic (small abdominal incisions), and open abdominal (larger incision). Minimally invasive approaches are preferred when possible. Surgery takes 1-3 hours.

Vaginal or laparoscopic: 2-4 weeks recovery, home in 1-2 days. Open abdominal: 4-6 weeks recovery, hospital stay 2-3 days. Avoid heavy lifting and intercourse for 6 weeks. Menstruation stops permanently after hysterectomy.

Risks include bleeding, infection, blood clots, injury to urinary tract or bowel, vaginal cuff dehiscence (rare), early menopause (if ovaries removed), and emotional effects. Mortality risk is less than 0.1%.

Alternatives depend on the condition: medications (hormonal therapy, GnRH agonists), uterine artery embolization for fibroids, endometrial ablation for heavy bleeding, myomectomy (fibroid removal preserving the uterus), and IUD placement.

Covered by insurance when medically indicated. May require documentation of failed conservative treatments. Pre-authorization is commonly required for non-emergency procedures.