What is a hysterectomy?

A hysterectomy is the most common non-obstetric* surgical procedure among women, with 600,000 of these procedures performed each year in the United States.

But while this surgery is common, it’s often not well understood. In one article published by The New York Times, a doctor estimated that 50% of her patients who had previously undergone hysterectomies didn’t know the details of their surgeries—including which organs were removed.

Knowledge is power with any sort of medical treatment—not just for the patient, but also for employers providing treatment coverage. And, since Carrum Health recently started providing hysterectomies, we thought it was important to cover the information you should know.

Hysterectomy 101

A hysterectomy is a surgical procedure during which a person’s uterus is removed. In some cases, the cervix or other tissues and organs (such as the ovaries or fallopian tubes) are also removed. Exactly how much of the uterus and which related organs are removed depends on the reason for and method of the hysterectomy.

There are numerous reasons why a woman might need a hysterectomy, including:

• Heavy periods
• Pelvic pain (which can be caused by fibroids, endometriosis, pelvic inflammatory disease, or adenomyosis)
• Uterine prolapse (when the uterus “drops” due to weakened pelvic floor muscles and ligaments)
• Cancer of the uterus, ovaries, or cervix

The reason a woman is pursuing a hysterectomy dictates the details of her procedure—including how much of the uterus is removed, which organs (if any) are removed with it, and the technique used for the surgery.
 

 

Types of hysterectomies

With any surgery, it seems strange that a patient would lack clarity about exactly what was removed. However, it’s fairly common with hysterectomies (and also why the answer to “What is a hysterectomy?” is not quite as simple as one may think).

That’s because there are several different types of hysterectomies—and all of them differ in terms of what organs and tissues (and how much of them) are removed.

Here’s a brief overview of the different types of hysterectomies:

Total hysterectomy

With this procedure, the uterus and cervix (the lower end of the uterus that connects the uterus to the vagina) are removed, but the ovaries remain intact. This is the most common type of hysterectomy.

Partial hysterectomy

This procedure removes only the upper part of the uterus but leaves the cervix. For that reason, this procedure is also commonly called a “supracervical hysterectomy.”

Radical hysterectomy

According to Stanford Medicine, a radical hysterectomy is generally considered the most serious hysterectomy and is typically only done when treating cancer. This procedure removes the uterus, cervix, top portion of the vagina, the majority of the tissue that surrounds the cervix, and occasionally the pelvic lymph nodes.

Hysterectomy with salpingo-oophorectomy

This type of hysterectomy removes the uterus along with either one or both ovaries and fallopian tubes. It’s sort of a middle ground between the other procedures—it removes more than a total or partial hysterectomy, but less than a radical hysterectomy.

Surgical approaches for hysterectomies

Hysterectomies don’t just differ in their purpose. They also differ in their techniques—meaning, the method a physician uses to remove the uterus. Here’s a look at the most common approaches:

Abdominal hysterectomy

The uterus is removed through a six- to eight-inch-long incision in the abdomen, making this the most invasive approach for a hysterectomy.

Recovery: Two to three nights in the hospital with four to six weeks of reduced activity

Vaginal hysterectomy

The uterus is removed through the vaginal opening, rather than an incision in the abdomen. There’s no external incision with this approach. But, due to the size and position of the vagina, it’s not the right technique for all types of conditions.

Recovery: Up to one night in the hospital with four to six weeks of reduced activity

Laparoscopic hysterectomy

In any type of laparoscopic surgery, a doctor inserts a thin, flexible tube containing a video camera (this is called a laparoscope) through small incisions in the body. With a hysterectomy, this small incision(s) can be in the:

• Abdomen (called an abdominal laparoscopic hysterectomy)
• Vagina (called a vaginal laparoscopic hysterectomy)

The doctor will remove the uterus in sections through those same small incisions. This is less invasive than an abdominal hysterectomy, as the incisions are much smaller.

Recovery: Up to one night in the hospital with four to six weeks of reduced activity

Robotic hysterectomy

Much like with an abdominal laparoscopic hysterectomy, the doctor will make several small incisions on the abdomen. But, instead of a laparoscope, the surgeon inserts robotic instruments to view and remove the uterus.

Recovery: Up to one night in the hospital with four to six weeks of reduced activity

What happens after someone gets a hysterectomy?

Because a hysterectomy involves the removal of the uterus, the patient will no longer have a menstrual cycle. Additionally, they will not be able to get pregnant. Pregnancy can still occur (although, it’s very rare) if the ovaries and fallopian tubes are kept intact. However, that would be an ectopic pregnancy—a non-viable pregnancy and medical emergency.

According to the American College of Obstetricians and Gynecologists, it’s common for women to experience the following recovery systems after a hysterectomy:

• Bleeding and discharge from the vagina
• Constipation
• Temporary problems emptying the bladder

Aside from the physical symptoms, many women also experience emotional impacts from the surgery—particularly for those who had hoped to carry their own biological children and did not get the chance to prior to the procedure.

Many people mistakenly assume that removing the uterus will affect a woman’s hormone levels. However, the uterus doesn’t produce hormones. So, a total or partial hysterectomy won’t have any impact on hormones.

With that said, if a hysterectomy includes removal of the ovaries (so, a radial hysterectomy or a hysterectomy with a salpingo-oophorectomy), that does directly impact hormone levels. When the ovaries are removed, estrogen production is reduced dramatically. This can cause the rapid onset of menopause (if the patient has not gone through this phase yet), which can bring along hot flashes, night sweats, fatigue, insomnia, and depression.

A hysterectomy is the surgical removal of the uterus, yes. But that’s just the broad definition, and different types of procedures fall under this category—all of which differ in their purpose and approach. When a patient understands the details of their specific type of hysterectomy, they’re better equipped to approach their procedure with clarity (rather than confusion), and when an employer understands the details, they’re better equipped to provide high-quality healthcare coverage for all types of this procedure.

Learn more about how to partner with Carrum Health here.

*There are some instances in which hysterectomies need to be performed during vaginal or Caesarean child delivery. These are known as emergency obstetric hysterectomies.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional legal or medical advice, diagnosis, or treatment.