Purpose of Hysterectomy Surgery

Why You May Need Your Uterus Removed

Doctor discussing hysterectomy options with woman

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A hysterectomy is a major surgery where the entire uterus, and sometimes surrounding organs, are removed. Most hysterectomies are elective, but the surgery is based on a physician’s recommendation as a way to resolve a medical issue such as fibroids or cancer. There are a number of conditions that a hysterectomy may be used to treat, but there are also alternative treatments. These may include medications or less invasive surgical procedures.

A hysterectomy may be performed as a personal choice, but you should expect extensive counseling from your doctor about the decision. 

Hysterectomy surgery carries a number of risks and long-term health effects to consider. If you are considering a hysterectomy, you should consult your doctor for personalized guidance.

Diagnosis Related to Hysterectomy

There are a number of medical conditions that could lead you to consider a hysterectomy. The following are some diagnoses that could lead to a hysterectomy.

  • Adenomyosis. When the lining of the uterus ( the endometrium) begins to grow where it does not belong, it is called adenomyosis. This condition results in a thickening of the endometrium, which can cause a lot of pain and heavy bleeding.
  • Cancer. A number of cancers can impact the pelvis and reproductive organs, like cervical, ovarian, uterine, and endometrial cancers. About 10% of all hysterectomies are performed to treat one of these types of cancer.
  • Endometriosis. This condition happens when cells normally found in the uterus, called endometrial cells, travel outside the uterus. These cells may attach themselves to other organs, growing in places throughout the pelvic cavity where they don’t belong. This can cause general pelvic pain, pain during intercourse, heavy bleeding, infertility, and cramping. While a hysterectomy is sometimes used to treat endometriosis, it is not a cure.
  • Endometrial hyperplasia. This occurs when the lining of the uterus (the endometrium) becomes too thick. An imbalance in the hormones estrogen and progesterone are a common cause, particularly during severe the hormonal shifts in perimenopause. The endometrium is normally shed each month, but when it becomes too thick from hyperplasia, abnormally heavy bleeding can result.
  • Fibroid tumors. These non-cancerous tumors can grow and crowd space in the uterus. While they may not cause cancer or spread to other organs, fibrous growths can cause pressure in the uterus and on surrounding organs, pain throughout the pelvis, and heavy vaginal bleeding. About one-third of all hysterectomies are performed to treat fibroids.
  • Pelvic blockage. Cancers or others growths in the pelvic cavity or uterus may create a blockage to other important organs like the intestines or bladder. A hysterectomy may be performed to clear these blockages.
  • Uterine prolapse. Multiple births, obesity, and even menopause can cause the uterus to slip out of place down into the vagina. This abnormal position of the uterus can cause urinary and bowel problems, as well as pelvic pain and pressure.

If you request a hysterectomy for sterilization or other personal reasons, your doctor will likely ask you to complete a mental health evaluation or deny your request. According to guidelines from the American College of Obstetrics and Gynecology (ACOG), there are a number of sterilization techniques that are less invasive and carry less risk than a hysterectomy. When the hysterectomy is not medically necessary to safeguard a pregnancy or treat a disease, ACOG says hysterectomies for sterilization are medically and ethically unadvisable.

A 2018 study found that a rate of hysterectomies decreased by 12.4% from 2010 to 2013. The largest drops were in hysterectomies used to treat fibroids, abnormal bleeding, and endometriosis in women under age 55.

There are multiple ways to perform a hysterectomy, depending on the indication and purpose of the surgery. The decision about which procedure to perform will be made by you and your doctor based on your diagnosis and individual situation.

For example, an open abdominal hysterectomy is often performed when disease has spread beyond the uterus, like in cancer, or when surrounding structures like the ovaries need to be removed, as well. On the other hand, a vaginal hysterectomy may be the preferred method when the surgery is being performed for something like uterine prolapse.

Tests and Labs

A hysterectomy is a major surgery. As with any surgery, your doctor will first want to be sure that you are medically stable and healthy enough to tolerate a major surgical procedure. Lab work and a number of other tests may be performed. Counseling may also be a part of your preparation for surgery, as fertility loss, hormonal changes, and emotional challenges may follow your decision for a hysterectomy.

Some of the tests that may be performed before a hysterectomy include:

  • Blood counts. Your doctors will want to examine your white blood cell count to look for infection or issues with immunity before surgery, as well as a red blood cell count. Both can be done with a complete blood count (CBC). This test is performed through a blood draw.
  • Coagulation studies. It’s important for your doctor to see how well your blot clots before surgery. This is done with a prothrombin time/partial thromboplastin time (PT/PTT) test, which is performed with a blood draw.
  • Metabolic panel. A basic or complete metabolic panel will give your doctor a lot of information about your general health status, which can help determine your eligibility for surgery and how well you will recover. This blood test will tell your doctor about important mineral and electrolyte levels in your body including potassium, sodium, and glucose. It can also reveal information about your renal system and the health of your kidneys.
  • Urinalysis. A urinalysis is performed by a urine sample, and gives your doctor additional information about your health, or if you have any infections that could complicate your surgery or recovery.
  • Electrocardiogram. An electrocardiogram is often done before surgery to make sure you don’t have any heart problems or underlying conditions that affect your heart and could cause problems with your surgery or recovery.
  • Chest X-ray and breathing studies. Your doctor may also request a chest X-ray or various breathing studies to help reduce your chances of complications during surgery from anesthesia or the breathing tube used during surgery.
  • Physical exam. Your doctor may want to do a general head-to-toe assessment to determine how good your general health is. This is important to the success of your surgery and your recovery.
  • Pelvic ultrasound/exam. You may also need a pelvic exam or ultrasound before hysterectomy surgery in particular. This will help your doctor assess or visualize your internal structures and prepare for surgery.

A Word From Verywell

There are a number of reasons why you may want a hysterectomy, or why your doctor might recommend one. Even if a vaginal rather than an open hysterectomy is performed, it is still a significant surgery that will require extended recovery time.

You should discuss your plans and options with your doctor based on individual factors before deciding on a hysterectomy. There are treatment alternatives for many conditions hysterectomy is used to treat, including medications or less invasive procedures.

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Article Sources
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  2. Johns Hopkins Medicine. Hysterectomy. 2020.

  3. Harvard Health Publishing, Harvard Medical School. Hysterectomy. March 2019.

  4. The American College of Obstetrics and Gynecology, Committee on Ethics. Committee Opinion Number 695: Sterilization of women: Ethical issues and considerations. April 2017.

  5. Morgan DM. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women. American Journal of Obstetrics and Gynecology. 2018;218(4):425. doi:10.1016/j.ajog.2017.12.218

  6. Johns Hopkins Medicine. Tests done before surgery. 2020.