Hysterectomy in the United States

Helpful Things to Know If You're Considering Surgery

a woman lying in a hospital bed
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Hysterectomy—a type of surgery in which a woman's uterus (or womb) is removed, sometimes along with the ovaries, cervix, fallopian tubes, or other structures—ranks just behind Cesarean section as the second most common surgery among women in the United States. It may be recommended as a treatment for uterine fibroids, endometriosis, and certain gynecological cancers, among other concerns.

If you have a hysterectomy, you're in good company among the 20 million American women who have had one. The Centers for Disease and Prevention (CDC) reports that approximately 600,000 hysterectomies are performed in the United States each year. About a third of all women will have a hysterectomy by the age of 60, according to the American College of Obstetricians and Gynecologists (ACOG).

Hysterectomies may be common, but you may be surprised to learn that research shows nearly all of them are elective. Furthermore, about 90 percent of hysterectomies aren't necessary: The conditions they're meant to treat can be effectively dealt with in other ways that usually are less risky and that preserve the uterus. For example, a 2017 study found that a minimally-invasive procedure for treating uterine fibroids called uterine fibroid embolization is vastly underused.

So if your doctor is recommending you have a hysterectomy, make sure you understand everything about the condition you have and other possible treatment options.

Types of Hysterectomy

There are three ways to perform a hysterectomy:

  • Abdominal, or open incision, hysterectomy, in which the abdominal area is fully opened. This often is necessary if multiple organs or cancerous tissue, as well as the uterus, must be removed. This type of surgery poses the most risks, according to the Mayo Clinic, including blood clots, infection, bleeding, side effects from anesthesia, damage to other organs in the pelvic area, and (very rarely), death. Women younger than 35 who have an abdominal hysterectomy also are at an increased risk of cardiovascular disease and certain metabolic conditions.
  • Laparoscopic surgery, in which small incisions are made in the abdomen to accommodate the surgical instruments as well as a small camera to guide the surgeon. Sometimes this is performed with the aid of a robotic instrument (that the surgeon guides). Whether a robot is used or not, laparoscopic hysterectomy can take longer than an abdominal procedure and there is a slightly higher risk of damage to the urinary tract and nearby organs. In general, though, it's a safer alternative.
  • Vaginal hysterectomy, in which the uterus is removed via the vaginal canal. ACOG advises that this is the least risky approach to hysterectomy, requires less healing time, and whenever possible should be the first choice.

Note that both laparoscopic and vaginal hysterectomies often can be done as outpatient procedures, which means a woman can go home within 23 hours of surgery. ACOG reports that 18 percent of hysterectomies in the United States are performed as same-day operations. 

The method used hinges on the type of hysterectomy that needs to be performed. The decision to choose one over another mostly has to do with the extensiveness of the area being treated.

  • Total hysterectomy: In this procedure, the entire uterus and the cervix are removed. Other organs also may be removed, such as the ovaries or fallopian tubes (if these organs are affected by endometriosis, for example). 
  • Partial or supracervical (or subtotal) hysterectomy: The upper part of the uterus is removed but the cervix is left in place. It can be done laparoscopically or abdominally.
  • Radical hysterectomy: When uterine cancer has spread to structures surrounding the uterus, they, along with the uterus, may need to be removed in this surgery. 

Reasons Hysterectomies Are Performed

Women at highest risk of needing a hysterectomy are those between ages 40 and 45, while the lowest risk is among women aged 15 to 24. Still, there are reasons women outside of these age groups might need to have a hysterectomy. The most common reasons for a woman to have a hysterectomy are:

  • Uterine fibroids: These are noncancerous growths in the wall of the uterus. Although they're almost always benign, these tumors sometimes wreak all sorts of health havoc, from pain, particularly during menstruation, to abnormal bleeding, to abdominal swelling. Larger fibroids can affect bladder or bowel function, or even cause back pain. There are many alternatives to surgery for treating mild uterine fibroids, so be sure to talk to your doctor about your options. 
  • Heavy or unusual vaginal bleeding caused by fluctuations in hormone levels, infection, cancer, or fibroids.
  • Uterine prolapse: With this condition, the muscles and ligaments that support the pelvic floor become too weak to hold up the uterus, allowing it to literally drop down through or even protrude from the vagina. It can lead to bowel or urinary problems. Uterine prolapse is most common in those who have reached menopause who had one or more vaginal deliveries when younger. The condition is not a medical emergency, however, and is a good example of one that can be treated in less invasive ways. If a uterine prolapse is mild, Kegel exercises to strengthen the pelvic floor muscles may do the trick of shoring them up enough to support the uterus. Many women also benefit from wearing a pessary—a rubber disk that resembles a diaphragm and is fitted to provide the support for the uterus that the weakened pelvic floor no longer can. 
  • Endometriosis: Endometriosis happens when the endometrium (or endometrial lining), which covers the walls of the uterus and becomes thick with tissue and blood vessels each month in preparation for pregnancy, proliferate in areas outside of the uterus. Endometrial tissue may grow on the ovaries, for example, or on other organs within the pelvis. The result often is heavy bleeding with nowhere to go, scarring, and adhesions that can lead to pain and, ultimately, permanent damage. It's important to note that a hysterectomy is not a cure for endometriosis. Even when the uterus is gone, endometrial tissue can continue to grow on structures within the pelvis. Seeking out a doctor who specializes in treating this condition is highly advisable. 
  • 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: Although chemotherapy and radiation can be used for these conditions, hysterectomy may be the best treatment option, depending on the type of cancer and how advanced it is, according to the National Cancer Institute.

Things to Consider

If you've been advised to have a hysterectomy, here are some general things to keep in mind and to ask your doctor about as you weigh the pros and cons:

Risks/complications: Like any surgery, hysterectomy can give way to potential concerns. In particular, talk about the long-term risks of cardiovascular disease and urinary issues in relation to your overall health profile. Know, too, that hysterectomy can cause early onset menopause. You cannot carry a child after a hysterectomy.

Removal of ovaries (oophorectomy): Sometimes this is done to lower a woman's risk of ovarian cancer. For women who haven't gone through menopause, however, loss of the ovaries also means loss of protection from potential health problems. Research shows that bilateral oophorectomy (removal of both ovaries) as part of a hysterectomy may increase a woman's risk of fatal and non-fatal coronary heart disease and lung cancer. Estrogen also provides protection from osteoporosis. There's also evidence that ovarian cancer tends to originate in fallopian tubes, and so removing those rather than the ovaries may provide protection from ovarian cancer. 

Recovery: A hysterectomy is not minor surgery, even if it's elective—and even if you have a laparoscopic or vaginal procedure. It typically takes four to six weeks to get back to normal, during which time you'll need to rest, refrain from lifting heavy objects, avoid bathing in a tub, and take other precautions.

Expense: In many cases, hysterectomy—particularly if it's elective—isn't covered by insurance. Some plans may only cover hysterectomy to treat cancer or hemorrhaging (severe and life-threatening bleeding), for example.  If your condition can be treated in another way, it may benefit your bank account to ask your doctor about alternatives before you sign on for surgery.

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