FAQ

A hysterectomy is the surgical removal of the uterus.

A hysterectomy may be done to treat conditions that affect the uterus:

• Uterine fibroids
• Endometriosis
• Pelvic support problems (such as uterine prolapse)
• Abnormal uterine bleeding
• Cancer
• Chronic pelvic pain

There are several types of hysterectomy:

• Total hysterectomy—The entire uterus, including the cervix, is removed.
• Supracervical (also called subtotal or partial) hysterectomy—The upper part of the uterus is removed but the cervix is left in place.
• Hysterectomy with removal of the fallopian tubes and ovaries

There are three ways that hysterectomy can be performed:

1. vaginal hysterectomy
2. abdominal hysterectomy
3. and laparoscopic hysterectomy.

In a vaginal hysterectomy, the uterus is removed through the vagina. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. There may be less pain during recovery. Vaginal hysterectomy causes fewer complications than the other types of hysterectomy and is a very safe way to remove the uterus. It also is associated with a shorter hospital stay and a faster return to normal activities than abdominal hysterectomy.

In an abdominal hysterectomy, the surgeon makes an incision through the skin and tissue in the lower abdomen to reach the uterus. This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation. This procedure may be chosen if you have large tumors or if cancer may be present. Abdominal hysterectomy may require a longer healing time than vaginal or laparoscopic surgery, and it usually requires a longer hospital stay.

In a laparoscopic hysterectomy, a laparoscope is used to guide the surgery. A laparoscope is a thin, lighted tube that is inserted into the abdomen through a small incision in or around the navel. It allows the surgeon to see the pelvic organs   on a screen. Additional small incisions are made in the abdomen for other instruments used in the surgery. In a total laparoscopic hysterectomy, the uterus is detached from inside the body and then removed in small pieces through the incisions or through the vagina. In a laparoscopic assisted vaginal hysterectomy, the uterus is removed through the vagina, and the laparoscope is used to guide the procedure. In a robot-assisted laparoscopic hysterectomy, the surgeon uses a robot attached to the instruments to assist in the surgery.

Hysterectomy is one of the safest surgical procedures. But as with any surgery, problems can occur:

• Infection
• Bleeding during or after surgery
• Injury to the urinary tract or nearby organs
• Deep vein thrombosis (DVT), which is a risk with any surgery
• Problems related to anesthesia
• Death
• Bowel blockage from scarring of the intestines
• Formation of a blood clot in the wound

You will be urged to walk around as soon as possible after your surgery. Walking will help prevent DVT. You also may receive medicine or other care to help prevent DVT.

You can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain.

You will have bleeding and discharge from your vagina for several weeks. Sanitary pads can be used after the surgery. Do not put anything in your vagina during the first 6 weeks. That includes douching, having sex, and using tampons.

After hysterectomy, your periods will stop. If the ovaries are left in place and you have not yet gone through menopause, they will still produce estrogen, a hormone that affects the body in many ways. Depending on your age, if your ovaries are removed during hysterectomy, you will have signs and symptoms caused by a lack of estrogen, which include hot flashes, vaginal dryness, and sleep problems. You also may be at risk of a fracture caused by osteoporosis at an earlier age than women who go through natural menopause. Most women who have these intense symptoms can be treated with estrogen therapy.

Some women feel depressed because they can no longer have children. Other women may feel relieved because the symptoms they were having have now stopped.

Some women notice a change in their sexual response after hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.

Some women feel more sexual pleasure after hysterectomy. This may be because they no longer have to worry about getting pregnant. It also may be because they no longer have the discomfort or heavy bleeding caused by the problem leading to hysterectomy.

Cervix: The opening of the uterus at the top of the vagina.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in a deep vein, usually in the leg.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually in the ovaries, fallopian tubes, and other pelvic structures.

Estrogen: A female hormone produced in the ovaries.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fibroids: Benign (noncancerous) growths that form in the muscle of the uterus.

Hormone: Substance produced by the body to control the functions of various organs. 

Hysterectomy: Removal of the uterus.

Laparoscope: A slender, light-transmitting instrument that is used to view abdominal and pelvic organs or perform surgery.

Menopause: The time in a woman’s life when the ovaries have stopped functioning, defined as the absence of menstrual periods for 1 year.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Uterine Prolapse: A condition in which the uterus drops down into the vagina.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal (see the FAQ Abnormal Uterine Bleeding).

Hysteroscopy also is used in the following situations:

• Remove adhesions that may occur because of infection or from past surgery
• Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row
• Locate an intrauterine device
• Perform sterilization, in which the hysteroscope is used to place small implants into a woman’s fallopian tubes as a permanent form of birth control

Before the procedure, you may be given a medication to help you relax, or general anesthesia or local anesthesia may be used to block the pain. If you have general anesthesia, you will not be awake during the procedure.

Hysteroscopy can be done in a doctor’s office or at the hospital. It will be scheduled when you are not having your menstrual period. To make the procedure easier, your health care provider may dilate (open) your cervix before your hysteroscopy. You may be given medication that is inserted into the cervix, or special dilators may be used.

A speculum is first inserted into the vagina. The hysteroscope is then inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (salt water), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your health care provider see the lining more clearly. The amount of fluid used is carefully checked throughout the procedure. Your health care provider can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If a biopsy or other procedure is done, small instruments will be passed through the hysteroscope.

You should be able to go home shortly after the procedure. If you had general anesthesia, you may need to wait until its effects have worn off.

Hysteroscopy is a safe procedure. However, there is a small risk of problems. The uterus or cervix can be punctured by the hysteroscope, bleeding may occur, or excess fluid may build up in your system. In rare cases, hysteroscopy can cause life-threatening problems.

Adhesions: Scars that bind together affected surfaces of the tissues inside the abdomen or uterus.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a labor- atory.

Cervix: The opening of the uterus at the top of the vagina.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Intrauterine Device: A small plastic device inserted in the uterus to prevent pregnancy.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Miscarriage: Early pregnancy loss.

Speculum: An instrument used to open the walls of the vagina.

Sterilization: A permanent method of birth control.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

• Disorders of the uterus or endometrium
• Endometrial hyperplasia
• Cancer of the uterus
• Recent pregnancy
• Current or recent infection of the uterus

Pregnancy is not likely after ablation, but it can happen. If it does, the risk of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.

A woman who has had ablation still has all her reproductive organs. Routine Pap tests and pelvic exams are still needed.

The following methods are those most commonly used to perform endometrial ablation:

• Radiofrequency — A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it.
• Freezing — A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.
• Heated fluid — Fluid is inserted into the uterus through a hysteroscope, a slender, light-transmitting device. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
• Heated balloon — A balloon is placed in the uterus with a hysteroscope. Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
• Microwave energy — A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
• Electrosurgery — Electrosurgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other methods.

Some minor side effects are common after endometrial ablation:

• Cramping, like menstrual cramps, for 1–2 days
• Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
• Frequent urination for 24 hours
• Nausea

Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

Cervix: The lower, narrow end of the uterus that extends into the vagina.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick; if left untreated for a long time, it may lead to cancer.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Pelvic Exam: A manual internal and external examination of a woman’s reproductive organs.

Sterilization: An operation that prevents a woman from becoming pregnant or a man from fathering a child.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vulva: The external female genital area.

Laparoscopy is a way of doing surgery without making a large incision (cut). A thin tube known as the laparoscope is inserted into the abdomen through a small incision. The laparoscope allows your health care provider to see the pelvic organs. If a problem needs to be treated, other instruments are used. These instruments are inserted either through the laparoscope or through other small cuts in your abdomen.

Laparoscopy often is done as outpatient surgery. You usually can go home the same day, after you have recovered from the anesthesia. More complex procedures, such as laparoscopic hysterectomy, may require an overnight stay in the hospital.

Before surgery, you will be given general anesthesia that puts you to sleep and blocks the pain. Regional anesthesia instead of general anesthesia may be used. This type of anesthesia numbs the area, but you remain awake.

Your health care provider will make a small incision in your navel and insert the laparoscope. During the procedure, the abdomen is filled with a gas (carbon dioxide or nitrous oxide). Filling the abdomen with gas allows the pelvic reproductive organs to be seen more clearly.

The laparoscope shows the pelvic organs on a screen. Other incisions may be made in the abdomen for surgical instruments. These incisions usually are no more than one half an inch long. Another instrument, called a uterine manipulator, may be inserted through the cervix and into the uterus. This instrument is used to move the organs into view.

If you had general anesthesia, you will wake up in the recovery room. You will feel sleepy for a few hours. You may have some nausea from the anesthesia. If you have had an outpatient procedure, you must have someone drive you home.

For a few days after the procedure, you may feel tired and have some discomfort. You may be sore around the incisions made in your abdomen and navel. Sometimes, the tube put in your throat to help you breathe during the surgery may give you a sore throat for a few days. If so, try throat lozenges or gargle with warm salt water. You may feel pain in your shoulder or back. This pain is from the gas used during the procedure. It goes away on its own within hours or a day or two. If pain and nausea do not go away after a few days or become worse, you should contact your health care provider.

Your health care provider will let you know when you can get back to your normal activities. For minor procedures, it is often 1–2 days after the surgery. For more complex procedures, it can take longer. You may be told to avoid heavy activity or exercise.

As with any surgery, there is a small risk of problems with laparoscopy. These risks include:

• Bleeding or hernia in the incision sites
• Internal bleeding
• Infection
• Injury to internal organs
• Problems caused by anesthesia

Sometimes the problems do not appear right away. The risk that a problem will occur is related to the type of surgery that  is performed. The more complex the surgery, the greater the risk. Be sure to ask your health care provider about the risks associated with your specific surgery. There also may be other ways to treat your condition besides surgery, such as medications.

In some cases, the surgeon decides that a laparoscopy cannot be done during the surgery. An abdominal incision is made instead. If this happens, you may need to stay in the hospital for a day or two. Your recovery also will take longer.

Laparoscopy has many benefits. There is less pain after laparoscopic surgery than with open abdominal surgery, which involves larger incisions, longer hospital stays, and a longer recovery. The risk of infection also is lower. You will be able to recover from laparoscopic surgery faster than from open abdominal surgery. It can be done as outpatient surgery, so you usually will not have to spend the night in the hospital. The smaller incisions that are used allow you to heal faster and have smaller scars.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Regional Anesthesia: The use of drugs to block sensation in certain areas of the body.

D&C is a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage).

D&C is used to diagnose and treat many conditions that affect the uterus, such as abnormal bleeding. A D&C also may be done after a miscarriage. A sample of tissue from inside the uterus can be viewed under a microscope to tell whether any cells are abnormal. A D&C may be done with other procedures, such as hysteroscopy, in which a slender device is used to view the inside of the uterus.

A D&C can be done in a health care provider’s office, a surgery center, or a hospital.

Your health care provider may want to start dilating your cervix before surgery using laminaria. This is a slender rod of natural or synthetic material that is inserted into the cervix. It is left in place for several hours. The rod absorbs fluid from the cervix and expands. This causes the cervix to open. Medication also may be used to soften the cervix, making it easier to dilate. You also may receive some type of anesthesia before or during your D&C.

During the procedure, you will lie on your back and your legs will be placed in stirrups. A speculum will be inserted into your vagina. The cervix will be held in place with a special instrument.

The cervix will then be slowly dilated. This is done by inserting a series of slender rods that become progressively larger through the cervical opening. Usually only a small amount of dilation is needed (less than one half inch in diameter).

Tissue lining the uterus will be removed, either with an instrument called a curette or with suction. In most cases, the tissue will be sent to a laboratory for examination.

Complications include bleeding, infection, or perforation of the uterus (when the tip of an instrument passes through the wall of the uterus). Problems related to the anesthesia used also can occur. These complications are rare.

After the procedure, you probably will be able to go home within a few hours. You will need someone to take you home. You should be able to resume most of your regular activities in 1 or 2 days. Pain after a D&C usually is mild. You may have spotting or light bleeding.

You should contact your health care provider if you have any of the following:

• Heavy bleeding from the vagina
• Fever
• Pain in the abdomen
• Foul-smelling discharge from the vagina

After a D&C, a new lining will build up in the uterus. Your next menstrual period may not occur at the regular time. It may be early or late.

Until your cervix returns to its normal size, 

bacteria from the vagina can enter the uterus and cause infection. It is important not to put anything into your vagina after the procedure. Ask your health care provider when you can have sex or use tampons again.

Adhesions: Scarring that binds together the surfaces of tissues.

Anesthesia: Relief of pain by loss of sensation.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervix: The opening of the uterus at the top of the vagina.

Hysteroscopy: A procedure in which a device called a hysteroscope is inserted through the cervix and vagina into the uterus. The hysteroscope is used to view the inside of the uterus or perform surgery.

Laminaria: A slender rod made of natural or synthetic material that expands when it absorbs water; it is inserted into the opening of the cervix to widen it.

Miscarriage: Early pregnancy loss.

Speculum: An instrument used to hold open the walls of the vagina.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

If you have an abnormal Pap test result, your health care provider may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment (see the FAQ The Pap Test). LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the cervix.

A LEEP should be done when you are not having your menstrual period to give a better view of the cervix. In most cases, LEEP is done in a health care provider’s office. The procedure only takes a few minutes.

During the procedure you will lie on your back and place your legs in stirrups. The health care provider then will insert   a speculum into your vagina in the same way as for a pelvic exam. Local anesthesia will be used to prevent pain. It is given through a needle attached to a syringe. You may feel a slight sting, then a dull ache or cramp. The loop is inserted into the vagina to the cervix. There are different sizes and shapes of loops that can be used. You may feel faint during the procedure. If you feel faint, tell your health care provider immediately.

After the procedure, a special paste may be applied to your cervix to stop any bleeding. Electrocautery also may be used to control bleeding. The tissue that is removed will be studied in a lab to confirm the diagnosis.

The most common risk in the first 3 weeks after a LEEP is heavy bleeding. If you have heavy bleeding, contact your health care provider. You may need to have more of the paste applied to the cervix to stop it.

LEEP has been associated with an increased risk of future pregnancy problems. Although most women have no problems, there is a small increase in the risk of premature births and having a low birth weight baby. In rare cases, the cervix is narrowed after the procedure. This narrowing may cause problems with menstruation. It also may make it difficult to become pregnant.

After the procedure, you may have

• a watery, pinkish discharge
• mild cramping
• a brownish-black discharge (from the paste used)

It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have intercourse. Your health care provider will tell you when it is safe to do so.

You should contact your health care provider if you have any of the following problems:

• Heavy bleeding (more than your normal period)
• Bleeding with clots
• Severe abdominal pain

After the procedure, you will need to see your health care provider for follow-up visits. You will have Pap tests to be sure that all of the abnormal cells are gone and that they have not returned. You most likely will have a Pap test every 6 months until you have three normal results. If you have another abnormal Pap test result, you may need more treatment.

You can help protect the health of your cervix by following these guidelines:

• Have regular pelvic exams and Pap tests.
• Stop smoking—smoking increases your risk of cancer of the cervix.
• Limit your number of sexual partners and use condoms to reduce your risk of sexually transmitted diseases.

Cervix: The opening of the uterus at the top of the vagina.

Electrocautery: A procedure in which an instrument works with electric current to destroy tissue.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Speculum: An instrument used to hold apart the walls of the vagina so that the cervix can be seen.

Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

• Disorders of the uterus or endometrium
• Endometrial hyperplasia
• Cancer of the uterus
• Recent pregnancy
• Current or recent infection of the uterus

Pregnancy is not likely after ablation, but it can happen. If it does, the risk of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.

A woman who has had ablation still has all her reproductive organs. Routine Pap tests and pelvic exams are still needed.

Some minor side effects are common after endometrial ablation:

• Cramping, like menstrual cramps, for 1–2 days
• Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
• Frequent urination for 24 hours
• Nausea

Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

Cervix: The lower, narrow end of the uterus that extends into the vagina.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick; if left untreated for a long time, it may lead to cancer.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Pelvic Exam: A manual internal and external examination of a woman’s reproductive organs.

Sterilization: An operation that prevents a woman from becoming pregnant or a man from fathering a child.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vulva: The external female genital area.