Hysterectomy:

Hysterectomy, the surgical removal of the uterus, is the second most frequently performed surgery in premenopausal women (Cesarean sections are first). Endometriosis accounts for a significant percentage of these procedures. Hysterectomy, however, does not necessarily cure endometriosis.

A woman cannot become pregnant after having a hysterectomy. Women should realize that hysterectomy causes immediate menopause if the ovaries are removed.

[For more information, see In-Depth Report #73: Uterine fibroids and hysterectomy.]

Types of Hysterectomies

Once a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed. The common choices are:

• Total Hysterectomy (Removal of uterus and cervix). Removing only the uterus with hysterectomy has the same risk for recurrence as conservative surgery. Subtotal hysterectomy involves removing the uterus but keeping the cervix intact.
• Bilateral Oophorectomy (Removal of both ovaries) or Bilateral Salpingo-Oophorectomy (Removal of the fallopian tubes and ovaries). For endometriosis treatment, removal of the ovaries is often performed in combination with hysterectomy. This is the only potential cure for endometriosis. If endometriosis has developed outside the uterus then even ovary removal procedures are not curative.

Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A hysterectomy may be done through an abdominal or a vaginal incision.

Removal of the ovaries (oophorectomy) along with hysterectomy significantly reduces the likelihood that endometriosis will recur. However, there is still a small chance that recurrence can happen.

Types of Hysterectomy Procedures

Hysterectomies may be performed abdominally (through an incision in the abdomen) or vaginally (through a vaginal incision). A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy (LAVH). There are other laparoscopic approaches as well.

Recovery times for vaginal hysterectomy and LAVH are shorter than those for abdominal hysterectomy. However, hospital stays may be longer with LAVH than standard vaginal hysterectomy. It is not clear whether LAVH adds any significant benefits compared to the standard vaginal procedure. Abdominal hysterectomy is still the most commonly performed procedure.

After Hysterectomy

After hysterectomy, women may have hot flashes, a symptom of menopause, even if they retain their ovaries. However, women who have a hysterectomy are less likely to have hot flashes than women who have a natural menopause.

If both ovaries have been removed in premenopausal women, the procedure causes premature menopause. Other menopausal symptoms include vaginal dryness and irritation, insomnia, and weight gain.

If hormone replacement therapy (HRT) is recommended after hysterectomy and ovary removal, it is given as estrogen-only replacement therapy (ERT). (Women without ovaries do not need to take combination estrogen-progesterone HRT.) Estrogen-replacement therapy carries certain risks, including stroke and possible increased risk of breast cancer. [For more information, see In-Depth Report #40: Menopause.]

After a total hysterectomy, in which the cervix has been removed, a woman does not need annual Pap smears of the cervix. However, she still should get regular pelvic and breast exams.