Hysterectomy

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Overview

Hysterectomy is a surgical operation to remove the uterus (womb). It may also include removing other parts of the female reproductive system such as the cervix, ovaries, and fallopian tubes.

Following hysterectomy, menstruation (menstrual periods) stops and the woman is no longer able to have a baby. In women who have not reached menopause, removal of the ovaries causes early menopause.

Indications

Hysterectomy is performed for one of several reasons, including the following:

• Fibroids: These are benign tumors that grow inside the uterus. Fibroids can cause persistent bleeding, anemia, pelvic pain, and/or bladder pressure.
  
• Endometriosis: This is a condition in which uterine tissue grows outside the uterus—on the ovaries, fallopian tubes, or elsewhere in the body. Endometriosis can cause painful menstrual periods and/or heavy bleeding, and can sometimes cause infertility.
  
• Uterine prolapse: If the ligaments and tissues supporting the uterus become weakened, the uterus can slip down into the vagina. Uterine prolapse can lead to urinary incontinence, a feeling of pelvic pressure, or difficulty with bowel movements.
  
• Gynecologic cancer: Hysterectomy is often part of treatment for cancer of the uterus, cervix, ovaries, and/or fallopian tubes.
  
• Persistent vaginal bleeding: Heavy, irregular periods that consistently last longer than 5-7 days may be treated with hysterectomy when other treatments are ineffective.
  
• Chronic pelvic pain: In some cases, no cause is found for this condition. Hysterectomy may be performed as a last resort when other treatments have failed.
  

Incidence and Prevalence

Hysterectomy is the second-most-common abdominal surgery among women in the United States. Over 600,000 hysterectomies are performed every year, and one in three women has a hysterectomy by the age of 60. The United States has the highest hysterectomy rate in the world.

About 90% of the hysterectomies performed each year are classified as "elective" surgery (i.e., surgery done by choice and not as a lifesaving measure). Women and doctors are beginning to question whether hysterectomy is the best solution to many gynecologic conditions, and are seeking alternatives that avoid the drastic and irreversible consequences of the procedure. As these alternative therapies are developed and explored, the number of hysterectomies performed is beginning to decline.

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