Hysterectomy (removal of the uterus, uterine excision) is one of the most common procedures in gynecology. For certain conditions, there are alternatives to this surgery. In contrast, uterine cancer usually requires a radical removal of the uterus (total hysterectomy). Here you will find further information as well as selected specialists and centers to learn more about the benefits and risks, alternative treatment options, and potential complications.
A hysterectomy is performed for both benign and malignant gynecological conditions. The most common reasons for this surgery include:
Location and size of the uterus in the female body © SciePro | AdobeStock
Most fibroids only require surgery if they cause symptoms, such as:
In cases of pelvic or lower abdominal pain, the exact cause must be clarified before surgery to ensure the procedure will address the problem.
A hysterectomy is not always necessary. For uterine fibroids, there are uterus-preserving therapies such as:
Women are often faced with the decision to live with mild symptoms or undergo hysterectomy. Before deciding on a radical (total) hysterectomy, patients should receive thorough counseling from their gynecologist.
The reason for the hysterectomy determines which surgical approach will be chosen.
One option is the subtotal hysterectomy (also called supracervical hysterectomy), in which only the uterine body is removed while the cervix remains.
A total hysterectomy removes both the uterus and cervix, and is the most common form of the procedure.
A radical hysterectomy is performed in cases of cervical cancer and involves removal of:
For malignant conditions, removal of lymph nodes in the pelvis and along the aorta may be necessary. In some cases, ovaries and fallopian tubes are also removed. For benign conditions, this is decided individually.
There are four main approaches to hysterectomy:
The surgical approach is chosen by the gynecologist based on the disease, uterine size, and in consultation with the patient.
Abdominal hysterectomy is performed through an incision in the abdominal wall, offering:
While abdominal hysterectomy was once more common, today less invasive methods are preferred, allowing quicker recovery and earlier hospital discharge.
Anatomy of the uterus © bilderzwerg | AdobeStock
With vaginal hysterectomy, the uterus is removed through the vagina. This is possible when the uterus is not too large. Benefits include:
For benign conditions, laparoscopically assisted vaginal hysterectomy (LAVH) is increasingly used, combining laparoscopy with a vaginal approach. This requires only small incisions in the abdomen.
Total laparoscopic hysterectomy (TLH) removes the entire uterus via laparoscopy, while laparoscopic supracervical hysterectomy (LASH) preserves the cervix.
Worldwide, the number of subtotal hysterectomies for benign disease is rising. However, disadvantages include up to 20% risk of persistent cyclic bleeding and a 2–5% chance of requiring later cervical removal.
Advantages include faster recovery. Suggested benefits such as reduced risk of prolapse, incontinence, or improved sexual function have not been proven.
The most significant permanent effect is loss of fertility. Pregnancy is no longer possible, so future childbearing plans should be discussed before surgery.
If the cervix and ovaries are also removed, menstruation will no longer occur.
If you have questions or need support, please consult a physician.
Hysterectomy is performed by specialists in gynecology and obstetrics.
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