12 Frequently Asked Questions About Hysterectomy, Answered

ByThe PartialHysterectomy.net Editor

If a hysterectomy has been suggested to you, you probably have a long list of questions. This page answers the 12 we hear most often, in plain language and with sources at the end. Each answer is short on purpose: where a topic needs more space, we link to a full guide.

Every situation is different, so use these answers to prepare for a conversation with your gynecologist, not to replace it. Our checklist of questions to ask before a hysterectomy can help you get the most out of that appointment.

1. What is a hysterectomy, and what are the different types?

A hysterectomy is an operation to remove the uterus (womb). The main types differ in how much is removed:[1][2]

Advertisement
  • Total hysterectomy: the uterus and the cervix are removed. This is the most common type.
  • Supracervical (subtotal) hysterectomy: the upper part of the uterus is removed and the cervix is left in place.
  • Radical hysterectomy: the uterus, cervix, the upper part of the vagina and the tissue around the cervix are removed. It is used mainly for cervical cancer.

Removing the ovaries (oophorectomy) or the fallopian tubes (salpingectomy) is a separate decision that can be made with any of these types (see question 5). In everyday speech, “partial hysterectomy” can mean a supracervical hysterectomy or a hysterectomy that keeps the ovaries, so it is worth asking your surgeon exactly what will be removed. Our guides explain what a partial hysterectomy is and how partial and total hysterectomy compare.

Labeled illustration of the female body showing the main organs, including the thyroid, lungs, heart, liver, stomach, intestines, bladder and the female reproductive system in the pelvis
The uterus sits low in the pelvis, between the bladder in front and the bowel behind. That is why a hysterectomy carries a small risk of injury to these neighboring organs.

2. Why do doctors recommend a hysterectomy?

Most hysterectomies are done for conditions that are not cancer. The most common reasons are:[1]

  • Uterine fibroids that cause heavy bleeding, pain or pressure
  • Heavy or irregular bleeding that other treatments have not controlled
  • Adenomyosis or severe endometriosis
  • Uterine prolapse (the uterus dropping into the vagina)
  • Long-term pelvic pain linked to the uterus
  • Cancer of the uterus, cervix or ovaries, or some precancerous changes

For cancer, a hysterectomy is often the main treatment. For the other conditions, it is usually one option among several. Read more about the signs and reasons you might need a hysterectomy.

3. Are there alternatives to a hysterectomy?

Often, yes. Many of the conditions above can first be treated with medicines or with smaller procedures.[1] Depending on the problem, options may include hormonal treatments, a hormonal IUD, endometrial ablation for heavy bleeding, uterine fibroid embolization, a myomectomy (removing fibroids and keeping the uterus) or a pessary for prolapse.

A hysterectomy is permanent and ends the possibility of pregnancy, so it makes sense to ask which alternatives fit your situation, and why your doctor does or does not recommend them. If fibroids are the reason, see how myomectomy and hysterectomy compare.

4. How is a hysterectomy done?

There are four main approaches:[1][4]

  • Vaginal: the uterus is removed through the vagina, with no cuts on the abdomen.
  • Laparoscopic (keyhole): the surgeon works through a few small cuts in the abdomen, using a camera and long, thin instruments.
  • Robotic-assisted: a type of laparoscopic surgery in which the surgeon controls the instruments from a console.
  • Abdominal (open): the uterus is removed through one larger cut in the lower abdomen.

For non-cancerous conditions, the American College of Obstetricians and Gynecologists (ACOG) recommends a vaginal or laparoscopic approach whenever it is possible, because recovery is usually faster than after open surgery.[3] A large Cochrane review found, for example, that people went back to normal activities sooner after a vaginal hysterectomy than after an abdominal one.[4] Open surgery is still the right choice in some cases, such as a very large uterus or certain cancers. Learn more about laparoscopic hysterectomy and robotic hysterectomy.

5. Will my ovaries be removed?

Not automatically. A hysterectomy removes the uterus; the ovaries are only removed if you and your surgeon decide to. For people who have not reached menopause and do not have a higher inherited risk of ovarian cancer (for example, a BRCA gene change), ACOG advises strong consideration of keeping normal ovaries, because they keep making hormones that protect the heart and bones.[5]

Many surgeons now also offer to remove the fallopian tubes while keeping the ovaries. This is called an opportunistic salpingectomy, and ACOG supports discussing it because many ovarian cancers are thought to start in the tubes.[6] Ask your surgeon before the operation what will be removed and why, and make sure the consent form matches what you agreed.

6. Will a hysterectomy put me into menopause?

It depends on your ovaries:

  • If both ovaries are removed before menopause, menopause starts straight away. This is called surgical menopause, and symptoms such as hot flashes can be sudden and strong.[1]
  • If you keep your ovaries, they keep working and you reach menopause naturally. However, one study that followed women for up to five years found that those who had a hysterectomy were nearly twice as likely to reach ovarian failure early as women of the same age who had not.[7]
  • If you were already past menopause, the operation does not change your menopause status.

7. Will I need hormone replacement therapy (HRT)?

Not everyone does. If you keep your ovaries, you usually do not need HRT because of the surgery. If your ovaries are removed before the usual age of menopause, The Menopause Society (formerly NAMS) recommends hormone therapy until about the average age of natural menopause, unless there is a medical reason not to take it, because it helps protect the bones and heart as well as easing symptoms.[8]

Without a uterus, most people can take estrogen on its own. A progestogen is normally added only to protect the lining of the uterus, so it is usually not needed after a hysterectomy.[8] Estrogen comes as tablets, patches, gels and sprays, and low-dose vaginal estrogen can help with dryness. Your doctor will weigh the benefits and risks for you, especially if you have had a hormone-sensitive cancer or blood clots.

8. Will I still have periods?

After a total hysterectomy, no. Periods come from the lining of the uterus, so once the uterus is gone there is nothing to shed.

Advertisement

After a supracervical hysterectomy, a small number of people still have light monthly bleeding, because some lining can remain in the cervix. In a Cochrane review of randomized trials, ongoing cyclical bleeding was much more common after a supracervical hysterectomy than after a total one.[2] If you keep your ovaries, your hormones keep cycling, so you may still notice monthly changes such as breast tenderness or mood swings even without bleeding.

Some light bleeding or discharge in the first weeks after surgery is normal while you heal. Heavy bleeding, clots or a bad-smelling discharge are not, and need a call to your doctor.[9]

9. Can I get pregnant or have children after a hysterectomy?

You cannot carry a pregnancy after any type of hysterectomy, including a supracervical one, because the uterus is where a pregnancy grows. Pregnancy after hysterectomy is limited to extremely rare case reports of ectopic pregnancy, which is a medical emergency.

If you keep at least one ovary, you may still be able to have a genetic child through IVF, using your own eggs and a gestational carrier (surrogate). If your ovaries are removed, donor eggs and a gestational carrier are the main options. If you might want children in the future, raise this before surgery: it may change which treatment is best for you, or you may want to freeze eggs or embryos first.

10. How long does recovery take?

It depends mostly on how the operation is done. Average recovery times are:[1][9]

  • Laparoscopic or robotic: about 2 to 4 weeks
  • Vaginal: about 3 to 4 weeks
  • Abdominal (open): about 4 to 8 weeks

After a vaginal or laparoscopic hysterectomy many people leave the hospital within 1 to 4 days; after open surgery the stay is usually longer.[9] Tiredness often lasts longer than the pain. Walking from the first days helps recovery and lowers the risk of blood clots. Your surgeon will tell you when you can drive, lift heavier things and go back to work. Our week-by-week recovery guide covers what to expect in more detail.

11. What are the risks, and when should I call my doctor?

Hysterectomy is a common and generally safe operation, but like any major surgery it has risks. The main ones are:[1][10]

  • Bleeding during or after surgery
  • Infection of the wound, bladder or inside the pelvis
  • Blood clots in the legs or lungs
  • Injury to the bladder, the ureters (the tubes from the kidneys to the bladder) or the bowel, which is rare
  • Reactions to the anesthetic
  • Early menopause, if the ovaries are removed or stop working sooner

Your own risk depends on your health, your weight, any previous surgery and the approach used, so ask your surgeon to explain it. After you go home, contact your doctor straight away if you have:[9]

  • Heavy vaginal bleeding or blood clots
  • A strong-smelling vaginal discharge
  • A fever, or a wound that becomes red, hot, swollen or starts to leak
  • Pain that gets worse instead of better
  • Pain or difficulty passing urine

Call 911 if you have chest pain, sudden shortness of breath, or you are coughing up blood, as these can be signs of a blood clot in the lungs.

12. Will my sex life change?

For most people, sex stays the same or gets better, often because the pain or heavy bleeding that led to surgery is gone. A review of the research found that most women had unchanged or improved sexual function after a hysterectomy for a non-cancerous condition, while a minority reported problems.[11] The same review found no proven sexual benefit from keeping the cervix.

You will need to wait until the inside has healed and any discharge has stopped, which usually takes at least 4 to 6 weeks; your surgeon will tell you when it is safe.[9] If your ovaries are removed, lower hormone levels can cause vaginal dryness or lower desire, and lubricants, vaginal estrogen or HRT can help.[1] Pain during sex is not something you have to put up with: tell your doctor. For more, see our guide to rediscovering pleasure after a hysterectomy.

More practical questions

Do I still need Pap smears?

If you had a total hysterectomy for a non-cancerous reason and have never had high-grade cervical precancer or cervical cancer, US guidelines say you no longer need cervical screening.[12] If you kept your cervix, keep having routine screening. If the hysterectomy was for cancer or precancer, ask your doctor what follow-up tests you need. Read more about hysterectomy for cervical cancer.

How much does a hysterectomy cost?

The price varies widely with the type of surgery, the hospital, where you live and your insurance. Our guide on how to afford a hysterectomy explains typical costs and what to ask your insurer.

What is the ICD-10 code for a past hysterectomy?

You may see these codes on medical records or insurance forms. In the US ICD-10-CM system, the codes for having had part or all of the uterus or cervix removed are:[13]

  • Z90.710: acquired absence of both cervix and uterus (after a total hysterectomy)
  • Z90.711: acquired absence of uterus with remaining cervical stump (after a supracervical hysterectomy)
  • Z90.712: acquired absence of cervix with remaining uterus

Coding questions about a specific bill are best answered by your doctor’s billing office or your insurer.

Advertisement

Sources

  1. MedlinePlus Medical Encyclopedia. Hysterectomy. US National Library of Medicine. medlineplus.gov
  2. Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database of Systematic Reviews. 2012;(4):CD004993. pubmed.ncbi.nlm.nih.gov
  3. American College of Obstetricians and Gynecologists. Committee Opinion No. 701: Choosing the route of hysterectomy for benign disease. Obstetrics & Gynecology. 2017;129(6):e155–e159. pubmed.ncbi.nlm.nih.gov
  4. Pickett CM, Seeratan DD, Mol BWJ, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. 2023;(8):CD003677. pubmed.ncbi.nlm.nih.gov
  5. American College of Obstetricians and Gynecologists. Practice Bulletin No. 89: Elective and risk-reducing salpingo-oophorectomy. Obstetrics & Gynecology. 2008;111(1):231–241. pubmed.ncbi.nlm.nih.gov
  6. American College of Obstetricians and Gynecologists. Committee Opinion No. 774: Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention. Obstetrics & Gynecology. 2019;133(4):e279–e284. pubmed.ncbi.nlm.nih.gov
  7. Moorman PG, Myers ER, Schildkraut JM, et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics & Gynecology. 2011;118(6):1271–1279. pubmed.ncbi.nlm.nih.gov
  8. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. pubmed.ncbi.nlm.nih.gov
  9. NHS. Hysterectomy: recovery. nhs.uk
  10. NHS. Hysterectomy: risks. nhs.uk
  11. Thakar R. Is the uterus a sexual organ? Sexual function following hysterectomy. Sexual Medicine Reviews. 2015;3(4):264–278. pubmed.ncbi.nlm.nih.gov
  12. US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674–686. pubmed.ncbi.nlm.nih.gov
  13. Centers for Disease Control and Prevention, National Center for Health Statistics. ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification). cdc.gov

This article is for general information and is not a substitute for medical advice. Every hysterectomy decision depends on your diagnosis, health and plans for the future, so always discuss your own situation with your gynecologist or doctor, and contact them or emergency services if you are worried about any symptom.

Similar Posts