Confused enough? Exactly. So, it is best not to use these names. I prefer to clearly spell out what comes out and what remains.

Examples: We removed the uterus and left the ovaries behind. Or we removed the uterus, left the cervix (which means that you will still need to do your pap tests) and removed the ovaries as well.

This page here will talk about the 'old fashion' hysterectomy; the one that use to be the 'standard of care'. On the following page, LAVH, we talk more about 'laparoscopic hysterectomy' and its advantages. 

I greatly believe that each woman should be offered one type of the other of laparoscopic hysterectomy. 

Type of Hysterectomy

So, here, we are talking about taking the uterus out through an open cut, or incision on your abdomen (tummy). Whether we take the ovaries out or not has no effect on this discussion.

So, how do we take the uterus out? Well, the old fashioned way, is opening you tummy like what we would do for a C Section. This is medically called a 'laparotomy'.

Type of Incision

Side ways:

This has been the 'standard' way for a long time, and this is how your grandmother, mother and aunt had their uterus taken out. The thing I do not like about this (and you probably will not like it as well) is that there is usually the pain associated with the cut, the (large) scar and the 2-3 days stay in the hospital. For that type of surgery, you usually get about 6 weeks off work, although most people are OK to go back to work in about 4 weeks or so. And for that, sideways cut, (AKA Pfannensteil incision), you usually get what I call the "magic glue". In reality, there is no 'glue'. You just get a stitch that is berried under the skin, and that you usually do not need to remove. It dissolves on its own (hence feels and acts like glue). Very rarely will you get removable stitches or staples.

Did you know that you can actually ask your physician NOT to use removable stitches or staples, and request disolvable stitches?

Up and Down

If you have a large uterus (e.g. with large fibroids), or have large ovaries, or large and fast growing lesions, you will probably end up with an 'up and down' incision. This is called a 'midline' incision. The advantages of this is that it can be extended (vs the side-way cut that can only go so far) and can allow for other procedures to be added on. The example would be if you had previous bowel surgery and much scarring, and you may need bowel dissection at the same time of your hysterectomy. .

If you get a midline incision, your recovery may be a little bit longer. Well, the scar is also a little but more painful, it hurts more with breathing and walking. It also might take longer to heal. This type of entry to the abdomen may need a longer recovery time and more time to get back to normal, more around the 6 weeks mark. And with this type of incision, you are more likely to get staples. Dissolving stitches do not hold very well in up and down incisions.

Reason for Hysterectomy ( Indications)

So, why do we take the uterus out?
A long list of reasons exist of why we take the uterus out. I hope you have had a good discussion with your gynecologist about what you are complaining of, and why a hysterectomy is the best option for you. Again, make sure you are aware of the other management option for your condition.

Read here for more options for management of heavy periods.

Other Options:
Examples: If you have heavy bleeding, you can try Birth Control Pills, Mirena IUD or Ablation of the lining of the uterus, just to name a few.
For pain, again, you may try Birth Control Pills, Visanne, Mirena IUD, etc (depending on the likely cause of the pain). Your doctor will suggest these as needed.

Pelvic Pain and Hysterectomy

I do like to take a moment to pause here and reflect on hysterectomy as a treatment for pelvic pain. Well, it is usually not. If the pain is cramping, menstrual like, and associated with irregular bleeding, the uterus may be the cause of the pain, and talking it out may be a solution for that pain. But what I hate for you to go through is, you go through surgery, go through all the risks, and possible complications of a surgical intervention, go off work etc, only to end up with the same pain 3 months later. Why does this happen? because there are other causes of pain, and other organs in the pelvic can cause pain. Examples: Ovarian cysts are usually NOT painful. The colon can be the cause of the pain (especially if associated with bloating, diarrhea, constipation, etc). Muscles and ligaments are knows causes of pain as well. Bladder pain (e.g. Interstitial cystitis) is a known cause of pelvic pain in women. 

So, what I am trying to say is, make sure that you have a proper evaluation, and make sure other causes of pain have been rule out.

Ovarian Cysts and Hysterectomy

Ovarian cysts are not a routine cause of taking the uterus out. Actually, most, if not all women have ovarian cysts. You have a cyst on your right ovary, repeat the ultrasound a few weeks later, it is gone, only to repeat the ultrasound a month later to find the cyst is now popping up on the left side. This is an all too common a story, with all the anxiety and frustration that come with cysts that keep coming back. Well, this is perfectly normal, actually,  and I would be worried if you have not had these 'cysts'. They are better called 'eggs'. This is how women ovulate. This is how women get pregnant. Very rarely are these cyst painful, although, sometimes at the time of actual ovulation (when they actually burst open to release the egg), they may be associated with sharp pain, that might even take you to emerge. More often than not, that pain will last anything from half a day to 2-3 days maximum. But this is rare. 
And by the way, the treatment for that is, again, Birth Control Pills, not surgery.

Endometriosis and Hysterectomy

If you have 'endo' or 'endometriosis' this is a different story. You will need to try different forms of medications, pills, shots, etc. before you need surgery. When you actually do need surgery, this may be for diagnosis (confirm it is actually endo) or for treatment (burning of the endo spots). A hysterectomy for endometriosis is a last resort after many other medical and more conservative surgical approaches have failed to treat the pain.

So, you need a hysterectomy:

Now that you have had enough time to talk to your doctor, and had all reasons and options checked out, and a decision is made to take your uterus out, this is when you need a hysterectomy.

What will come out?

The next question will be: what will we take out? The cervix usually comes out as part of the uterus. In the past, it used to be left behind for a variety of presumptive reasons. Studies have not shown any advantage (or difference) between leaving the cervix and taking it out. For the sake of not leaving an organ that can cause problems in the future, and given the fact that we do not know of any value for the cervix other in pregnancy and childbirth, the consensus is to take it out. If you have it taken out, you will not need to do any more pap tests. Note: if you have seen a gynecologist for colposcopy for abnormal pap in the past, had ccryo,laser or LEEP to your cervix, have a discussion with your gynecologist: you may need a pap test of the vagina every 3 years or so (even after removing your cervix).

What about the ovaries? Actually, the ovaries are a separate organ that does have its own functions separate from the uterus. While they do produce the eggs you need to get pregnant, they more importantly, at all other times, produce the female hormones that keep women, well, feminine. They start working at the time of puberty, when the child starts turning into a mature woman, in shape, form and mind. They keep on working till about the age of menopause. This is usually about age 50-52 or so. After that, the ovaries work less and less, and women get their hormones from other sources (mainly actually, from their fat!). So, if you are about this age, taking the ovaries out might make sense. Like the cervix, if we leave them behind, we leave an organ that has no useful function, but can be a source of problems in the future.

If you are younger, much younger, taking the ovaries out would be a bad idea. First, you will get very strong bad and sudden menopause. You get very frequent night sweats, hot flashes, mood swings, sleeplessness, irritability, and the list goes on. You lose your skin vitality, hair, and start the body changes of menopause at your young age. These symptoms can be treated by using hormones (like HRT, or like Birth Control Pills), but you cannot use them if you have a few medical conditions, smoking being a contra indication.

If you are young, you need your ovaries. Do talk to your doctor about the options and rational of what you agree to.

The Tubes:

There is a recent trend of removing your tubes, even if you leave your ovaries. Again, have a discussion with your gynecologist about the reason behind this, risks, benefits, etc.

How to take the uterus out
Now that we agreed on the need to take your uterus out, comes the question: how will we take it out.
The old way was through open surgery, like a C section cut.
An alternate ways, is through the vagina. This usually is the case when the uterus 'prolapsed' or falling out of the vagina. This is typically associated with a vaginal repair procedure to reconstruct and tighten the vagina back to its normal functional length and depth.

The new way now, is through scopes.

You may read a few different names here: TLH (Total Laparoscopic Hysterectomy) LH (Laparoscopic Hysterectomy) LAVH (Laparoscopic Assisted Vaginal Hysterectomy). To any of these, you may find some other names: BSO, RSO or LSO, etc. These are add-ons and describe whether we are also removing one to two ovaries and or the tubes. 

To you, the patient, the differences between these procedure is academic. It does not matter much which one of them is performed as long as you have ANY one of them performed. They are all within taking the uterus our with the open cut. 

Please read our next page, LAVH. This will talk more about the procedure as we recommend it. 



What is a hysterectomy


A hysterectomy is the surgical procedure by which we remove a diseased uterus, or one that is giving the woman unacceptable pain or bleeding.The surgery traditionally was done through a cut in the abdomen, like a C section cut. Rarely, when the uterus was falling down (prolapse), it was removed from down below.

There are many names that are used to describe a hysterectomy: total, partial, subtotal, total or  complete. There is a problem with this naming system. Physicians and patients use them to mean different things. Patients usually call it partial when the ovaries are left behind and complete when the ovaries are removed. Physicians call it total when the uterus its taken out complete with the cervix.