Hysterectomy is surgical removal of uterus. However, even though it is about removing the uterus, the operation may involve also the removal of the cervix, ovaries and the fallopian tubes (Pic. 1). Depending on the reason of the operation, the extensity of the operation and removal is set.

Hysterectomy may be made due to several reasons. It includes from heavy or irregular menstruation periods, through severe chronic pains as the result of adenomyosis (inner lining of the uterus grows into uterus muscle) or endometriosis (inner lining of the uterus grows outside and cause pain and bleeding), uterine prolapse (when uterus drops through the cervix and protrudes from the vagina) until uterine fibroids (non-cancerous growths within the muscular walls of the uterus, outside the uterus and within the uterine cavity) and several types of cancer (cervical, uterine, ovarian, fallopian tube cancer).  After the procedure of hysterectomy, the woman has no longer the menstrual period or is able to have a child in natural way. 

The different types of hysterectomy

Usually, hysterectomy is classified into 5 types:

  • total hysterectomy – the entire uterus, including the cervix is removed.
  • subtotal hysterectomy – only the upper part of uterus is removed, the cervix is left on the place, connected to the top of the vagina. Cervix is seen as a potential cancer site (cervical cancer). If there is suspicion to cervical cancer, the cervix ought to be removed during the hysterectomy (reference to total hysterectomy). There is also good reason to remove also the cervix in case of uterine cancer, as the cancer can spread down the body. If there is no need to remove cervix from this point of view, some women feel the cervix is part of their sexual enjoyment, and its removal may diminished sexual pleasure. If the cervix is kept, regular Pap test (Papanicolaou test - the method of cervical screening to detect potentially pre-cancerous and cancerous processes) is still necessary.
  • hysterecotmy with prophylactic bilateral salpingectomy – uterus and fallopian tubes are removed.
  • hysterectomy and bilateral salpingo-oophorectomy – the uterus is removed as well as the fallopian tubes and ovaries. This procedure is performed in case of the ovarian or uterine cancer, due to pelvic infections or recurrent endometriosis 
  • radical hysterectomy – involves the removal of uterus, fallopian tubes, ovaries, cervix and upper part of the vagina. It is the most extensive type of the operation and it is performed in case of cancer of any of mentioned organ depending also on the cancer stage.

Hysterectomy may be performed by three main techniques: 

  1. abdominal hysterectomy – the type of hysterectomy is performed via a horizontal incision (cut) in lower abdomen.
  2. laparoscopic hysterectomy – the telescope and three or four instruments are inserted through small incision around the navel and lower abdomen and uterus (with or without the fallopian tubes and ovaries) is removed through the vagina (Pic. 2). 
  3. vaginal hysterectomy – this technique is performed by an incision at the top of vagina. Usually this technique is used when there is uterine prolapsed (slipping down of the uterus into the vagina due to weak pelvic floor muscles).

In case of uterine prolapse, pelvic floor exercises, insertion of a pesary into the vagina to support the uterus or surgical procedures without hysterectomy are also possible solutions. 

Associated diseases

  • heavy bleeding at menstruation periods
  • uterine prolapse
  • endometriosis
  • uterine, cervical, ovarian cancer or the cancer of fallopian tubes
  • adenomyosis uterine fibroids


  • infertility
  • amenorrhoea (the absence of menstrual period)
  • hormonal imblanaces when the ovaries are removed as well

Risk factors

  • heavy bleeding
  • irregular menstruation periods
  • hormonal imbalance (estrogen level dominance)
  • chronic pain 
  • infections 
  • injury of surrounding organs 
  • vaginal prolapse (part of the vagina coming out of body)
  • uterine cancer
  • uterine leiomyosarcomas (smooth muscle tumor arising from the muscular part of the uterus)
  • abnormal heavy bleeding (or other complication) during caesarian section delivery

Uterus is main part of female reproductive system and place in the body, where the embryo and baby develop after the conceiving. Without uterus, the eggs from ovaries cannot be fertilized naturally and woman cannot conceive the baby and be pregnant.

A hormonal birth control or an intrauterine device may successfully treat endometriosis and heavy vaginal bleeding the causes of possible hysterectomy in future. These options might also allow controlling the symptoms of uterine fibroids (causes of heavy bleeding).

In case of uterine prolapse, pelvic floor exercises to strengthen the muscles are also beneficial prevention.

Symptoms may be connected to associated diseases, mostly in case, when hysterectomy is later executed. For hysterectomy, the most common reason is uterine fibroids, benign growths of the uterus. Uterine fibroids may cause excessive size of uterus, pressure or pain, bleeding or even severe anemia. Pelvic relaxation is another condition which may lead until hysterectomy. Mild relaxation may cause first degree prolapse when the cervix is on the halfway down to vagina. A woman experiences a loosening of the support muscles and tissues in the pelvic floor area.

There are several causes for hysterectomy procedure, from which heavy bleeding or pain, are the most common ones. However, there are ways how to reduce the causes and thus to avoid hysterectomy.

Heavy bleeding and painful periods may be influenced by diet. For a woman with these problems, reducing the meat and dairy products consumption is recommended as well as avoiding to drink coffee and alcohol. Besides, stress management techniques are a plus.

In addition, dietary supplements with essential fatty acids, acidophilus and bioflavonoids are seen beneficial. These supplements acts as weak natural estrogens and are able to block stronger estrogens; the estrogen dominance is the primary cause of uterine fibroids development and thus pains and heavy bleeding. Natural progesterone is also the way to correct estrogen dominance and return hormonal balance to the body.
Homeopathic medication and herbal remedies has shown to be beneficial as well to treat the problems with pains and heavy bleedings.

Correcting hormonal imbalance in general may be accomplished through a purification program, stress release, eating well and changing other lifestyle factors.

There are some methods and procedure which may be chosen to treat heavy or irregular periods, chronic pains and other problems without hysterectomy, such as hormonal therapy. In other cases of other reasons and diagnoses (uterine cancer, uterine fibroids, uterine prolapse, and more), the hysterectomy may be the first and best solution. However, when providing hysterectomy itself, there is just the surgical solution.


Hormone replacement therapy

When removing uterus surgically, a woman looses the organs producing typical feminine hormones, which are needed to replace pharmacologically.

Surgical therapy

For some of these causes, nowadays, there exist also different procedures except the hysterectomy. Hormone therapies or combined oral contraceptive pills might be the solution to treat abnormal uterine bleeding. Besides, there are the procedures of treating heavy bleeding, fibroids, endometriosis or adenomyosis:

  • hysteroscopy - a lighted instrument called hysteroscope is inserted into uterus through vagina, the biopsies may be taken and the areas of bleeding may be treated directly by laser beam or electric current (electrocautery method). 
  • endometrial ablation – minimally invasive alternative to hysterectomy. In this procedure, the inner lining of the uterus is destroyed by laser, electricity or heat. The lining of uterus heals by scaring which usually reduces or prevents the heavy bleeding. 
  • laparoscopy and endometriosis excision - the removal of endometriosis lesions which are located outside of the uterus.
  • myomectomy – surgical removal of fibroids from the uterus. 
  • uterine artery embolization (UAE) – nonsurgical treatment of fibroids by cutting of the blood supply of the fibroids which consequently shrink.

If all treatments used by conventional medicine fail, the approaches of artificial reproductive techniques are used. 

If the ovaries show the normal development and normal function, there is possibility of egg retrieval and following in vitro fertilization (IVF). IVF and ART generally start with stimulating the ovaries to increase egg production. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body.

The fertilized eggs (embryos) are cultivated under very stringent conditions and examined every day by the embryologist to evaluate their progress. The embryos are usually cultured for 3 to 5 days, before the best one(s) are selected to be put (transferred) in to the womb.

Infertile couples may also resort to egg donation or embryo donation when the female partner cannot have genetic children because her own eggs cannot generate a viable pregnancy.

However if the uterus is absent, there is necessary to place the fertilized egg into surrogate mother, if the law of the country allows to do so. Surrogacy via a gestational carrier is also an option when a patient's medical condition prevents a safe pregnancy, when a patient has ovaries but no uterus due to congenital absence or previous surgical removal, and where a patient has no ovaries and is also unable to carry a pregnancy to full term.

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