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There are different types of hysterectomies:

• Total hysterectomy. Your uterus and cervix are removed; your ovaries and fallopian tubes remain.
• Supracervical hysterectomy. Only your uterus is removed; your cervix, fallopian tubes, and ovaries remain. (This used to be called partial or subtotal hysterectomy.)
• Hysterectomy with bilateral salpingo-oophorectomy (BSO). Your ovaries and fallopian tubes are removed as well as your uterus. You may experience symptoms of menopause after this surgery.

Why It Is Done

A hysterectomy can be a solution for a variety of medical conditions. Common reasons a woman may have a hysterectomy include:

• Abnormal vaginal bleeding. May conditions can cause abnormal vaginal bleeding, including polyps, fibroids, infection, precancer/cancer, or hormonal imbalances. Hysterectomy might be a solution if other treatments have not been effective. 
• Fibroids.  Benign (noncancerous) growths are called fibroids. They can result in heavy, irregular bleeding, as well as pain and pressure.
• Uterine prolapse. When the uterus is not well supported by your pelvic muscles, it may descend into the vagina. This is called uterine prolapse and can cause urinary problems, the sensation of a bulge or pressure in the vagina, or pain during sex.
• Pelvic pain. If you have chronic pain in your pelvic area, a hysterectomy may help if other treatments have not been effective. Sometimes, removal of the ovaries is beneficial in the treatment of pelvic pain.
• Adenomyosis or endometriosis. This chronic disease can result when tissue similar to the lining of the uterus is found growing in other parts of the abdominal cavity. These conditions can cause pelvic pain.
• Gynecologic cancer. Some cancerous and precancerous changes in your reproductive system are best treated with a hysterectomy.

For many of these conditions, a hysterectomy is not the only treatment. We can discuss your condition and decide whether a hysterectomy is a good option for you. 

Alternatives

Depending on the reason you need a hysterectomy, there may be other treatments to try first:

• Hormone therapy may help control vaginal bleeding and, in some circumstances, reduce pelvic pain.
• Endometrial ablation is a brief surgical procedure in which the lining of the uterus is removed or carefully worn away. It often permanently relieves problems with heavy bleeding.  
• Uterine artery embolization is often used to treat uterine fibroids. It is a procedure to decrease the amount of blood supplied to the uterus (and the fibroids) by surgically blocking several key blood vessels. 
• A pessary, a type of plastic ring you wear inside your vagina, can help to support the uterus. This could eliminate the need for a hysterectomy for uterine prolapse.
• Physical therapy may reduce pelvic pain.
• A minor surgical procedure called hysteroscopy can remove fibroids located close to the uterine lining.
• A minor surgical procedure called laparoscopy can help with pelvic pain and treat endometriosis. 
• The onset of menopause may cure problems with excessive bleeding.

If these alternatives to surgery do not control your symptoms or your medical condition, a hysterectomy is the ultimate and final treatment. We can discuss which option is the best choice for you.

Methods of Surgery

The way your surgery is performed may depend on your condition, the size of your uterus, and your medical history. The most common methods of performing a hysterectomy are:

• Vaginal hysterectomy
• Laparoscopic hysterectomy
• Laparoscopic-assisted vaginal hysterectomy (LAVH)
• Abdominal hysterectomy
• Mini-laparotomy hysterectomy (mini-lap)

If a hysterectomy is the best treatment for your medical condition, we can discuss which method of hysterectomy surgery is best for you.

You may have inpatient surgery, where you come to the surgical unit for the operation and stay in the hospital for a short recovery. Or, you may have outpatient surgery, where you come to the surgical unit for the operation and then go home a few hours later.

Vaginal hysterectomy

During a vaginal hysterectomy, your uterus and cervix are removed through an incision in your vagina. Unlike other types of hysterectomy surgery, the incision is inside your vagina, so any marks left by the surgery are not visible to others.

Most women who have a vaginal hysterectomy go home the same day of the surgery or the day after surgery. Most women recover from this surgery in 2 to 4 weeks.

Laparoscopic hysterectomy

During a laparoscopic hysterectomy, your uterus is removed through small incisions in your abdomen. These incisions are about half an inch long. This type of surgery is done by putting a small lighted tube (called a laparoscope) through your belly button. Several other small incisions are made in the abdomen to place the surgical tools needed to perform the surgery.

Most women who have a laparoscopic hysterectomy go home the same day of the surgery or the day after surgery. The advantage of this type of hysterectomy is that the recovery and return to normal activities happens quickly. Most women recover from this surgery in 2 to 4 weeks.

Laparoscopic-assisted vaginal hysterectomy (LAVH)

This type of hysterectomy is a combination of a vaginal hysterectomy and laparoscopic hysterectomy. During an LAVH, the ligaments that support your uterus, tubes, and ovaries are cut using a small lighted tube (called a laparoscope) inserted through your belly button and small incisions (cuts) in your abdomen. Several other small incisions are made in the abdomen to place the surgical tools needed to perform the surgery. An incision is also made in your vagina, in order to remove the uterus through the vagina – this incision will not be visible to others.

Most women who have an LAVH go home the same day of the surgery or the day after surgery. Most women recover from this surgery in 2 to 4 weeks.

Abdominal hysterectomy

During an abdominal hysterectomy, your uterus is removed through a large incision in your abdomen. The incision is usually 6 to 8 inches long. The surgery can be done through a horizontal incision sometimes called a "bikini cut" near the pubic hairline. The surgery may also be done through a vertical incision, usually between the belly button and the pubic bone.

Most women who have an abdominal hysterectomy go home in 1 to 3 days. Most women recover from this surgery in 4 to 6 weeks.

Mini-laparotomy hysterectomy (mini-lap)

During a mini-lap hysterectomy, your uterus is removed through a small incision in your abdomen. This incision is about 2 to 3 inches long and is made low, just above the pubic hairline.

Most women who have a mini-lap hysterectomy go home the same day of their surgery or the day after surgery. The advantage of this type of hysterectomy is that the recovery and return to normal activities are quicker than if you have surgery through a standard open incision. Most women recover from this surgery in 2 to 4 weeks.

Risk Factors

As with any surgery, there is a slight chance that problems may occur. Problems could include:

• More bleeding than expected 
• Infection
• Side effects from anesthesia
• Damage to nearby organs
• Allergic reactions to medications
• Blood clots in legs or lungs

Recovery after Surgery

The length of time you will need to recover depends on your health and the type of surgery you had. Here are some tips to make your recovery period quicker and more effective:

• Plan to rest 1 to 2 hours a day.
• Gradually increase your rate of activity while you recover.
• Take short walks twice a day.
• Do not use tampons or douches. They can increase your risk of infection. Use sanitary pads to absorb bleeding or discharge.
• Do not have intercourse for at least 8 weeks.
• Take showers instead of baths until your incisions heal.
• Take your pain medications as directed, if needed.
• Eat foods high in fiber, such as fruits, vegetables, and whole grains to avoid constipation.
• Drink at least 8 glasses of water a day.
• Take an over-the-counter stool softener if you are constipated.
• Do not drive if you are taking narcotic pain medications.
• If you are not taking pain medication, take a test drive with a companion to make sure you are not too sore to drive.
• Avoid movements and tasks that can strain the incisions, such as heavy lifting, stair climbing, or bending.

Your Care with Me

If you and I have decided that a hysterectomy is the best treatment for your health condition, we will also discuss which method of surgery would be best, based on your health and medical history. My department will arrange a date and time for your procedure, and we will give you specific instructions on how to prepare.

Contacting Me

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

How We Coordinate Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a pre-operative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.