A hysterectomy is one of the most common gynecologic surgeries performed in the United States, yet many women feel overwhelmed when they first begin researching it online. Search results can be confusing, outdated, or contradictory when you’re trying to understand what the procedure actually involves.
To help clear up the confusion, Dr. Lynn Kowalski, gynecologic oncologist at Nevada Surgery & Cancer Center in Las Vegas, explains the fundamentals of what a hysterectomy is — and what it isn’t.
What is a Hysterectomy?
A hysterectomy is the surgical removal of the uterus, the organ responsible for menstruation and pregnancy. Once the uterus is removed, a woman will no longer have periods and cannot become pregnant.
While many people assume a hysterectomy automatically includes removing other reproductive organs, that is not the case. A hysterectomy does not by definition include removing the ovaries, fallopian tubes or cervix.
These structures may or may not be removed during the same surgery, depending on a woman’s diagnosis, age, hormonal needs, and long‑term health goals.
In many cases, especially for women who have not yet reached menopause, surgeons aim to preserve the ovaries so the body can continue producing hormones. For others, such as women with a high risk of ovarian cancer or those who are post‑menopausal, removing the ovaries and fallopian tubes may be recommended as part of the procedure.
3 Types of Hysterectomies
Dr. Kowalski emphasizes that much of the confusion comes from terminology. Here’s how physicians classify the procedure:
- Total hysterectomy
A total hysterectomy involves removing both the uterus and the cervix. Together, these two organs make up the entire uterine structure. It may or may not include removal of the ovaries or fallopian tubes. A total hysterectomy is the most common form of hysterectomy performed today.
Many women choose this option when dealing with fibroids, abnormal bleeding, adenomyosis, or precancerous cervical changes. Because the cervix is removed, patients will no longer need cervical cancer screening or Pap tests after a total hysterectomy.
- Supracervical (partial) hysterectomy
A supracervical hysterectomy removes the upper portion of the uterus while leaving the cervix in place. It is typically done using minimally invasive techniques, such as laparoscopic or robotic surgery.
Since the cervix remains intact, some women may still experience light cyclical spotting after a supracervical hysterectomy. This can depend on how much uterine tissue remains after the procedure.
Some patients prefer to keep the cervix because they believe it may help with pelvic support or sexual function, though research shows mixed results. It is important for patients to know that keeping the cervix means they must continue routine cervical cancer screening.
- Hysterectomy with bilateral salpingo‑oophorectomy
A hysterectomy with bilateral salpingo-oophorectomy includes removal of the uterus plus the ovaries and fallopian tubes. This is a more extensive surgery that is usually only done when there is a medical reason to remove the ovaries. It is typically recommended for women who are post-menopausal or who have certain cancer risks.
Removing the ovaries causes immediate menopause. Because of this, pre-menopausal women should make this decision carefully after a full discussion with their physician about symptoms, long-term health effects, and hormone therapy options.
Why a Hysterectomy May Be Recommended
Surgeons and patients typically consider a hysterectomy when other treatments haven’t provided relief or when a condition poses a risk to a woman’s long‑term health. Some of the most common reasons include:
- Uterine fibroids — Noncancerous growths that can cause heavy menstrual bleeding, pelvic pressure, pain, or anemia. When fibroids are large, numerous, or recurrent, removing the uterus may be the most effective long‑term solution.
- Endometriosis — A condition where tissue similar to the uterine lining grows outside the uterus, leading to chronic pelvic pain, painful periods, and sometimes infertility. A hysterectomy may be recommended when symptoms are severe and other treatments haven’t helped.
- Adenomyosis — Occurs when the uterine lining grows into the muscular wall of the uterus, causing intense cramping, heavy bleeding, and enlargement of the uterus. Removing the uterus is the only definitive cure.
- Pelvic organ prolapse — When weakened pelvic floor muscles allow the uterus to drop into the vaginal canal, a hysterectomy may be part of the surgical repair to restore pelvic support.
- Chronic abnormal bleeding — A hysterectomy can provide permanent relief from persistent heavy or irregular bleeding that doesn’t respond to medications or less invasive procedures.
- Gynecologic cancers or precancers — Conditions such as endometrial cancer, cervical cancer, or complex atypical hyperplasia often require removal of the uterus, and sometimes the ovaries and tubes, as part of treatment.
Your doctor can walk you through each hysterectomy option so you can make an informed decision that aligns with your current situation and your long-term health priorities.
Modern Approaches to Hysterectomy
Today, most hysterectomies are performed using minimally invasive techniques, which allow surgeons to remove the uterus through small incisions or through the vagina rather than a large abdominal opening. These approaches typically offer:
- smaller incisions that reduce scarring
- less postoperative pain
- faster recovery times, often returning to normal activities within a few weeks
- shorter hospital stays, with many patients going home the same day
Three popular options for minimally invasive techniques are:
- Laparoscopic hysterectomy — The surgeon uses a thin camera and specialized instruments inserted through small abdominal incisions. This method provides excellent visualization and is widely used for benign conditions like fibroids or abnormal bleeding.
- Robotic‑assisted hysterectomy — A form of laparoscopic surgery where the surgeon controls robotic instruments for enhanced precision and flexibility. This approach is especially helpful for complex cases, such as severe endometriosis or large fibroids.
- Vaginal hysterectomy — The uterus is removed through the vagina without any abdominal incisions. This technique often results with the quickest recovery and is commonly used for pelvic organ prolapse or when anatomy allows easy access.
Although minimally invasive surgery is preferred whenever possible, open abdominal hysterectomy still plays an important role and is still used when medically necessary. Some examples include cases of large tumors, extensive scar tissue, or certain cancers. Open abdominal hysterectomy is far less common than it once was due to the advantages of minimally invasive methods.
Expert Hysterectomy Care in Las Vegas
If you’re considering whether a hysterectomy may be a good option for you, speaking with an experienced specialist can make all the difference.
Dr. Lynn Kowalski of NVSCC has performed thousands of minimally invasive gynecologic surgeries and provides personalized guidance for each patient’s needs.
To schedule a consultation, call 702‑739‑6467 or visit us online at www.nvscc.com.