A hysterectomy is a surgical procedure involving the removal of the uterus, the organ where a fetus develops during pregnancy. This operation is a common treatment for various conditions, including chronic pelvic pain, uterine fibroids, and certain cancers. Pregnancy requires the uterus for a fertilized egg to successfully implant and grow. Therefore, regardless of the extent of the procedure, a person cannot carry a child after a hysterectomy because the necessary organ for gestation has been removed.
Defining the Types of Hysterectomy
The term “partial hysterectomy” is often confusing, as it refers specifically to the removal of the main body of the uterus while leaving the cervix intact. The medically precise term for this procedure is a supracervical or subtotal hysterectomy. This procedure is sometimes chosen to reduce surgical time or decrease the risk of injury to surrounding structures.
A total hysterectomy involves the removal of the entire uterus along with the cervix. The removal of the cervix is the defining difference between a total and a supracervical hysterectomy. In both procedures, the ovaries and fallopian tubes may or may not be removed, which is a separate decision based on the patient’s health and risk factors.
The removal of the fallopian tubes is called a salpingectomy, while the removal of the ovaries is an oophorectomy. The most extensive procedure is a radical hysterectomy, typically reserved for treating gynecologic cancers, which involves removing the uterus, cervix, upper part of the vagina, and surrounding tissue.
The confusion surrounding the word “partial” often leads people to believe that enough of the uterus remains to sustain a pregnancy, but this is not the case. Even in a supracervical hysterectomy, the entire uterine cavity, which is the site of fetal development, is gone. The remaining cervix is only the lower, narrow part of the organ that connects to the vagina.
The Biological Necessity of the Uterus
Conception begins with fertilization, the union of a sperm and an egg, which typically takes place within the fallopian tube. If the ovaries and fallopian tubes remain intact after a hysterectomy, the ovaries continue to release eggs, and fertilization can still occur.
The fertilized egg, now an embryo, must travel to the uterus for implantation and gestation. The inner lining of the uterus, the endometrium, is prepared by hormones each month to receive and nourish the embryo. Implantation into this tissue is necessary for the embryo to receive the blood supply and nutrients required to grow.
Without the uterine cavity and its specialized lining, the embryo has nowhere to attach and develop. The uterus is the only organ capable of expanding to contain a full-term fetus and supplying the complex support system for gestation. Therefore, the removal of the uterus, even partially, makes it biologically impossible to carry a pregnancy to term.
While the ability to sustain a pregnancy is permanently ended, it is still possible to have genetically related children through assisted reproductive technologies. If the ovaries remain, they can be stimulated to produce eggs, which are then collected, fertilized via in-vitro fertilization, and transferred to a gestational surrogate’s uterus.
Pregnancy-Related Risks After the Procedure
While a viable pregnancy is impossible, a rare but serious medical risk remains if the fallopian tubes were not removed during the hysterectomy. This risk is an ectopic pregnancy, where the fertilized egg implants somewhere other than the uterine cavity. The most common location for this implantation is within the fallopian tube itself.
Ectopic pregnancy after a hysterectomy is extremely rare. However, some reports suggest that the frequency might be increasing, particularly following supracervical hysterectomies. This occurs because the path for sperm to travel to the egg may still be present, and the fertilized egg can become trapped in the tube or implant in the cuff tissue at the top of the vagina.
An ectopic pregnancy is a medical emergency because the fallopian tube is not designed to expand like the uterus, and the growing embryo can cause the tube to rupture, leading to severe internal bleeding. Any woman of reproductive age who has retained her ovaries and fallopian tubes should seek immediate medical attention for acute abdominal pain or unusual bleeding. The diagnosis is often missed or delayed in post-hysterectomy patients because pregnancy is not expected.
Cyclic Bleeding
Another post-procedure effect is cyclic bleeding, which only occurs after a partial (supracervical) hysterectomy where the cervix is left intact. This happens because a small amount of endometrial tissue, the tissue that sheds during a menstrual cycle, may remain on the cervical stump. If the ovaries are still functioning, the hormones they produce continue to stimulate this residual tissue.
This stimulation causes the small amount of tissue to bleed monthly, mimicking a light period. This phenomenon occurs in about 17% to 25% of patients who undergo the supracervical procedure. This bleeding is usually light and expected, but it is not a sign of fertility returning or a pregnancy.