A hysterectomy removes the uterus, but exactly how much tissue comes out depends on the type of procedure. Some hysterectomies take only the upper body of the uterus, while others remove the cervix, fallopian tubes, ovaries, or surrounding tissue as well. Understanding the differences helps you know what to expect and what questions to ask your surgeon.
The Three Main Types
The word “hysterectomy” covers several distinct operations, and each one removes different structures.
A supracervical (partial) hysterectomy removes the body of the uterus but leaves the cervix in place. This is sometimes chosen for conditions like fibroids or heavy bleeding when the cervix is healthy.
A total hysterectomy removes the entire uterus and the cervix. This is the most common type. Despite the name “total,” it does not automatically include the ovaries.
A radical hysterectomy is reserved for cancer, most often cervical cancer. It removes the uterus, cervix, the upper portion of the vagina, and the ligaments and connective tissue surrounding the uterus (called the parametrium). Pelvic lymph nodes are also typically removed during the same surgery so they can be checked for cancer spread.
Ovaries and Fallopian Tubes Are Separate Decisions
One of the biggest misconceptions is that a hysterectomy always means losing your ovaries. It doesn’t. Removing one or both ovaries is a separate procedure called an oophorectomy, and removing the fallopian tubes is called a salpingectomy. Your surgeon may recommend one or both alongside your hysterectomy, but they’re distinct choices with their own risks and benefits.
When both ovaries and both fallopian tubes come out together, the combined procedure is called a bilateral salpingo-oophorectomy. This is sometimes done at the same time as a hysterectomy for people at high risk of ovarian cancer, or for those who already have ovarian disease. But for many patients, keeping the ovaries is the better option because it preserves natural hormone production.
Fallopian Tube Removal Is Increasingly Routine
Even when the ovaries stay, surgeons now commonly recommend removing the fallopian tubes during a hysterectomy. Research has shown that many cancers previously labeled “ovarian cancer” actually originate in the fallopian tubes. Because of this, the Society of Gynecologic Oncology has recommended since 2013 that women at average cancer risk consider having their tubes removed at the time of hysterectomy, even if the ovaries are being kept. ACOG guidelines note that adding this step does not increase the risk of complications like blood transfusions, infections, or readmissions compared to hysterectomy alone. The tubes are removed completely from the fimbriated (finger-like) end up to where they connect to the uterus.
What Happens to Your Hormones
If your ovaries are removed during the procedure, your body loses its primary source of estrogen and progesterone. This triggers immediate surgical menopause, regardless of your age. Hot flashes, sleep disruption, vaginal dryness, and bone density loss can begin within days.
If your ovaries stay, you won’t enter menopause right away, but the timeline may shift. Even with ovaries intact, research from UPMC shows that hormone levels can decline after hysterectomy, potentially bringing menopause a few years earlier than the average age of 52. The reasons aren’t entirely clear, but changes in blood flow to the ovaries after the uterus is removed likely play a role.
Does Keeping the Cervix Matter?
Whether to keep or remove the cervix is a decision that affects both cancer screening and sexual function. If the cervix stays, you’ll still need periodic Pap smears. If it’s removed, that screening is no longer necessary in most cases.
Sexual sensation is the other consideration. Nerves that contribute to internal orgasms pass near the cervix. Research from Boston University found that women who kept their cervix during hysterectomy reported no loss of sexual function, while those who had it removed were more likely to notice changes. When the nerve clusters around the cervix (the uterine cervical ganglia) are preserved during a cervix-sparing procedure, sexual function tends to remain intact. That said, many women who have a total hysterectomy report satisfactory sexual function afterward, so individual experiences vary.
How the Surgery Is Performed
The organs removed are the same regardless of surgical approach, but the way surgeons access them differs. There are three main routes.
- Vaginal hysterectomy: The uterus is removed through the vagina with no external incisions. This typically has the shortest recovery time and is preferred when anatomy allows it.
- Laparoscopic hysterectomy: Small incisions in the abdomen allow a camera and instruments inside. Some versions use robotic assistance. Recovery is faster than open surgery.
- Abdominal hysterectomy: A larger incision across the lower abdomen gives the surgeon direct access. This is more common when the uterus is very large, when there’s significant scar tissue from previous surgeries, or when cancer is involved and the surgeon needs to visually inspect the abdominal cavity.
Fallopian tube removal can be safely accomplished during any of these approaches, including vaginal hysterectomy. However, if the goal is a risk-reducing procedure for someone at high cancer risk, a laparoscopic or abdominal approach is typically needed so the surgeon can properly inspect the surrounding tissue.
A Quick Reference by Type
- Supracervical: Uterus only (cervix stays)
- Total: Uterus and cervix
- Total with salpingectomy: Uterus, cervix, and fallopian tubes
- Total with salpingo-oophorectomy: Uterus, cervix, fallopian tubes, and one or both ovaries
- Radical: Uterus, cervix, upper vagina, parametrium, and pelvic lymph nodes (plus often tubes and ovaries)
The specific combination depends on why the hysterectomy is being done, your age, cancer risk, and personal preferences. Every structure removed or kept carries trade-offs, and these are worth discussing in detail before surgery.