A hysterectomy is a surgical procedure that removes the uterus. It is one of the most common surgeries performed on women in the United States, where roughly 14.6% of women aged 18 and older have had one. The prevalence climbs sharply with age: about 3% of women under 45 have had a hysterectomy, compared to 22% of women between 45 and 64, and over 40% of women 75 and older.
Why a Hysterectomy Is Recommended
Hysterectomies are performed to treat a range of conditions, most of them noncancerous. Uterine fibroids, which are noncancerous growths in the wall of the uterus, are one of the most common reasons. Other frequent indications include endometriosis (tissue similar to the uterine lining growing outside the uterus), adenomyosis (that same type of tissue growing into the muscular wall of the uterus), abnormal or very heavy menstrual bleeding, severe menstrual pain, and uterine prolapse, where the uterus drops from its normal position into the vaginal canal.
Cancers of the uterus, cervix, ovaries, or endometrium can also require a hysterectomy. For noncancerous conditions, doctors typically try other treatments first, including medications, hormonal therapies, or less invasive procedures. A hysterectomy becomes the next step when those alternatives haven’t worked. The surgery is also performed as part of gender-affirming care for some transgender men and nonbinary individuals.
Types of Hysterectomy
The word “hysterectomy” covers several different operations, depending on how much tissue is removed.
- Supracervical (partial) hysterectomy: Removes the upper part of the uterus but leaves the cervix in place. The ovaries and fallopian tubes may or may not be removed at the same time.
- Total hysterectomy: Removes the uterus and cervix but leaves the ovaries.
- Total hysterectomy with bilateral salpingo-oophorectomy: Removes the uterus, cervix, both fallopian tubes, and both ovaries.
- Radical hysterectomy: Removes the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina, and surrounding tissue and lymph nodes. This is typically reserved for cancer treatment.
Which type you have depends on the underlying condition. For fibroids or heavy bleeding, a total or supracervical hysterectomy is often sufficient. For gynecologic cancers, a radical hysterectomy may be necessary to ensure all affected tissue is removed.
How the Surgery Is Performed
Beyond what gets removed, there are different ways a surgeon can physically access the uterus. The approach affects the size of the incision, hospital stay, and how quickly you recover.
The American College of Obstetricians and Gynecologists considers vaginal hysterectomy the preferred approach whenever it’s feasible. The uterus is removed through the vagina with no abdominal incision at all, which translates to shorter recovery times and lower costs. Laparoscopic hysterectomy, where the surgeon operates through several small incisions in the abdomen using a camera, is the preferred alternative when a vaginal approach isn’t possible. Many of these surgeries are now done on an outpatient basis, meaning you go home the same day.
Open abdominal hysterectomy involves a larger incision across the lower abdomen. It remains important for certain patients, particularly when the uterus is very large, there are significant adhesions from prior surgeries, or the surgeon needs broader access for cancer staging. Recovery takes longer compared to minimally invasive routes.
Robotic-assisted hysterectomy uses a surgical robot controlled by the surgeon to perform the laparoscopic procedure. Despite the high-tech appeal, studies have found no significant benefit to robotic assistance over conventional laparoscopic surgery in terms of outcomes. The choice between the two often comes down to surgeon experience and hospital resources.
Several factors influence which surgical route is right for you: the size and shape of the uterus, whether you’ve had previous pelvic surgery, the extent of disease outside the uterus, any additional procedures being done at the same time, and your surgeon’s training and experience.
What Happens to Your Hormones
This is one of the most important and misunderstood aspects of hysterectomy. The hormonal impact depends almost entirely on whether your ovaries are removed.
If both ovaries are removed, you will enter menopause immediately, regardless of your age. Your body loses its primary source of estrogen, progesterone, and testosterone. The Rancho Bernardo Study found that women who had both ovaries removed had 40% lower total and bioavailable testosterone levels compared to women who kept their uteruses and ovaries. This sudden hormonal shift can cause hot flashes, sleep disruption, mood changes, vaginal dryness, and other menopausal symptoms, often more intense than natural menopause because the change is abrupt rather than gradual.
If your ovaries are kept, you won’t enter menopause right away, but the picture is more nuanced than many people realize. Multiple studies have found that hysterectomy with ovarian preservation is associated with reduced blood flow to the ovaries, lower levels of estrogen and progesterone, and earlier onset of natural menopause compared to women who haven’t had the surgery. A meta-analysis of 14 studies confirmed measurable declines in ovarian function after hysterectomy, even when the ovaries stayed. That said, other research has found minimal hormonal changes at 12 months post-surgery, so the effect varies from person to person. Either way, you will no longer have periods after any type of hysterectomy, and you will not be able to become pregnant.
Risks and Complications
Hysterectomy is considered a safe surgery overall, but like any major operation, it carries risks. The most common short-term complications are infection (at the wound site or in the urinary tract, usually treatable with antibiotics) and heavy bleeding, which occasionally requires a blood transfusion. There is a small risk of injury to nearby organs like the bladder, ureters, or bowel during surgery.
For vaginal hysterectomies specifically, problems can develop at the top of the vagina where the cervix was removed. These range from infection or slow healing in the weeks after surgery to vaginal vault prolapse in later years. Some women also experience depression or a sense of lost sexual identity after the procedure, which is worth discussing with your care team beforehand.
Recovery: What to Expect
Most people need a few weeks off from work after a hysterectomy. Fatigue is common for 2 to 4 weeks even after pain improves. Over the past few decades, the shift toward minimally invasive techniques has shortened recovery significantly. Many patients who have a vaginal or laparoscopic hysterectomy go home the same day.
Open abdominal surgery typically involves a longer hospital stay and a slower return to normal activity. Regardless of the approach, you’ll generally be told to avoid heavy lifting, strenuous exercise, and sexual intercourse for several weeks while internal healing takes place. Once the vaginal stitches have fully healed, a hysterectomy does not typically affect your sex life long-term.
Preparing for Surgery
If you have a hysterectomy scheduled, preparation starts well before the day of surgery. You’ll need to review all your current medications, including over-the-counter drugs, supplements, and herbs, with your surgical team, because some may need to be paused or adjusted. If you smoke, stopping beforehand reduces your risk of complications and improves healing.
The day before and morning of surgery, you’ll typically bathe or shower with a special antiseptic soap to reduce infection risk. Your care team may also ask you to use a vaginal cleanse or an enema. Eating healthy, staying active, and reaching a healthy weight in the weeks leading up to surgery can all contribute to a smoother recovery.