A total hysterectomy is the surgical removal of both the uterus and the cervix. It’s the most common type of hysterectomy performed, and it differs from other types primarily by which organs are taken out. In a subtotal (also called partial) hysterectomy, the cervix is left in place. In a radical hysterectomy, the uterus, cervix, ovaries, fallopian tubes, and surrounding tissue are all removed. The word “total” refers specifically to the uterus and cervix together.
What Gets Removed (and What Doesn’t)
A total hysterectomy removes the uterus and cervix. Your ovaries and fallopian tubes are not automatically removed. When doctors do remove the ovaries and tubes alongside a total hysterectomy, the procedure has a different name: total hysterectomy with salpingo-oophorectomy. That distinction matters because keeping your ovaries has significant consequences for your hormones and long-term health, which is covered below.
Because the cervix is removed, you’ll no longer need Pap smears afterward, as long as you don’t have a history of high-grade precancerous cervical changes or cervical cancer. The U.S. Preventive Services Task Force specifically recommends against continued cervical cancer screening in this group, since the tissue where cervical cancer develops is no longer present.
Why It’s Done
The most common reasons for a total hysterectomy include heavy menstrual bleeding (often caused by fibroids), chronic pelvic pain from conditions like endometriosis or adenomyosis, uterine prolapse, and cancers of the uterus, cervix, ovaries, or fallopian tubes.
Fibroids are noncancerous growths made of muscle and fibrous tissue that develop in or around the uterus. They vary widely in size, and a hysterectomy is typically recommended when fibroids are large, cause severe bleeding, and the patient doesn’t plan to have future pregnancies. Endometriosis, where tissue similar to the uterine lining grows outside the uterus, is another common reason. A hysterectomy can remove the areas generating pain, but it’s usually considered only after less invasive treatments have failed.
For gynecologic cancers, a hysterectomy may be part of a broader treatment plan or, in advanced cases, the primary treatment option.
Surgical Approaches
There are three main ways surgeons perform a total hysterectomy: vaginally, laparoscopically (sometimes with robotic assistance), or through an open abdominal incision. Vaginal and laparoscopic approaches are considered minimally invasive because they avoid a large abdominal cut, which translates to shorter hospital stays and faster recovery.
Among these options, vaginal hysterectomy generally has the shortest operating time and hospital stay. When a vaginal approach isn’t feasible, laparoscopic hysterectomy offers advantages over open abdominal surgery, including a faster return to normal activity, shorter hospitalization, and fewer wound infections. According to ACOG, the American College of Obstetricians and Gynecologists, a vaginal approach should be considered first whenever possible for benign conditions.
An open abdominal hysterectomy is more common when the uterus is very large, when cancer is involved and the surgeon needs more visibility, or when significant scar tissue from prior surgeries complicates a minimally invasive approach.
What Happens to Your Hormones
This is one of the most misunderstood aspects of a total hysterectomy. If your ovaries are kept, you won’t go through immediate menopause, because your ovaries continue producing estrogen and progesterone. However, a total hysterectomy still affects ovarian function in measurable ways. The uterine artery supplies roughly 50 to 70% of the blood flow to the ovaries, and tying it off during surgery reduces that supply. This leads to a 20 to 30% decline in ovarian reserve markers and can accelerate the onset of menopause by about 3 to 4 years.
When both ovaries are preserved, about 89% of women still have normal ovarian function five years after surgery. That drops to 66% when only one ovary is kept. Women who have one ovary removed alongside a total hysterectomy are roughly two to three times more likely to experience premature ovarian insufficiency, and they reach menopause an average of 4.4 years earlier than those who keep both ovaries.
If both ovaries are removed, menopause begins immediately regardless of your age. This is called surgical menopause, and it tends to cause more abrupt and intense symptoms than natural menopause because hormone levels drop suddenly rather than declining gradually over years.
Recovery Timeline
Recovery depends on which surgical approach was used. For minimally invasive procedures (vaginal or laparoscopic), general recovery takes about 2 to 4 weeks, though more strenuous activities take longer. Open abdominal surgery typically requires a longer recovery window.
For the first six weeks after surgery, you should avoid lifting anything heavier than 10 pounds. That includes groceries, laundry baskets, children, and pets. Pushing heavy objects like vacuum cleaners or grocery carts is also off limits during this period. If you have a desk job or work from home, returning to work after 1 to 2 weeks is reasonable. Jobs that involve a lot of physical movement typically require 2 to 4 weeks off.
Nothing should be placed in the vagina for at least six weeks, including tampons. Sexual intercourse is also off the table during this window to allow the surgical site at the top of the vagina (called the vaginal cuff, where the cervix used to be) to heal fully.
Potential Complications
As with any major surgery, a total hysterectomy carries risks. Bladder injury occurs in roughly 0.5 to 2% of all hysterectomies, since the bladder sits directly in front of the uterus and can be affected during separation of the tissue. Pelvic infection develops in about 4% of cases regardless of surgical approach.
Surgical site infections are more common with abdominal hysterectomy (6 to 25%) compared to vaginal hysterectomy (4 to 10%). Urinary tract infections after surgery occur in about 1 to 5% of patients. The overall risk of developing a fever from a postoperative infection is around 30%, though many of these cases resolve without serious consequences.
Life After a Total Hysterectomy
You will no longer have menstrual periods after a total hysterectomy, and pregnancy is not possible. If your ovaries were preserved, you’ll still go through menopause naturally, just potentially a few years earlier than you otherwise would have. You won’t need Pap smears unless you have a history of high-grade precancerous cervical changes.
Many people experience significant relief from the symptoms that led to surgery, particularly heavy bleeding and chronic pelvic pain. The hormonal shifts described above are worth discussing with your doctor before surgery, especially if you’re younger, since the decision about whether to preserve one or both ovaries has lasting effects on bone density, cardiovascular health, and menopausal timing.