The most common reason women get a hysterectomy is uterine fibroids, followed by abnormal bleeding, endometriosis, uterine prolapse, and cancer. As of 2021, about 14.6% of U.S. women aged 18 and older have had the procedure, making it one of the most frequently performed gynecologic surgeries in the country.
Uterine Fibroids
Fibroids are noncancerous growths in the wall of the uterus, and they’re the single leading reason women undergo hysterectomy. Many fibroids cause no symptoms at all, but when they grow large enough, they can cause heavy periods, pelvic pressure, frequent urination, and pain during sex. A hysterectomy is typically considered when fibroids are too large or too numerous for less invasive treatments to work.
Doctors often describe fibroid-related uterine size the way they describe pregnancy: in weeks. A uterus enlarged to around 12 weeks’ size or smaller can usually be removed through the vagina or with a laparoscope. When the uterus measures larger than 12 weeks, surgeons generally need a traditional abdominal incision. Above 18 weeks, an abdominal approach is almost certain. Large fibroids make it harder for surgeons to see critical landmarks inside the pelvis and safely control blood vessels, which is why smaller, less invasive procedures sometimes aren’t an option.
Not every woman with fibroids needs a hysterectomy. Medications, hormonal IUDs, and procedures that shrink or remove individual fibroids (like myomectomy or uterine artery embolization) are tried first in most cases, especially for women who want to preserve fertility.
Heavy or Abnormal Bleeding
Chronic heavy menstrual bleeding that soaks through pads or tampons in under an hour, lasts more than seven days per cycle, or causes anemia can significantly disrupt daily life. Many women live with it for years before seeking treatment, sometimes not realizing how much it affects their energy, work, and well-being.
A hysterectomy for heavy bleeding is generally reserved as a last resort, after other options have failed or can’t be used. That might mean hormonal birth control, progesterone-releasing IUDs, or a procedure called endometrial ablation (which destroys the uterine lining) didn’t control the bleeding, or that a woman had side effects that made those treatments intolerable. The decision factors in how severely the bleeding impairs quality of life, whether future pregnancy is desired, and whether surgical risk factors like obesity or prior abdominal surgeries are present. Because a hysterectomy permanently ends menstruation, it’s the only treatment that guarantees the bleeding won’t return.
Endometriosis and Adenomyosis
Endometriosis happens when tissue similar to the uterine lining grows outside the uterus, attaching to the ovaries, fallopian tubes, bowel, or pelvic walls. Adenomyosis is a related condition where that tissue grows into the muscular wall of the uterus itself. Both cause intense cramping, heavy periods, chronic pelvic pain, and pain during sex.
For many women, hormonal medications or laparoscopic surgery to remove the misplaced tissue provides relief. But when pain is severe and hasn’t responded to other treatments, hysterectomy becomes a reasonable option. With adenomyosis in particular, removing the uterus is often the only definitive solution because the abnormal tissue is embedded throughout the uterine muscle and can’t be surgically separated from it. When a hysterectomy is done for endometriosis or adenomyosis, keeping the cervix in place isn’t recommended, since residual disease in the cervix can continue causing symptoms.
Uterine Prolapse
Uterine prolapse occurs when the muscles and ligaments of the pelvic floor weaken enough that the uterus drops down into the vaginal canal. This is more common after multiple vaginal deliveries, during menopause (when lower estrogen weakens pelvic tissues), and with chronic straining from constipation or heavy lifting. Symptoms include a feeling of heaviness or pulling in the pelvis, tissue visibly bulging from the vagina, urinary problems, and difficulty with bowel movements.
Mild prolapse can sometimes be managed with pelvic floor exercises or a pessary (a device inserted into the vagina to support the uterus). When prolapse is significant or causing persistent symptoms, hysterectomy combined with pelvic floor repair is a common surgical approach. A partially prolapsed uterus actually rules out certain less invasive hysterectomy techniques, so the surgical plan is tailored to how far the uterus has descended.
Gynecologic Cancer
Cancer of the uterus, cervix, or ovaries often requires a hysterectomy as part of treatment. Endometrial cancer (cancer of the uterine lining) is the most common gynecologic cancer, and fortunately, the majority of cases are caught early enough that surgery alone can be curative. For early-stage endometrial cancer, the standard approach involves removing the uterus, cervix, both ovaries and fallopian tubes, and sampling nearby lymph nodes to check whether cancer has spread.
Cervical cancer beyond its earliest stages also typically requires a hysterectomy. In some cases, when cervical cancer is caught very early in a young woman who wants children, fertility-sparing procedures may be possible, but these are the exception. Ovarian cancer treatment usually involves removing the ovaries along with the uterus as part of a broader surgical effort. For any precancerous condition of the cervix or uterine lining, such as cervical dysplasia or endometrial hyperplasia with abnormal cells, a partial hysterectomy (leaving the cervix) is not appropriate because the diseased tissue needs to come out entirely.
Total vs. Partial Hysterectomy
Not every hysterectomy removes the same organs. A total hysterectomy removes both the uterus and cervix. A supracervical (partial) hysterectomy removes the uterus but leaves the cervix in place. Which type you get depends on why you need the surgery.
Keeping the cervix is an option for conditions like fibroids or heavy bleeding when there’s no cervical disease, no precancerous changes, and no endometriosis or adenomyosis. Some women, particularly those under 45, prefer cervical preservation. However, anyone who keeps their cervix still needs regular cervical cancer screening afterward. When cancer, precancerous cells, endometriosis, adenomyosis, or cervical fibroids are involved, the cervix needs to be removed.
What Happens to Your Ovaries
A separate but important decision during hysterectomy is whether to remove the ovaries. This matters because ovaries produce estrogen and other hormones well beyond your reproductive years. Removing them before menopause triggers immediate surgical menopause, with hot flashes, sleep disruption, and long-term risks.
For women under 45 with no genetic risk factors, current guidelines strongly recommend keeping the ovaries. Removing healthy ovaries before age 46 is linked to higher rates of heart disease, osteoporosis, and cognitive decline. Between 50 and 54, the decision becomes more individualized based on personal health factors. After 55, there’s no significant mortality difference either way. The exception is women who carry BRCA1, BRCA2, or Lynch syndrome gene mutations, where removing the ovaries substantially lowers the risk of ovarian and breast cancer and is often recommended.
Recovery by Surgery Type
How you feel afterward and how quickly you return to normal life depends largely on the surgical approach. Vaginal hysterectomy has the fastest recovery, typically two to four weeks, with the fewest complications. Laparoscopic and robotic-assisted hysterectomies have a similar timeline of two to four weeks. Abdominal hysterectomy, which involves a larger incision, usually requires a two- to three-day hospital stay and up to six weeks of recovery.
Regardless of approach, you can expect some light vaginal bleeding or dark brown discharge for up to six weeks. Standard restrictions during recovery include no lifting anything over 10 pounds for four to six weeks, no sex for six weeks, no baths or swimming for six weeks, and a gradual return to exercise starting around four to six weeks based on how you feel. Most women find that the first two weeks require the most rest, with energy and comfort improving steadily after that.