Hysterectomy Wisdom: Know Your Surgery Options

When Hysterectomy Is the Only Option

Back in the day, hysterectomy was much more common than it is today. In fact, for some women, a hysterectomy was nearly viewed as a rite of passage from their reproductive years to menopause. However, the thinking on hysterectomy has changed, and many women and their doctors seek to avoid hysterectomy whenever possible.

However, for some women, regardless of their ages, hysterectomy is the only choice. When severe symptoms such as heavy bleeding, fibroids and displacement of the bladder and uterus cannot be treated by less radical approaches, a hysterectomy can bring relief.  That said, there are hysterectomies, and there are hysterectomies.  Many doctors believe that a minimally invasive hysterectomy is ideal for women, and their patients often agree.

Abdominal Hysterectomy

In past decades, having a hysterectomy meant undergoing an abdominal hysterectomy. With an abdominal hysterectomy, an incision is cut into the abdomen, and the uterus is removed through the incision. The operation usually requires the woman to remain in the hospital for several days, with six weeks or more downtime after she is released.

Despite the longer downtime, abdominal hysterectomy is less complex and less expensive than alternative procedures. Women who must pay more of their own medical expenses may opt for abdominal hysterectomy for this reason.  If abdominal hysterectomy is chosen, the surgeon can position the scar immediately above the pubic area so that it is less likely to be visible.

Laparoscopic hysterectomy

For women who desire less downtime, and for whom expense is less of a factor, laparoscopic hysterectomy is often the procedure of choice. There are actually two types of laparoscopic hysterectomy.  Each type has both advantages and limitations.

With laparoscopic-assisted vaginal hysterectomy, the surgeon accesses the uterus through the vagina. However, the surgery is only suitable for women with small fibroids, small uterus and no previous births by caesarian section. The recovery time is about two weeks. This type of laparoscopic hysterectomy has been practiced since the late1990s.

Total laparoscopic hysterectomy requires only extremely small incisions that are often made through the belly button. The removal of the uterus produces very small scars. There is almost no downtime, and full recovery requires about two weeks. However, this type of surgery has only been performed since 2005 and many surgeons are not experienced in performing the procedure.

Alternatives to Hysterectomy

For women of childbearing age who wish to preserve their fertility, a myomectomy, or surgery to remove fibroids while leaving the uterus intact, is an option when less radical methods of reducing fibroids has failed. Like an abdominal hysterectomy, a myomectomy involves an abdominal incision and requires the woman to remain in the hospital for several days after the surgery, with a total recovery time of about six weeks.

Another alternative to hysterectomy is uterine artery embolization, which destroys the lining of the uterus can relieve symptoms. Another option is endometrial ablation, which focuses on the lining of the uterus. However, endometrial ablation usually eliminates the option of pregnancy for women who have the procedure. It is unclear whether fertility is adversely affected by uterine artery embolization.


Routine removal of the uterus used to include removal of the ovaries as well, which is a procedure known as oophorectomy. However, oophorectomy produces the immediate equivalent of menopause for women, with accompanying hot flashes and loss of libido.  As a result, many women are hesitant to undergo oophorectomies and physicians avoid performing the procedure whenever possible.  In women of childbearing age, and even in women past childbearing age, preserving the ovaries is desirable, except where cancer or the imminent threat of cancer is present.