Hysterectomy is surgery to remove the uterus. After a hysterectomy, you will not menstruate (have periods) or be able to get pregnant. Uterus removal is a common treatment for a variety of conditions that affect a woman’s reproductive organs.

About half a million hysterectomies are performed each year in the U.S. It is the second most common surgical procedure for women, after cesarean delivery (C-section). Most hysterectomies are performed between the ages of 40 and 50.

What is a hysterectomy?

A hysterectomy removes the uterus and the attached cervix. The type of hysterectomy you have will depend on the reason for treatment.

Types of Hysterectomies

There are several types of hysterectomies. Your doctor will discuss the risks, benefits and potential side effects of each procedure. It’s important to ask your doctor if removal of the ovaries and fallopian tubes during your hysterectomy is recommended. Types of hysterectomies include:

• Total hysterectomy removes the entire uterus and the cervix (most common type).
• Partial hysterectomy (also called supracervical hysterectomy) removes only the uterus, leaving behind the cervix (research is ongoing about the risks and benefits of leaving the cervix intact).
• Radical hysterectomy removes the uterus, cervix and upper part of the vagina (usually for cancer treatment).

How long does hysterectomy surgery take?

Hysterectomy surgery can take between one and four hours. The duration of surgery depends on the type of procedure you have and how it is performed.

Reasons for a Hysterectomy

There are a variety of reasons your doctor may recommend a hysterectomy, including:

• Abnormal bleeding
• Adenomyosis
• Dysmenorrhea (painful menses)
• Endometriosis
• Gynecologic cancers, including cancer of the uterus, ovary, cervix or endometrium
• Heavy or prolonged menstrual bleeding (menorrhagia)
• Fibroids
• Uterine prolapse, which may be combined with bladder repair
• Gender affirmation for males who are transgender and people who are nonbinary

Abdominal Hysterectomy

A surgeon performs an abdominal, or open, hysterectomy through an incision (cut) in your abdomen. The incision can be horizontal and low on your belly, just above your pubic bone, or vertical extending up to or beyond the belly button, depending on the indication for surgery and the size of the pathology.

For an abdominal hysterectomy, you can expect:

• Anesthesia: general
• Hospitalization: two to three days
• Incision size: six to twelve inches for horizontal incisions; longer for vertical incisions
• Procedure time: one to four hours
• Recovery: six to twelve weeks, depending on the incision size and type

Laparoscopic or Robotic Hysterectomy

In many cases, a hysterectomy can be performed using minimally invasive techniques. A laparoscopic hysterectomy is performed through several small incisions in your abdomen instead of one large incision.

A surgeon inserts an endoscope (a thin video camera) through one incision. The laparoscope allows the surgeon to view your pelvic organs on a video monitor. The abdomen is distended with gas to create a space to operate in. Small surgical tools are used in the other incisions to remove your uterus intact or in sections.

A robotic hysterectomy is another type of minimally invasive uterus removal. Your surgeon uses the assistance of a robotic device to remove your uterus through small abdominal incisions.

For a laparoscopic or robotic hysterectomy, you can expect:

• Anesthesia: general
• Hospitalization: none (outpatient) or one night
• Incision size: 5–12 millimeters
• Procedure time: one to four hours
• Recovery: two to six weeks

Hysteroscopic Hysterectomy

Hysteroscopic (vaginal) hysterectomy is the least invasive approach to uterus removal. The uterus is removed through an incision at the top of the vagina, so you don’t have any abdominal incisions.

Several factors may determine whether you are a candidate for a vaginal hysterectomy, including conditions that could prevent vaginal access to the uterus, such as lack of uterine descent, severe endometriosis, uterine fibroid, need to remove the ovaries and/or fallopian tubes, adhesions (scar tissue) or surgeon preference/experience.

For a vaginal hysterectomy, you can expect:

• Anesthesia: general
• Hospitalization: one or two nights
• Incision size: none
• Procedure time: one to four hours
• Recovery: three to four weeks

Hysterectomy Side Effects and Risks

Hysterectomy is generally a safe procedure with excellent success rates. However, potential risks and side effects of the procedure include:

• Early menopause, with symptoms such as hot flashes, mood swings or insomnia if ovaries are removed
• Excessive bleeding and need for blood transfusion
• Potential injury to adjacent organs such as the bladder, intestines, ureters, blood vessels and nerves
• Blood clots to legs or lungs
• Scar tissue formation
• Hernia
• Pain
• Reactions to anesthesia
• Infection

Hysterectomy Recovery

After a hysterectomy, avoid strenuous activity, intercourse and lifting heavy objects. Your doctor will let you know when you can resume normal activities such as work, exercise and sexual intercourse.

Hysterectomy for Gender Affirmation

Males who are transgender and people who are nonbinary may consider hysterectomy, salpingectomy (removal of the fallopian tubes), oophorectomy (removal of the ovaries) or a combination of these procedures as part of their gender affirmation surgery plan.

The procedure or procedures you and your doctor decide on may depend on several factors. These may include your general health and your preferences regarding fertility and the ability to carry a pregnancy or to become a biological parent. Reproductive technology experts can explain your options, including egg freezing and other ways to retain fertility.