Hysterectomy is the surgical removal of the uterus, sometimes combined with removal of the cervix and/or fallopian tubes and ovaries, and it may be performed for benign conditions (such as fibroids or prolapse) or for gynecologic cancers.In Canada, decision-making is ideally shared: the goal is the least invasive, most appropriate approach for the diagnosis, anatomy, and patient priorities, often vaginal or laparoscopic when feasible.
Table of contents
- Hysterectomy in plain terms
- Canadian context
- When hysterectomy is appropriate
- Before deciding: the work-up
- Uterus-preserving alternatives
- Choosing the surgical route
- Perioperative safety essentials
- What to expect: surgery to discharge
- Recovery at home
- Risks and long-term considerations
- Tubes, ovaries, and risk reduction
- Morcellation and informed consent
- Who benefits from uterine preservation
- Frequently asked questions
- Evidence-based resources
- Meta tags
Hysterectomy in plain terms
A hysterectomy removes the uterus, which ends menstrual bleeding and makes pregnancy impossible.
Types of hysterectomy
- Total hysterectomy: Uterus and cervix are removed (common for many indications).
- Supracervical (subtotal) hysterectomy: Uterus is removed and cervix remains (selected situations).
- Radical hysterectomy: Uterus and cervix are removed with surrounding tissues (typically for certain cancers).
What happens to tubes and ovaries
Decisions about fallopian tubes and ovaries should be discussed separately from “removing the uterus,” because they change long-term outcomes (especially menopause symptoms and cardiometabolic/bone health).
- Salpingectomy: Fallopian tubes removed.
- Oophorectomy: Ovaries removed.
- Salpingo-oophorectomy: Tubes and ovaries removed.
Canadian context
Canadian guidance emphasizes that hysterectomy is one of the most frequently performed major gynecologic surgeries and that hysterectomy rates vary by region without a proven link to better outcomes or greater satisfaction.
The same guideline summary notes that in 1999–2000, vaginal hysterectomy accounted for about 32% of hysterectomies in Canada, reflecting a trend toward less invasive routes.
When hysterectomy is appropriate
Hysterectomy can be the treatment of choice for specific gynecologic conditions, but the predicted benefit should be carefully weighed against surgical risks and against available alternatives.
Benign (non-cancer) indications
- Symptomatic fibroids (leiomyomas): Hysterectomy provides a permanent solution to heavy bleeding (menorrhagia) and pressure/bulk symptoms from an enlarged uterus.
- Abnormal uterine bleeding (AUB): Endometrial lesions should be excluded, and medical alternatives should be considered first-line therapy.
- Endometriosis: Often considered when symptoms are severe, other treatments have failed, and future fertility is no longer desired.
- Pelvic organ prolapse (“pelvic relaxation”): When hysterectomy is performed for prolapse, the plan should include pelvic supporting procedures.
- Chronic pelvic pain: A multidisciplinary approach is recommended, because evidence that hysterectomy cures chronic pelvic pain is limited; it may help when pain is confined to dysmenorrhea or linked to significant pelvic disease.
Pre-cancer and cancer indications
- Endometrial hyperplasia with atypia: Hysterectomy is usually indicated.
- Cervical intraepithelial neoplasia (CIN): CIN alone is not an indication for hysterectomy.
- Adenocarcinoma in situ (AIS) of the cervix: Simple hysterectomy can be an option after invasive disease is excluded.
- Endometrial cancer: Hysterectomy is an accepted treatment or staging procedure and may have roles in cervical, ovarian, and fallopian tube cancers depending on the case.
Acute indications
- Intractable postpartum hemorrhage when conservative therapy fails.
- Ruptured or antibiotic-refractory tubo-ovarian abscess in selected cases (sometimes with bilateral salpingo-oophorectomy).
- Acute menorrhagia refractory to medical or conservative surgical treatment.
Before deciding: the work-up
Good preoperative assessment helps confirm the diagnosis and ensures hysterectomy is being chosen for the right reason, not simply because it is available.
Canadian guidance stresses that for abnormal uterine bleeding, endometrial lesions should be excluded and medical alternatives should be considered first-line.
- Clarify the main problem: bleeding, bulk/pressure, pain, prolapse, cancer risk, or confirmed malignancy.
- Review treatments already tried (medical therapy, IUD, conservative surgery, interventional radiology options).
- Confirm reproductive goals and values (fertility, uterine conservation for personal/cultural reasons).
- Optimize health (anemia, diabetes control, smoking cessation, sleep apnea management when relevant).
Uterus-preserving alternatives
Many conditions that lead to hysterectomy can also be treated with uterus-preserving options, and selecting among them depends on diagnosis, anatomy, symptom severity, and reproductive plans.
Fibroids and heavy bleeding
- Medical therapy (e.g., anti-inflammatories, tranexamic acid, hormonal options, LNG-IUD where appropriate).
- Myomectomy (hysteroscopic, laparoscopic, or open) for uterine preservation and fertility goals.
- Uterine artery embolization (UAE) for selected patients who want to avoid hysterectomy and do not prioritize future pregnancy.
- Radiofrequency ablation (RFA) or focused ultrasound in selected settings (availability varies).
- Endometrial ablation for carefully selected patients who have completed childbearing and do not have significant cavity-distorting fibroids.
Endometriosis and pelvic pain
For endometriosis, hysterectomy is generally reserved for severe, refractory symptoms after other treatments have failed and when future fertility is not desired, aligning with Canadian guidance.
Pelvic organ prolapse
Prolapse does not automatically require hysterectomy, and uterine-preserving prolapse repairs (hysteropexy) can be appropriate for patients who want uterine conservation and have no uterine pathology requiring removal.
A 2025 prospective cohort study reported uterine-preserving prolapse surgery was associated with shorter surgery and hospitalization, fewer procedural complications, and lower composite recurrence up to 1 year compared with hysterectomy-based repair, without clinically meaningful differences in functional outcomes.
Choosing the surgical route
Surgical route affects recovery time, complication risk, and overall cost, so the route should be selected deliberately rather than by habit.
Canadian guidance
- The vaginal route should be considered first choice for all benign indications.
- The laparoscopic route should be considered when it reduces the need for laparotomy (open surgery).
International route-selection factors
ACOG notes route selection for benign disease can be influenced by uterine/vaginal size and shape, uterine accessibility, extrauterine disease, need for concurrent procedures, surgeon experience, available resources, whether the case is emergent, and the informed patient’s preference.
ACOG also states minimally invasive approaches (vaginal or laparoscopic) should be used whenever feasible, with vaginal preferred when possible and laparoscopic preferred over open abdominal if vaginal is not feasible.
Routes at a glance
| Route | How it’s done | Common advantages | Common limitations |
|---|---|---|---|
| Vaginal | Uterus removed through the vagina. | Often least invasive; typically faster recovery vs open; preferred option when feasible. | May be limited by uterine size, adhesions, adnexal disease, or complex concurrent procedures. |
| Laparoscopic (± robotic) | Small abdominal incisions; uterus removed vaginally or using other appropriate techniques. | Minimally invasive alternative when vaginal is not feasible; avoids large incision. | Requires equipment and expertise; some cases require conversion to open surgery. |
| Abdominal (open) | Larger incision (laparotomy). | Important option when minimally invasive routes are unsafe or impractical. | More postoperative pain and longer recovery vs minimally invasive routes. |
Perioperative safety essentials
Perioperative safety focuses on infection prevention, clot prevention, pain control, and early mobilization.
Antibiotic prophylaxis (infection prevention)
Joint surgical prophylaxis guidelines state that prophylactic antibiotics should be given within 60 minutes before incision for most agents (and within 120 minutes for agents that require longer infusion, such as vancomycin or fluoroquinolones).
The same guideline includes recommended prophylactic regimens for hysterectomy (vaginal or abdominal), with agent selection individualized to allergy history and patient factors.
Thromboprophylaxis (clot prevention)
Clot prevention typically includes individualized risk assessment, early ambulation, mechanical compression, and medication prophylaxis when indicated by patient risk and local protocols.
What to expect: surgery to discharge
Many hysterectomies are done under general anesthesia, and postoperative pathways emphasize early mobilization and multimodal pain control.
- Pre-op check-in and anesthesia assessment.
- Procedure performed via the planned route (vaginal, laparoscopic, or open).
- Temporary urinary catheter during surgery and sometimes briefly afterward.
- Walking soon after surgery when safe to reduce clot and lung complications.
- Discharge planning with clear instructions (activity, bleeding expectations, pain control, warning signs).
Recovery at home
Recovery depends strongly on the surgical route and on whether additional procedures were performed (for example, prolapse repair).
- Expect fatigue, intermittent pelvic discomfort, bloating, and bowel sluggishness early on.
- Prioritize daily walking and hydration, and manage constipation proactively.
- Avoid heavy lifting until cleared by the surgical team.
- Follow individualized timelines for driving, work, exercise, bathing, and intercourse.
Risks and long-term considerations
Hysterectomy is common and often highly effective, but it is still major surgery and requires informed consent that includes short- and long-term risks.
Short-term risks
- Bleeding requiring transfusion (uncommon but possible).
- Infection (urinary tract, vaginal cuff, pelvic infection, wound infection).
- Injury to bladder, ureters, or bowel (risk varies with complexity and adhesions).
- Blood clots (DVT/PE) and anesthesia-related complications.
Long-term considerations
- Fertility ends after uterus removal.
- Pelvic floor outcomes depend on baseline support and concurrent repairs.
- Ovary removal causes immediate menopause; ovary conservation avoids surgical menopause but does not eliminate all long-term considerations.
Tubes, ovaries, and risk reduction
ACOG notes opportunistic salpingectomy (removal of fallopian tubes) can often be safely accomplished at the time of hysterectomy and that plans for salpingectomy should not automatically change the intended route of hysterectomy.
Ovary removal is a separate decision that must balance potential cancer-risk reduction benefits against the harms of immediate menopause and long-term health effects, with the balance shifting by age, genetic risk, and ovarian pathology.
Morcellation and informed consent
When hysterectomy is performed laparoscopically for presumed benign disease, tissue extraction methods (including morcellation) may be discussed, and ACOG highlights the concern that morcellation can spread an occult malignancy, making shared decision-making essential.
Who benefits from uterine-preserving care
Uterus-preserving options deserve special consideration for patients who want future pregnancy, those who prefer uterine conservation for personal/cultural reasons, and prolapse patients who are candidates for hysteropexy.
Evidence from a 2025 cohort study supports uterine-preserving prolapse surgery as a safe and effective alternative to hysterectomy-based repair in appropriately selected patients.
Frequently asked questions
Will hysterectomy stop my periods?
Yes. Removing the uterus stops menstruation because there is no uterine lining to shed.
Will it cure pelvic pain?
Not always. Canadian guidance recommends a multidisciplinary approach for chronic pelvic pain because evidence that hysterectomy cures chronic pelvic pain is limited, though it may help when pain is strongly linked to dysmenorrhea or clear pelvic disease.
Is vaginal hysterectomy “better”?
When feasible for benign disease, Canadian guidance recommends considering the vaginal route first, and ACOG likewise prefers vaginal hysterectomy when possible (with laparoscopic preferred over open if vaginal is not feasible).
Why would an open abdominal hysterectomy be needed?
Some clinical situations make minimally invasive routes unsafe or impractical (for example, complex adhesions, very large uterus, or disease requiring a specific oncologic operation).
Do antibiotics have to be given before surgery?
Prophylactic antibiotics are standard for many hysterectomy pathways, and surgical prophylaxis guidance emphasizes appropriate timing (within 60 minutes before incision for most agents).
Can the uterus be preserved in prolapse surgery?
Often, yes. A 2025 cohort study found uterine-preserving prolapse surgery was associated with fewer procedural complications and lower composite recurrence up to 1 year compared with hysterectomy-based repair, with no clinically meaningful differences in functional outcomes.
What should trigger urgent medical attention after discharge?
Heavy bleeding, fever, worsening pelvic/abdominal pain, chest pain or shortness of breath, fainting, or leg swelling/redness should be assessed urgently.
Evidence-based resources
The links below are commonly used for clinician and patient education and were selected for stability and accessibility.
- ACOG route guidance: Choosing the Route of Hysterectomy for Benign Disease (Committee Opinion)
- Surgical antibiotic prophylaxis guideline (AJHP): Clinical practice guidelines for antimicrobial prophylaxis in surgery
- Uterine-preserving prolapse surgery outcomes (PubMed): Hysterectomy versus uterine preservation for pelvic organ prolapse surgery (2025)