Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

Subtotal Hysterectomy involves only the removal of the uterus. The pelvic structural ligaments are not cut and the cervix is left in place. Fallopian tubes and ovaries may or may not be removed. This procedure is always done through the abdomen.

Total Hysterectomy involves removing both the body of the uterus and the cervix, which is the lower part of the uterus. It can sometimes be done through the vagina (vaginal hysterectomy); at other times, a surgical incision in the abdomen is preferable.

In a total hysterectomy and bilateral (both sides) salpingo-oophorectomy, the ovaries and fallopian tubes are removed, along with the uterus and cervix.

Radical Hysterectomy is reserved for serious disease such as cancer. The entire uterus and usually both tubes and ovaries as well as the pelvic lymph nodes are removed through the abdomen.

There are a variety of surgical methods which a physician may use in performing a hysterectomy. It is extremely important to talk with your doctor about the kind of surgical method recommended for you.

In addition to the direct surgical risks, there may be longer-term physical and psychological effects, potentially including depression and loss of sexual pleasure. If the ovaries are removed along with the uterus prior to menopause, there is an increased risk of osteoporosis and heart disease as well.

In making a decision, you should consider that a hysterectomy is not reversible. After a hysterectomy, you will no longer be able to bear children and you will no longer menstruate.

A hysterectomy may be life-saving in the case of cancer. It can also relieve the symptoms of bleeding, discomfort, or uterine prolapse related to fibroids. However, you may find other treatment choices allowing you to retain your uterus more reasonable for the treatment of your benign uterine fibroids.

Surgical Risks
The surgical risks of hysterectomy and myomectomy include the risks of any major operation. You may have a fever during recovery. You may have a bladder infection or wound infection. A blood transfusion before surgery may be necessary because of anemia or during surgery for blood loss. Complications related to anesthesia may occur.

As with any major abdominal or pelvic operation, serious complications such as blood clots, severe infection, adhesions, postoperative (after surgery) hemorrhage, bowel obstruction or injury to the urinary tract can happen. Rarely, even death can occur. (Eleven women die for every 10,000 hysterectomies performed.)

Myomectomy
Today, many women and their doctors are considering other minimally invasive treatment options, which may eliminate symptoms.

If a fibroid is particularly troublesome, the surgeon often can remove only the tumor, leaving the uterus intact. This procedure is called myomectomy. This is done when a woman wants to be able to have children or wishes to retain her uterus as a personal choice.

There are a number of techniques that can be used to perform a myomectomy:

Laparoscopic myomectomy (or robotic myomectomy), which involves the use of a thin, telescope-like instrument attached to a small video camera called a laparoscope inserted through a tiny incision at the belly button. The surgeon uses specialized surgical instruments inserted through this incision and two or three additional small incisions in the abdomen to remove the fibroids.

Hysteroscopic myomectomy, a procedure in which some fibroids are removed through the vagina using a surgical instrument called a hysteroscope (a thin, telescope-like instrument inserted through the cervix and into the uterus). This technique can be employed when the fibroid is within the uterine cavity.

Laparotomy, which involves an abdominal incision to remove all fibroids, no matter the size or location of the tumors.

Fibroid embolization. This treatment works by decreasing the blood supply to the fibroids, causing them to shrink. This is a minimally invasive procedure performed by an interventional radiologist. Patients are typically able to return home the day after the procedure. This treatment is not offered to women who want children.