The surgical removal of a woman’s uterus (womb) is called a hysterectomy. This procedure is the second most common operation for women in the United States after Caesarean sections, according to the American College of Obstetricians and Gynecologists (ACOG). 

The female reproductive organs include the uterus, vagina, fallopian tubes and ovaries. A woman’s uterus is an organ located in the pelvic region and its opening is called the cervix.

At times, women may develop problems within the uterus, including heavy menstrual periods, pelvic pain, endometriosis, fibroids or cancer. When all other less invasive options have been exhausted, physicians often recommend a hysterectomy to treat these conditions.

The Centers for Disease Control and Prevention (CDC) report that over 600,000 hysterectomies are performed each year in the United States, with more than half of these performed on women under 49 years old. In addition, the CDC estimates that more than one in nine women in the 35 to 45 year old age group has had a hysterectomy. By the age of 60, one in three American women will have had a hysterectomy. The most common reasons for having a hysterectomy are uterine fibroids, endometriosis and uterine prolapse (a condition in which the uterus drops from its position to lower in the pelvic area).

Depending on the reason for the procedure, the woman’s ovaries and fallopian tubes are sometimes removed during a hysterectomy. The removal of the ovaries is known as an oophorectomy, and the removal of the fallopian tubes is called a salpingectomy. When both of the ovaries and the fallopian tubes are removed, it is referred to as a bilateral salpingo-oophorectomy.

For premenopausal women, the removal of the ovaries will effectively cease the production of estrogen and progesterone, which leads to premature or surgical menopause. Therefore, depending on the reason for the hysterectomy, some women will elect to keep their ovaries. According to the CDC, slightly more than half of the women who undergo a hysterectomy also have an oophorectomy. Women who wish to become pregnant will need to consider other methods of treatment for their condition as conception of a child is no longer possible following this procedure or any of its variations.

Insurance companies classify the vast majority of hysterectomies as elective procedures. Elective means that the surgery is performed to improve the health of a patient or to better control her symptoms, but it is not strictly necessary to save the patient’s life. Therefore, hysterectomy may not be covered under the patient’s policy. Elective reasons for hysterectomy include:

• Uterine fibroids. Although the cause of uterine fibroids is unknown, these often undetected benign (noncancerous) masses that grow in the uterus are believed to be related to estrogen levels since they tend to grow when a woman takes oral contraceptives (birth control pills). This condition, also known as uterine leiomyomas, can cause difficulty achieving pregnancy, pelvic pain and heavy bleeding. It is the most common reason a hysterectomy is performed. According to the ACOG, uterine fibroids are clinically apparent in as many as 50 percent of women, and some studies suggest the prevalence could be as high as 80 percent.
  
  
• Endometriosis. This painful condition affects more than five million women in the United States, according to the CDC. Endometriosis develops when the endometrium (lining of the uterus) attaches to other nearby organs. The condition is the leading cause of chronic pelvic pain, female infertility and gynecologic surgeries (e.g., laparoscopy). Hysterectomy that results from endometriosis usually includes removal of the ovaries and fallopian tubes, and will be performed abdominally.
  
  
• Severe pelvic infections.
  
  
• Certain cases of hyperplasia. Hyperplasia is the presence of abnormal cells in the lining of the uterus which, left untreated, can develop into uterine cancer.
  
  
• Uterine prolapse. A condition in which the uterus drops from its position to lower in the pelvic area.
  
  
• Chronic pelvic pain.
  
  
• Ovarian cysts.
  
  
• Ectopic pregnancy. A pregnancy that develops outside of the uterus.

However, at times a hysterectomy is considered medically necessary. Some medically necessary reasons for a hysterectomy include:

• Cervical cancer or other invasive cancers of the reproductive system (including cancers of the uterus, ovaries, fallopian tubes or vagina).
  
  
• Severe infection (e.g., pelvic inflammatory disease or PID) that is unresponsive to treatment.
  
  
• Heavy menstrual bleeding (menorrhagia) that cannot be controlled.
  
  
• Rupture of the uterus (which may occur during childbirth).
  
  
• Placental bleeding during childbirth.
  
  
• Uterine growth blocking the bladder or intestines.
  
  
• Adenomyosis (endometrial tissue has deeply penetrated the muscle wall of the uterus).

A hysterectomy can be partial, complete or radical, depending on the reason for the procedure. The partial – or subtotal hysterectomy, as it is sometimes referred to – leaves the patient’s cervix intact. The complete (total) hysterectomy removes both the uterus and the cervix, and the radical hysterectomy removes the uterus, cervix and ovaries as well as the structures that support the uterus.

Hysterectomies are often performed by gynecologists (physicians who specialize in the female reproductive system). There are several different alternatives when it comes to having a hysterectomy, including:

• Abdominal hysterectomy. The most common type, in which the uterus is removed through an abdominal incision.
  
  
• Vaginal hysterectomy. Used only when the uterus can be easily removed through the vaginal opening and when the detection of a possible cancer is not a concern.
  
  
• Laparoscopic assisted vaginal hysterectomy. The uterus is removed through the vagina with the aid of one or more minute incisions in the abdomen into which a lighted viewing instrument is inserted to guide the procedure.
  
  
• Laparoscopic supracervical hysterectomy. Tiny incisions in the abdomen are used to insert a laparoscope and surgical instruments and the uterus is taken one small piece at a time while the cervix is left intact.

These procedures vary depending on the medical reason for the hysterectomy, the size and position of the uterus and any other individual health concerns of the patient.