Gynecologic Conditions
Types of Hysterectomy: Total, Partial, Radical and How It's Done
A hysterectomy is surgery to remove the uterus. The main types are total (uterus and cervix removed), supracervical or partial (uterus removed, cervix kept) and radical (uterus, cervix and surrounding tissue removed, usually for cancer). It can be done through the vagina, through small laparoscopic or robotic incisions, or through a larger abdominal incision, and the ovaries and fallopian tubes may or may not come out at the same time.
Hysterectomy is one of the most common surgeries in the United States. Afterward you won't have periods and can't get pregnant. Beyond that, "a hysterectomy" can mean very different operations, so the useful way to think about it is as three separate decisions.
Decision 1: What gets removed?
| Type | What is removed | Common reasons |
|---|---|---|
| Total hysterectomy | Uterus and cervix | Fibroids, bleeding, adenomyosis, prolapse |
| Supracervical (partial or subtotal) hysterectomy | Uterus only; cervix stays | Some benign conditions |
| Radical hysterectomy | Uterus, cervix, upper vagina and nearby tissue | Certain cancers, especially cervical cancer |
Total vs. partial, in real life. With a supracervical hysterectomy, the cervix stays, so you'll still need cervical cancer screening, and some people keep having light cyclic spotting. A total hysterectomy removes the cervix, and most people without a history of cervical precancer can stop Pap tests afterward.
Decision 2: What about the ovaries and tubes?
This is the part people most often misunderstand. A hysterectomy doesn't automatically include removing the ovaries.
- Salpingectomy removes the fallopian tubes. ACOG notes that removing the tubes during a hysterectomy (opportunistic salpingectomy) may lower the risk of ovarian cancer, because many ovarian cancers are thought to start in the tubes. Ask your surgeon whether it makes sense for you.
- Oophorectomy removes the ovaries. If both come out before menopause, you go into menopause immediately. That's called surgical menopause, and it can bring hot flashes, vaginal dryness and long-term effects on bone and heart health.
For people at average risk who haven't reached menopause, keeping healthy ovaries is often recommended. People with a high inherited risk of ovarian cancer, such as a BRCA mutation, may be advised to have them removed. Get this decision on paper before surgery day; it shouldn't be a surprise in the recovery room.
Decision 3: How is it done?
| Approach | How it works | Typical recovery |
|---|---|---|
| Vaginal | Uterus removed through the vagina; no abdominal incision | Often a few weeks |
| Laparoscopic | Small abdominal incisions with a camera; uterus removed through the vagina or small incisions | Often a few weeks |
| Robotic-assisted | A type of laparoscopic surgery using robotic instruments controlled by the surgeon | Similar to laparoscopic |
| Abdominal | Larger incision, either horizontal (bikini line) or vertical | Often about 4 to 6 weeks or longer |
ACOG recommends vaginal hysterectomy whenever it's feasible for benign conditions, with laparoscopic hysterectomy next when a vaginal approach isn't possible. These minimally invasive routes usually mean less pain, fewer infections, shorter hospital stays and faster recovery than abdominal surgery.
An abdominal hysterectomy may be needed for a very large uterus, a lot of scar tissue, some cancers, or other situations where minimally invasive surgery isn't safe. The surgeon's own experience matters too, so it's fair to ask, "Which approaches do you do, and how often?" If you're told abdominal is the only option for a benign condition, a second opinion is reasonable.
Why it's done, and what else might work
Common reasons:
- Uterine fibroids causing heavy bleeding, pain or pressure
- Abnormal or heavy uterine bleeding that hasn't responded to other treatment
- Adenomyosis
- Endometriosis, in some cases
- Uterine prolapse, when the uterus drops into the vagina
- Chronic pelvic pain
- Precancer or cancer of the uterus, cervix or ovaries
Because the surgery is permanent, it's worth knowing the other options. For noncancerous conditions, depending on your diagnosis, alternatives may include:
- Medicines like NSAIDs, tranexamic acid or hormonal birth control for heavy or painful periods
- A hormonal IUD, which can reduce heavy bleeding and pain for years
- Endometrial ablation for heavy bleeding, if you're done having children
- Myomectomy or uterine fibroid embolization for fibroids
- Laparoscopic removal of endometriosis
- A pessary or pelvic floor therapy for some types of prolapse
ACOG encourages clinicians to discuss alternatives before recommending hysterectomy for benign conditions. It's reasonable to ask which options you've tried, which you haven't, and why hysterectomy is the best fit. See our guides to fibroid treatment options and endometrial ablation.
Before surgery
You may have:
- A Pap test, endometrial biopsy or imaging to rule out cancer
- Blood tests, including a check for anemia (heavy bleeding often leaves people low on iron, and it's better to fix that before surgery)
- A review of your medicines, including blood thinners and supplements
Questions to bring to your surgeon
- Why do you recommend hysterectomy, and what are my alternatives?
- Which type and approach do you recommend, and why?
- Will you remove my cervix, tubes or ovaries?
- Will I stay overnight in the hospital?
- What are the risks for me specifically?
- How long until I can go back to work, drive, lift, and have sex?
What the first days are often like
After a laparoscopic or robotic surgery, many people are surprised by shoulder pain. It's from the gas used to inflate the belly during surgery, and it usually fades over a day or two. Light vaginal spotting or discharge for a few weeks is common. Walking short distances early, even laps around the apartment, helps with gas and lowers clot risk.
If you live in a walk-up, plan ahead: have someone carry groceries and laundry for the first couple of weeks. And arrange a ride home, since you won't be allowed to leave alone after anesthesia.
Risks
The surgery is generally safe, but like any major surgery it carries risks:
- Bleeding and the need for transfusion
- Infection
- Blood clots
- Injury to the bladder, ureters or bowel
- Reactions to anesthesia
- Early menopause if both ovaries are removed
Life afterward
- No more periods or pregnancy.
- Your ovaries keep making hormones if they're left in, until natural menopause.
- Sex can usually resume once you're cleared, often after about six weeks. For most people, hysterectomy doesn't harm sexual function, and some find sex more comfortable if pain or bleeding was the problem before.
- Feelings vary. Some people feel pure relief; others feel a sense of loss, even when they chose the surgery. Both are normal.
For a week-by-week look at healing, read our hysterectomy recovery guide.
When to see a doctor
Talk with a gynecologist about whether hysterectomy is right for you if you have:
- Heavy or painful periods that haven't improved with other treatments
- Fibroids, adenomyosis or endometriosis affecting your quality of life
- Pelvic pressure or a bulge in the vagina
- Abnormal results from an endometrial biopsy or cervical screening
After surgery, call your surgeon for fever, heavy bleeding, worsening belly pain, or redness or drainage at an incision. Call 911 for chest pain or sudden shortness of breath.
Finding a gynecologic surgeon in New York
Many gynecologists in New York perform minimally invasive hysterectomy. When you compare surgeons, ask how often they do vaginal, laparoscopic or robotic hysterectomy. Browse gynecologists by borough or county, or search the directory across New York City, Long Island and the Hudson Valley.
Frequently asked questions
What is the difference between a total and partial hysterectomy?
A total hysterectomy removes the uterus and cervix. A partial (supracervical) hysterectomy removes the uterus but leaves the cervix in place.
Will a hysterectomy put me into menopause?
Not if your ovaries are kept. Your periods stop, but your ovaries keep making hormones. If both ovaries are removed before menopause, you go into menopause right away.
Do I still need Pap tests after a hysterectomy?
If your cervix was kept, yes. If your cervix was removed and you have no history of cervical precancer or cancer, you can usually stop cervical cancer screening. Ask your clinician.
Which type of hysterectomy has the easiest recovery?
Vaginal and laparoscopic (including robotic) hysterectomies generally mean shorter recovery and less pain than abdominal hysterectomy. ACOG recommends the vaginal approach when it's feasible.
Sources
- ACOG — Hysterectomy (Patient FAQ)
- ACOG — Choosing the Route of Hysterectomy for Benign Disease (Committee Opinion 701)
- ACOG — Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (Committee Opinion 774)
- MedlinePlus — Hysterectomy
- NIH, Office on Women's Health — Hysterectomy
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.