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Hysterectomy

Surgery to remove the uterus and, sometimes, the cervix. When the uterus and the cervix are removed, it is called a total hysterectomy. When only the uterus is removed, it is called a partial hysterectomy.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

What works? Research summarized

Evidence reviews

Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

Hysterectomy versus hysterectomy plus ovary removal for premenopausal women

Review question: Cochrane authors reviewed the evidence on the risks and benefits of the removal or conservation of ovaries at the time of hysterectomy for benign gynaecological disease in premenopausal women.

Subtotal versus total hysterectomy

When hysterectomy is required for non‐cancerous conditions, either the uterus alone (subtotal hysterectomy) or the uterus and the cervix (total hysterectomy) are removed. It has been suggested that not removing the cervix (subtotal hysterectomy) would reduce the chances of sexual difficulties or problems with passing urine or stools. This review has found no evidence of a difference between these two different operations for these outcomes. Surgery is faster with subtotal hysterectomy and there is less blood loss during or just after surgery, although these benefits are not large. With subtotal hysterectomy, women are less likely to experience fever during or just after surgery but are more likely to have long term ongoing menstrual bleeding when compared with total hysterectomy.

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Summaries for consumers

Hysterectomy versus hysterectomy plus ovary removal for premenopausal women

Review question: Cochrane authors reviewed the evidence on the risks and benefits of the removal or conservation of ovaries at the time of hysterectomy for benign gynaecological disease in premenopausal women.

Subtotal versus total hysterectomy

When hysterectomy is required for non‐cancerous conditions, either the uterus alone (subtotal hysterectomy) or the uterus and the cervix (total hysterectomy) are removed. It has been suggested that not removing the cervix (subtotal hysterectomy) would reduce the chances of sexual difficulties or problems with passing urine or stools. This review has found no evidence of a difference between these two different operations for these outcomes. Surgery is faster with subtotal hysterectomy and there is less blood loss during or just after surgery, although these benefits are not large. With subtotal hysterectomy, women are less likely to experience fever during or just after surgery but are more likely to have long term ongoing menstrual bleeding when compared with total hysterectomy.

The effect of chemotherapy on survival from early womb cancer after hysterectomy

Womb (uterine/endometrial) cancer is a fairly common disease affecting approximately 1 in 70 women. A hysterectomy is usually curative because most cancers have a low risk of spreading (metastasising) to other sites which may result in a later recurrence. Microscopic examination of the hysterectomy specimen can tell doctors if there is a high risk of the cancer returning and this allows women to decide if they want further preventative treatment (adjuvant therapy) to reduce the risk. Chemotherapy can increase cure rates for other types of high‐risk cancer after initial surgery and this review examines the effectiveness of chemotherapy for primary womb cancer after hysterectomy. Data from nine high quality randomised clinical trials involving up to 2197 women were subjected to systematic statistical modelling. This shows that chemotherapy reduces the risk of recurrent disease, lengthens the duration women have before a metastasis is diagnosed and improves survival rates. There are many ways to examine the data. The subset analysis that excluded old fashioned drug regimens suggests that chemotherapy reduces the risk of being dead at any nominated time by a quarter. The number of women who would need to have need chemotherapy to prevent one death depends on the type of cancer. In these trials, one woman was cured for every 25 women treated with high dose platinum based chemotherapy after hysterectomy. This is an absolute risk reduction of 4%. Chemotherapy is associated with a greater survival advantage than radiotherapy and has added value when used with radiotherapy. It also appears to reduce the absolute risk of developing a recurrence outside the pelvis by about 5%. This would benefit one woman in every 20 treated. However, chemotherapy has side effects, risks and temporarily reduces a woman's quality of life. In many cases, the small reduction in the cancer recurrence risk may not be worth the side effects of adjuvant treatment.

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Terms to know

Abdominal Hysterectomy
Surgical removal of part or all of the uterus via an abdominal approach.
Cervix
The lower, narrow end of the uterus that forms a canal between the uterus and vagina.
Laparoscopic Surgery (Keyhole Surgery)
Surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Also called laparoscopic-assisted resection.
Laparoscopy
A procedure that uses a laparoscope, inserted through the abdominal wall, to examine the inside of the abdomen. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
Partial Hysterectomy (Subtotal Hysterectomy)
Surgery to remove the uterus, but not the cervix. Also called partial hysterectomy.
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy
Surgical removal of all of the uterus, and the right and left fallopian tubes, and the right and left ovaries.
Total Hysterectomy (Complete Hysterectomy)
Surgery to remove the entire uterus, including the cervix. Also called complete hysterectomy.
Uterus (Womb)
The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called womb.
Vaginal Hysterectomy
A surgical procedure to remove the uterine body and cervix, via the vaginal approach.

More about Hysterectomy

Photo of an adult woman

Also called: Uterine excision, Excision of the uterus

Other terms to know: See all 9
Abdominal Hysterectomy, Cervix, Laparoscopic Surgery (Keyhole Surgery)

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