A hysterectomy (from the Greek word histera, meaning "womb") is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body but leaving the cervical stump, also called "supracervical"). In 2005, there were 617,000 hysterectomies performed in the USA. During a hysterectomy, in the last decade, an average of 73% of surgeons removed ovaries and fallopian tubes during the same operation, a procedure known technically as bilateral salpingo-oophorectomy and less formally as ovariohysterectomy. “Surgeon” redirects here. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... The shamefulness associated with the examination of female genitalia has long inhibited the science of gynaecology. ... Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges (singular salpinx) are two very fine tubes leading from the ovaries of female mammals into the uterus. ... Oophorectomy is the surgical removal of the ovaries of a female animal. ... Oophorectomy is the surgical removal of the ovaries of a female animal. ...

This surgery is exclusively performed on those who are chromosonally female. Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes), and changes their hormonal levels considerably, so the surgery is normally recommended for only a few specific diseases and circumstances:

• Certain types of reproductive system cancers (uterine, cervical, ovarian);
• As a prophylactic treatment for those with either a strong family history of reproductive system cancers (especially breast cancer in conjunction with BRCA1 or BRCA2 mutation) or as part of their recovery from such cancers;
• Postpartum to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta accreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive postpartum bleeding;
• Female to male transsexuals, a.k.a. "transmen", as part of their gender transition.

Although hysterectomy is frequently performed for fibroids (benign tumor-like growths inside the uterus itself made up of muscle and connective tissue), conservative options in treatment are available by doctors who are trained and skilled at alternatives. It is well documented in medical literature that myomectomy, surgical removal of fibroids that leaves the uterus intact, has been performed for over a century.^[specify] Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ... Placenta accreta is a severe obstetric complication involving an abnormal attachment of the placenta to the myometrium (the middle layer of the uterine wall). ... A transsexual (sometimes transexual) person establishes a permanent identity with the opposite gender to their assigned (usually at birth) sex. ... Transmen or trans men are transsexual or transgendered people who were assigned female gender at birth (or, in some rare cases of intersexuality, later) and who feel that this is not an accurate or complete description of themselves. ...

The uterus is a hormone-responsive reproductive sex organ, and the ovaries produce the majority of estrogen and progesterone that is available in genetic females of reproductive age. According to the National Center for Health Statistics, of the 617,000 hysterectomies performed in 2004, 73% also involved the surgical removal of the ovaries. In the United States, 1/3 of genetic females can be expected to have a hysterectomy by age 60.^[1] There are currently an estimate of 22 million people in the United States who have undergone this procedure. An average of 622,000 hysterectomies a year have been performed for the past decade.^[1] National Center for Health Statistics (NCHS) is one of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. ...

Both the uterus and the ovaries have important life-long functions in the maintenance of a woman's health, and there is never an age or a time when the uterus and ovaries are not essential to health and well-being.^[2] Additionally, the removal of otherwise healthy ovaries is a form of castration because it involves removal of the female gonads^[3], which many opponents and even some supporters of hysterectomy^[4] do not support.

Indications

Hysterectomy is usually performed for problems with the uterus itself or problems with the entire female reproductive complex. Some of the conditions treated by hysterectomy include uterine fibroids (myomas), endometriosis (overgrowth of the uterine lining), adenomyosis (a more severe form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall), several forms of vaginal prolapse, heavy or abnormal menstrual bleeding, and at least three forms of cancer (uterine, advanced cervical, ovarian). Hysterectomy is also a surgical last resort in uncontrollable postpartum obstetrical haemorrhage.^[5] Uterine fibroids (leiomyomata, singular leiomyoma) are the most common neoplasm in females, and may affect about 25 % of white and 50% of black women during the reproductive years. ... Adenomyosis is a medical condition characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). ... Vaginal prolapse is characterized by a portion of the vaginal canal protruding from the opening of the vagina. ... It has been suggested that this article or section be merged with Endometrial cancer. ... Cervical cancer is a malignancy of the cervix. ... Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). ... Obstetrical hemorrhage refers to heavy bleeding during pregnancy, labor, or the puerperium. ...

Uterine fibroids, although a benign disease, may cause heavy menstrual flow and discomfort to some of those with the condition. Many alternative treatments are available: pharmaceutical options (the use of NSAIDs or opiates for the pain and hormones to suppress the menstrual cycle); myomectomy (removal of uterine fibroids while leaving the uterus intact); or uterine artery embolization. In mild cases, no treatment is necessary. If the fibroids are inside the lining of the uterus (submucosal), and are smaller than 4cm, hysteroscopic removal is an option. A submucosal fibroid larger than 4cm, and fibroids located in other parts of the uterus, can be removed with a laparotomic myomectomy, where a horizontal incision is made above the pubic bone for better access to the uterus. Uterine fibroids (leiomyomata, singular leiomyoma) are the most common neoplasm in females, and may affect about 25 % of white and 50% of black women during the reproductive years. ... Pharmacology (in Greek: pharmacon is drug, and logos is science) is the study of how chemical substances interfere with living systems. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... Menstrual cycle The menstrual cycle is a recurring cycle of physiological changes that occurs in the females of human beings and great apes. ... Arteries of the female reproductive tract (posterior view): uterine artery, ovarian artery and vaginal arteries. ... Hysteroscopy is the inspection of the uterine cavity by endoscopy. ...

Technique

Most hysterectomies in the United States and in most parts of the world are done via laparotomy, sometimes called the "open technique" or "open hysterectomy". The abdominal wall is sliced open, usually above the pubic bone, as close to the upper hair line of the individual's lower pelvis as possible, similar to the incision made for a caesarean section. This technique allows doctors the greatest access to the reproductive structures and is normally done for removal of the entire reproductive complex. The recovery time for an open hysterectomy is 4-6 weeks and sometimes longer due to the need to cut through the abdominal wall. The open technique carries increased risk of hemorrhage due to the large blood supply in the pelvic region, as well as an increased risk of infection from the need to move intestines and bladder in order to reach the reproductive organs and to search for collateral damage from endometriosis or cancer. However, an open hysterectomy provides the most effective way to ensure complete removal of the reproductive system as well as providing a wide opening for visual inspection of the abdominal cavity. A laparotomy is a surgical maneuver involving an incision through the abdominal wall to gain access into the abdominal cavity. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... In anatomy, the urinary bladder is a hollow, muscular, and distensible (or elastic) organ that sits on the pelvic floor in mammals. ...

An increasing number of uterine removals not involving removal of the ovaries are done through the cervix ("supracervical"), reducing the size of the incision and the recovery time as well. In this technique, the uterus is accessed either via the vaginal canal or through an incision inside the navel (or sometimes both, depending on the uterine problem being addressed by the surgery). The uterus itself is detached at the top of the cervical neck and pulled back through the vaginal canal (or out through the navel incision if fibroids or other indications prevent it from being able to pass through the cervix) , after which the cervical neck is stitched shut. This provides the patient with a comparatively normal-length vagina which helps provide some support to the bladder, as well as a significantly decreased recovery time.^[6] The main drawback with supracervical hysterectomy is the increased risk of cervical prolapse due to the removal of the much stronger uterus (which would normally support the organs around it to prevent prolapse). This surgery also does not eliminate the possibility of cervical cancer, since the cervix itself is left in place; those who have undergone this procedure must still have regular PAP smears to check for cervical cancer. Cervical cancer is a malignancy of the cervix. ...

The newest technique is robotic-assisted laparoscopic hysterectomy. Instead of a large incision, a few tiny incisions are made through which thin instruments are passed. This new technique significantly reduces scarring, pain, healing time, blood loss, and duration of hospital stay when compared to open technique.

Benefits

Women with a risk of breast cancer, especially those with BRCA1 or BRCA2 gene mutations, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy.^[7] In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-only HRT to be prescribed to aid the individual through their transition into surgical menopause, instead of estrogen-progestin HRT, which has a slightly increased risk of breast cancer as compared with post-menopausal non-hysterectomized women taking HRT.^[8] This page is a candidate to be moved to Wiktionary. ... Oophorectomy is the surgical removal of the ovaries of a female animal. ... Estriol. ... HRT is an abbreviation that can stand for: The Hartwell Railroad Company (AAR reporting mark HRT) High rising terminal, a feature of speech Hormone replacement therapy Hormone replacement therapy (trans) for transgender people The Hostage Rescue Team of the US Federal Bureau of Investigations Hrvatska Radiotelevizija, the Croatian public broadcasting...

The Maine Women's Health Study of 1994 followed for 12 months time approximately 800 women with similar gynecological problems (pelvic pain, urinary incontinence due to uterine prolapse, severe endometriosis, excessive menstrual bleeding, large fibroids, painful intercourse), around half of whom had a hysterectomy and half of whom did not. The study found that a substantial number of those who had a hysterectomy had marked improvement in their symptoms following hysterectomy, as well as significant improvement in their overall physical and mental health one year out from their surgery. The study concluded that for those who have intractable gynecological problems that had not responded to non-surgical intervention, hysterectomy may be beneficial to their overall health and wellness.^[4] Year 1994 (MCMXCIV) was a common year starting on Saturday (link will display full 1994 Gregorian calendar). ...

One of the conditions most cited by women who have complex pelvic and reproductive issues is pain^[9]. This is particularly true for women who have other conditions that amplify pain, such as fibromyalgia and chronic fatigue syndrome. Removal of a condition that is causing pain has a dramatic effect on reducing the overall pain levels of a person with such disorders; for many women with such pain conditions, a hysterectomy is preferable to the continual pain which adds to the burden of their already painful lives, even though the loss of hormones post-surgery may initially contribute to an increase in the symptoms of their disorder^[10]. Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. ... Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain etiology, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other industrialized countries, and a smaller fraction of adolescents. ...

Risks and side effects

The average onset age of menopause in those who underwent hysterectomy is 3.7 years earlier than average.^[11] This has been suggested to be due to the disruption of blood supply to the ovaries after a hysterectomy. When the ovaries are also removed, blood estrogen levels fall, removing the protective effects of estrogen on the cardiovascular and skeletal systems. Although sometimes referred to as surgical menopause, that is incorrect and misleading because it implies that its effects are the same as with natural menopause. In fact, those who are naturally menopausal have the benefit of the functions of their uterus and ovaries (which continue to produce small amounts of hormones even after natural menopause), while those who undergo hysterectomy and/or removal of the ovaries have a permanent loss of their functions. Menopause is the physiological cessation of menstrual cycles associated with advancing age in women. ...

When only the uterus is removed there is a three times greater risk of cardiovascular disease. If the ovaries are removed the risk is seven times greater. Several studies have found that osteoporosis (decrease in bone density) and increased risk of bone fractures are associated with hysterectomies.^{[12][13][14][15][16][17]} This has been attributed to the modulatory effect of estrogen on calcium metabolism and the drop in serum estrogen levels after menopause can cause excessive loss of calcium leading to bone wasting. Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... Wikipedia does not yet have an article with this exact name. ...

Those who experience uterine orgasm will not experience it if the uterus is removed. The vagina is shortened and made into a closed pocket and there is a loss of support to the bladder and bowel.^[specify]

Those who have undergone a hysterectomy with both ovaries conserved typically have reduced testosterone levels as compared to those left intact.^[18] Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density,^[19] while conversely, increased testosterone levels in women are associated with a greater sense of sexual desire.^[20] Hysterectomy has also been found to be associated with increased bladder function problems, such as incontinence.^[21] Testosterone is a steroid hormone from the androgen group. ...

An ectopic pregnancy,can be developed.

Alternatives

Many alternatives to hysterectomy exist. Those with dysfunctional uterine bleeding may be treated with endometrial ablation, which is an outpatient procedure in which the lining of the uterus is destroyed with heat. Endometrial ablation will greatly reduce or entirely eliminate monthly bleeding in ninety percent of patients with DUB. In addition, uterine fibroids may be removed without removing the uterus. This procedure is called a "myomectomy." A myomectomy may be performed through an open incision or, in appropriate cases, laparoscopically.^[22] Various other techniques (such as Fibroid Artery Embolization, Myolysis, HALT, and Focused Ultrasound Surgery) kill the fibroid, and then leave it in place to be (usually only partially) reabsorbed by the body. Prolapse may also be corrected surgically without removal of the uterus.^[23] Endometrial ablation is a medical procedure that is used to remove (ablate) or destroy the endometrial lining of a womans uterus. ... Myomectomy refers to the surgical removal of uterine fibroids. ...

Menorrhagia (heavy or abnormal menstrual bleeding) may also be treated with the less invasive endometrial ablation.^[24] Menorrhagia is an abnormally heavy and prolonged menstrual period at regular intervals. ... Endometrial ablation is a medical procedure that is used to remove (ablate) or destroy the endometrial lining of a womans uterus. ...

Gender transitioning

Hysterectomies with bilateral salpingo-oophorectomy are often performed either prior to or as a part of Transman (sometimes called "female-to-male" or "FTM") gender reassignment surgery. Some in the transman community prefer to have this operation along with testosterone therapy in the early stages of their gender transition to avoid complications from heavy testosterone use while still having female-hormone-producing organs in place (e.g. uterine cancer and hormonally-induced coronary artery disease) or to remove as many sources of female sex hormones as possible in order to better "pass" during the real life experience portion of their transition.^[25] Just as many, however, prefer to wait until they have full "bottom surgery" (removal of female sexual organs and construction of male-appearing external anatomy)^[26] to avoid undergoing multiple separate operations.^[27] Many FTM never complete "bottom surgery" for a number of reasons, and instead choose to have their breasts and reproductive organs removed to eliminate all outward appearances of their femininity.^[28] Transmen or trans men are transgender or transsexual people who were assigned female at birth based on genital appearance (or, in cases of intersexuality, were later assigned to the female gender) and who feel that this is not an accurate or complete description of themselves. ... Sex reassignment surgery (SRS) includes the surgical procedures by which a persons physical appearance and function of their existing sexual characteristics are changed to that of the other sex. ... Transmen or trans men are transgender or transsexual people who were assigned female at birth based on genital appearance (or, in cases of intersexuality, were later assigned to the female gender) and who feel that this is not an accurate or complete description of themselves. ... Hormone replacement therapy (HRT) for transgender and transsexual people replaces the hormones naturally occurring in their bodies with those of the other sex. ... It has been suggested that this article or section be merged with Endometrial cancer. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... Real life experience (RLE), sometimes called real life test (RLT), is a process where transsexual and transgender people live in their preferred gender role for a while, in order to demonstrate that they can do so; and historically to gain permission for hormonal treatment and sex reassignment surgery. ... Sexual reassignment surgery from female to male includes surgical procedures which will reshape a female body into a body with a male appearance. ...

References

--> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... November 20 is the 324th day of the year (325th in leap years) in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... 2004 : January - February - March - April - May - June - July - August - September - October - November - December Deaths in May • 28 Gerald Anthony • 27 Umberto Agnelli • 22 Richard Biggs • 20 Len Murray • 17 Tony Randall • 17 Ezzedine Salim • 9 Alan King • 9 Akhmad Kadyrov • 8... is the 183rd day of the year (184th in leap years) in the Gregorian calendar. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... For the Manfred Mann album, see 2006 (album). ... is the 183rd day of the year (184th in leap years) in the Gregorian calendar. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... June 7 is the 158th day of the year in the Gregorian calendar (159th in leap years), with 207 days remaining. ... is the 128th day of the year (129th in leap years) in the Gregorian calendar. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 129th day of the year (130th in leap years) in the Gregorian calendar. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 128th day of the year (129th in leap years) in the Gregorian calendar. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 129th day of the year (130th in leap years) in the Gregorian calendar. ... --> Year 2007 (MMVII) is now the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ...

External links

• Hysterectomy at the Open Directory Project
• A.D.A.M Medical Encyclopedia Article on Hysterectomy
• Mayo Clinic Guide to uterine fibroids, including surgical and non-surgical treatment options
• Encyclopedia of Surgery Article on Hysterectomy
• Hudson's FTM Resources, retrieved May 9, 2007