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Hysterectomy
A woman's reproductive organs include the uterus (womb), vagina, fallopian tubes, and ovaries. Surgery to remove the uterus is called hysterectomy. Hysterectomy is a common operation for women in the United States, second only to cesarean section (abdominal delivery of a pregnancy). Because hysterectomy is major surgery with risks, alternatives to this treatment may need to be considered along with the benefits of having a hysterectomy. Women who have a hysterectomy stop having menstrual periods and cannot become pregnant or give birth. If the tubes and ovaries are removed along with the uterus (called a hysterectomy with bilateral salpingo-oophorectomy) menopause will occur, regardless of the patient's age, because of the absence of estrogen produced by the ovaries. Removing the uterus may speed the onset of menopause by several years. The March 24/31, 2004, issue of JAMA includes an article about hysterectomy for abnormal uterine bleeding.
REASONS FOR HAVING A HYSTERECTOMY
Reasons for having a hysterectomy include abnormal uterine bleeding, such as menorrhagia (extremely heavy menstrual periods); uterine fibroids (benign tumors causing heavy or irregular bleeding or pressure); chronic pelvic pain due to uterine adenomyosis (uterine glands that penetrate into the muscle of the uterus) or endometriosis (uterine glands that implant into other pelvic tissues); uterine prolapse (uterus protruding into the vagina); and cancer of the female reproductive organs.
TYPES OF HYSTERECTOMY
- Supracervical (or subtotal) hysterectomy—most of the uterus is removed, but the cervix (neck of the uterus) is not removed.
- Total hysterectomy—the entire uterus is removed, with or without the tubes and ovaries.
- Radical hysterectomy—removal of the uterus and surrounding tissues, including the upper third of the vagina; this is mainly done, along with removal of pelvic lymph nodes, for treatment of early cervical cancer.
SURGICAL PROCEDURES FOR HYSTERECTOMY
• Vaginal—the uterus is removed through the vagina.
• Abdominal—the uterus is removed through an incision in the woman's abdomen.
• Laparoscopic—the uterus is removed in sections through small incisions using a laparoscope (a tube with a video camera to view organs).
FOR MORE INFORMATION
INFORM YOURSELF
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. A Patient Page on laparoscopic surgery was published in the January 16, 2002, issue; one on ovarian cancer was published in the July 17, 2002, issue; one on endometrial cancer was published in the October 2, 2002, issue; and one on perimenopause was published in the February 19, 2003, issue.
Sources: National Women's Health Information Center, American College of Obstetricians and Gynecologists, American Academy of Family Physicians
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.
TOPIC: WOMEN'S HEALTH
Janet M. Torpy, MD, Writer;
Cassio Lynm, MA, Illustrator;
Richard M. Glass, MD, Editor
JAMA. 2004;291:1526.
RELATED ARTICLE
Effect of Hysterectomy vs Medical Treatment on Health-Related Quality of Life and Sexual Functioning: The Medicine or Surgery (Ms) Randomized Trial
Miriam Kuppermann, R. Edward Varner, Robert L. Summitt, Jr, Lee A. Learman, Christine Ireland, Eric Vittinghoff, Anita L. Stewart, Feng Lin, Holly E. Richter, Jonathan Showstack, Stephen B. Hulley, and A. Eugene Washington
JAMA. 2004;291(12):1447-1455.
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