A hysterectomy is the surgical removal of the uterus, usually done by a gynecologist. Hysterectomy may be total (removing the body and cervix of the uterus) or partial (also called supra-cervical). In many cases, surgical removal of the ovaries (oophorectomy) is performed concurrent with a hysterectomy. The surgery is then called "Total abdominal hysterectomy with salpingo-oopherectomy."
Although many hysterectomies are performed via a full abdominal incision laparotomy, two common surgical approaches which are less invasive are laparoscopically or vaginally. Surgery with ovarian conservation is an option for the pre-menopausal patient with benign disease (non cancer).
Indications for hysterectomy include Fibroids, pelvic pain (including endometriosis and adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and cancer or pre-cancer diseases.
Fibroids, although a benign disease, may cause heavy menstrual flow and discomfort to some women. Many treatments are possible: medical (the use of NSAIDS for the pain or hormones to suppress the menstrual cycle), uterine artery embolization, or surgical. The surgical treatment varies depending on the location of the fibroids: if inside the lining of the uterus, the hysteroscopic removal might be an option. The safer option should be discussed between the doctor and the patient.
Treatment of cancer: Early stage cancer of the cervix and body of the uterus are both treatable by surgery. In some cases of early cervical cancer, the survival rates are the between a hysterectomy or radiotherapy.
New treatment options have begun to decrease the number of hysterectomies performed in the USA, Canada and UK. Despite this, some women still undergo unnecessary surgery, as some are not given adequate access to good therapeutic alternatives.