Dr. Suzanne Trupin is a Clinical Professor of Obstetrics and Gynecology at the University Of Illinois College Of Medicine at Urbana-Champaign. She graduated from Stanford University and completed her medical training at New York Medical in Valhalla, New York. She received her residency training at the University of Southern California Women's Hospital in Los Angeles, California. She is Board-Certified by the American Board of Obstetrics and Gynecology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
endometriosis, and uterine prolapse (including pelvic relaxation).
Only 10% of hysterectomies are performed for cancer. This article will primarily focus on the use of hysterectomy for non-cancerous, non-emergency reasons, which can involve even more challenging decisions for women and their doctors.
Uterine fibroids (also known as uterine leiomyomata) are by far the most common reason a hysterectomy is performed. Uterine fibroids are benign growths of the uterus, the cause of which is unknown. Although the vast majority are benign, meaning they do not cause or turn into cancer, uterine fibroids can cause medical problems. Indications for hysterectomy in cases of uterine fibroids are excessive size (usually greater than the size of a two-month pregnancy), pressure or pain, and/or bleeding severe enough to produce anemia. Pelvic relaxation is another condition that can require treatment with a hysterectomy. In this condition, a woman experiences a loosening of the support muscles and tissues in the pelvic floor area. Mild relaxation can cause first degree prolapse, in which the cervix (the uterine opening) is about halfway down into the vagina. In second degree prolapse, the cervix or leading edge of the uterus has moved to the vaginal opening, and in third degree prolapse, the cervix and uterus protrude past the vaginal opening. Second and third degree uterine prolapse must be treated with hysterectomy. A vaginal wall weakness such as a cystocele, rectocele, or urethrocele, can lead to symptoms such as urinary incontinence (unintentional loss of urine), pelvic heaviness, and impaired sexual performance. Urine loss tends to be aggravated by sneezing, coughing, jumping, or laughing. Childbearing is the most common risk factor for pelvic relaxation, though there may be other causes. Avoidance of vaginal birth and having a caesarean section doesn't necessarily eliminate the risk of developing pelvic relaxation.
A hysterectomy is also performed to treat uterine cancer or very severe pre-cancers (called dysplasia, carcinoma in situ, or CIN III, or microinvasive carcinoma of the cervix). A hysterectomy for endometrial cancer (uterine lining cancer) has an obvious purpose, that of removal of the cancer from the body. This procedure is the foundation of treatment for cancer of the uterus.
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Viewer Question: Is it necessary to have a Pap smear if you have had a hysterectomy?
Dr. Stöppler's Answer: In some types of hysterectomy, the entire uterus is removed, including the cervix
(the opening to the uterus). If you have had your cervix removed, you usually won't need to have regular Pap smears. In other types of hysterectomies, the cervix is left intact, and the portion of the uterus above the cervix is removed. In this case, the cervix is still present and
Pap smears are still required.