When it comes to managing conditions such as endometriosis, adenomyosis and persistent pelvic pain, a hysterectomy may be discussed as a potential treatment option. But did you know there are different types of hysterectomy and they don't all involve removing the same reproductive organs?
Understanding the differences can help you feel more informed, confident and empowered when discussing your treatment options with your healthcare team.
In this blog, we're breaking down the different types of hysterectomy, what each procedure involves, and some important considerations for those navigating pelvic health conditions.
What is a hysterectomy?
A hysterectomy is a surgical procedure that involves removing the uterus (womb). Depending on the type of surgery and the reason it is being performed, other reproductive structures, such as the cervix, fallopian tubes or ovaries, may also be removed.
A hysterectomy may be considered for several reasons, including heavy menstrual bleeding, fibroids, adenomyosis, certain cancers and some cases of persistent pelvic pain.
It's important to understand that a hysterectomy is a major, permanent procedure. Once the uterus is removed, menstrual periods stop and carrying a pregnancy is no longer possible.
However, having a hysterectomy does not automatically mean your ovaries will be removed or that you will immediately experience menopause.
The different types of hysterectomy
1. Partial (Subtotal) Hysterectomy
A partial hysterectomy involves removing the upper portion of the uterus while leaving the cervix in place.
Although menstrual periods generally stop, some people may experience ongoing light or cyclical bleeding. Because the cervix remains, cervical screening is still required.
2. Total Hysterectomy
A total hysterectomy involves removing both the uterus and cervix.
This is the most common type of hysterectomy. The ovaries may be left in place, allowing them to continue producing hormones.
The fallopian tubes may also be removed during the procedure. Current research recommends opportunistic removal of tubes as more than one third of all ovarian cancer originates from the tubes.
3. Radical Hysterectomy
A radical hysterectomy is a more extensive procedure involving removal of the uterus, cervix, surrounding tissues and upper portion of the vagina.
This type of hysterectomy is generally performed to treat certain gynaecological cancers rather than endometriosis or adenomyosis.
What about the ovaries and fallopian tubes?
One of the most important things to understand is that removing the uterus and removing the ovaries are two separate decisions.
You may hear your specialist use the following terms:
- Salpingectomy: Removal of one or both fallopian tubes.
- Oophorectomy: Removal of one or both ovaries.
- Bilateral salpingo-oophorectomy: Removal of both ovaries and both fallopian tubes.
If both ovaries are removed before natural menopause, this causes immediate surgical menopause, which can bring changes to hormone levels and symptoms such as hot flushes, sleep disturbances and vaginal dryness. This can also have long-term implications of reduced bone density and increased cardiovascular disease.
If the ovaries are retained, they can continue producing hormones even after the uterus has been removed.
This is particularly important for people with endometriosis, as the decision to retain or remove the ovaries may influence future symptoms, hormone management and long-term health.
How is a hysterectomy performed?
There are also different surgical approaches to hysterectomy. These describe how the procedure is performed, rather than which organs are removed.
A hysterectomy may be performed through:
- Laparoscopic surgery (keyhole surgery): Small incisions are made in the abdomen, allowing the surgeon to operate using a camera and specialised instruments.
- Vaginal surgery: The uterus is removed through the vagina, without abdominal incisions.
- Abdominal surgery (open surgery): A larger incision is made in the abdomen to access and remove the uterus.
- Robotic-assisted surgery: The surgeon controls robotic instruments to perform a laparoscopic procedure.
The most appropriate approach depends on several factors, including medical history, previous surgeries, the size of the uterus and the extent of any endometriosis or other pelvic conditions.
Is a hysterectomy a cure for endometriosis?
This is an especially important distinction.
A hysterectomy is not considered a cure for endometriosis.
Endometriosis involves tissue similar to the lining of the uterus growing outside the uterus. Removing the uterus does not necessarily remove endometriosis lesions elsewhere in the pelvis or body.
For some people, a hysterectomy may improve certain symptoms, particularly where adenomyosis or uterine bleeding is contributing to pain. However, endometriosis-related pain can persist after surgery, and additional treatment may still be required.
Adenomyosis is different because it affects the muscular wall of the uterus. Removing the uterus is considered a definitive treatment for adenomyosis itself, although it may not resolve pain caused by other coexisting conditions.
This is why an individualised treatment plan and a thorough discussion with an appropriately experienced specialist are so important.
Questions to ask your specialist
If you're considering a hysterectomy, it's okay to ask questions, seek clarification and take the time you need to make an informed decision.
Some helpful questions include:
1. Which type of hysterectomy are you recommending, and why?
2. Will my cervix, fallopian tubes or ovaries be removed?
3. How might this procedure affect my hormones and menopause?
4. If I have endometriosis, will any visible lesions also be treated during surgery?
5. What symptoms is this surgery expected to improve, and which might remain?
6. What are the risks, recovery expectations and alternative treatment options?
Remember, you deserve to understand your treatment options and be actively involved in decisions about your body.
Knowledge is power when navigating pelvic health
Making decisions about surgery can feel overwhelming, particularly when you've spent years navigating pain, symptoms or challenges accessing appropriate healthcare.
There is no one-size-fits-all approach to managing endometriosis, adenomyosis or persistent pelvic pain. What works for one person may not be the right option for another.
At QENDO, we believe everyone deserves access to reliable information, compassionate support and the opportunity to make informed decisions about their healthcare.
Whether you're considering a hysterectomy, preparing for an upcoming appointment or simply wanting to understand your options, we're here to support you.
Learn more about The Basics from Dr Albert Jung on AskQENDO The Basics with Dr Albert Jung - YouTube
________
This blog is intended for educational purposes only and does not replace the advice, diagnosis or treatment provided by qualified medical or allied health professionals. Endometriosis and persistent pelvic pain are best managed through a multidisciplinary approach to care. Please consult your healthcare professional before acting on or implementing any of the information shared in this blog.
