Surgical Options for Fibroids: Hysterectomy

Hysterectomy is one of the most common surgeries performed on women in the United States, with several hundred thousand procedures each year. Roughly 1 in 3 U.S. women has had a hysterectomy by age 60.

This article explains when hysterectomy is an option for fibroids, how it is done, and how to find the right surgeon.

Why choose a hysterectomy for fibroids?

Many women consider hysterectomy when other treatments have not relieved their fibroid symptoms, or when they prefer a permanent solution. After a hysterectomy, heavy periods, pelvic pressure, and frequent urination caused by fibroids are resolved, and new fibroids cannot form. A woman can no longer become pregnant after a hysterectomy, so it is generally for women who have finished having children.

Alternatives that keep the uterus include medications, myomectomy, uterine artery embolization, and radiofrequency ablation. You should hear about these before deciding.

What happens to the ovaries and tubes?

Removing the uterus does not require removing the ovaries. Before menopause, keeping healthy ovaries is usually recommended, because removing them causes immediate menopause, with hot flashes, vaginal dryness, and long-term effects on bone and heart health. Some women choose to have their ovaries removed, for example if they are near or past menopause or have a high inherited risk of ovarian cancer.

Surgeons now often remove the fallopian tubes during hysterectomy (salpingectomy), because many ovarian cancers are thought to begin in the tubes. This lowers ovarian cancer risk without causing menopause. Discuss the pros and cons of each option with your surgeon.

How is a hysterectomy performed?

The approach depends on the size of the uterus and fibroids, your medical history, prior surgeries, your surgeon’s expertise, and your preferences. When possible, a minimally invasive approach (vaginal, laparoscopic, or robotic) is preferred, because recovery is faster and there is less pain.

Vaginal hysterectomy

The uterus is removed through an incision at the top of the vagina, around the cervix, with no incisions on the abdomen. Many women go home the same day or the next. Recovery usually takes a few weeks. It works best when the uterus is not very large.

Laparoscopic hysterectomy

The surgeon inserts a laparoscope, a thin lighted tube with a camera, through a small incision, usually at the belly button, and uses small instruments through a few other small incisions. The uterus is removed through the vagina or a small incision. Recovery is typically two to four weeks.

Robotic hysterectomy

This is a type of laparoscopic hysterectomy in which the surgeon controls robotic instruments from a console. It can help with complex anatomy. Recovery is similar to laparoscopic surgery.

Abdominal hysterectomy

The uterus is removed through an incision in the lower abdomen. It may be needed for a very large uterus or complex situations. Recovery is longer, often around six weeks.

Large fibroid uteri sometimes have to be cut into smaller pieces for removal through small incisions. Because a rare cancer called leiomyosarcoma can look like a fibroid, ask your surgeon how tissue will be removed and what precautions they use.

Anesthesia, recovery time, pain after surgery, and risks all vary with the approach.

Which specialist should you see?

A hysterectomy should be performed by a board-certified obstetrician-gynecologist, or a gynecologic surgeon with specific training in minimally invasive surgery for complex cases. Ask how often your surgeon performs the approach recommended for you, and whether a minimally invasive option is possible.

The bottom line

A hysterectomy may be the right choice if fibroids cause heavy bleeding, pain, or pressure that other treatments have not relieved, and you have finished having children. Your clinician can help you weigh the benefits and risks, choose the surgical approach, and decide whether to remove the ovaries and fallopian tubes.