Hysterectomy
Removal of the uterus, where that is the right treatment. Most often for adenomyosis, rather than for endometriosis alone.
A hysterectomy treats adenomyosis. It does not, by itself, treat endometriosis: disease outside the uterus stays where it is. That distinction matters, because patients are still told a hysterectomy will cure their endometriosis, and it will not.
What the operation is
A hysterectomy removes the uterus. People have one for many different reasons, and the goal is always the same: to help you make your life into what you want it to be.
Two things are usually tied up in that decision. One is period symptoms, the cramping and the bleeding. The other is fertility. Much of the conversation before an operation is about the tension between those two.
How it is done
Most often laparoscopically. We remove the top of the uterus, called the fundus, together with the cervix, which is the entrance to the uterus, the part seen during an exam and where Pap smears are taken.
If you still have your fallopian tubes, we usually remove those at the same time. Once they are no longer connected to a uterus they are not doing anything, and they are the origin point for some of the less common cancers we see.
For most people with adenomyosis, the fundus and cervix come out together through the vagina, and the top of the vagina is closed. That tissue heals very well.
Keeping the cervix
It is possible to remove the fundus and leave the cervix, and we do that for some people.
The considerations are genuinely complicated. They include what you are worried about and how you feel about your own body, and the published data on several of these questions conflicts with itself. It needs a detailed conversation rather than a default.
Ovaries stay unless there is a reason
Removing the ovaries is a separate and much more complicated question, and it is not part of a standard hysterectomy here.
Some people do want them removed, because of a family history of cancer, or because of hormonal problems severe enough to cause intractable migraines or seizures. Those are conversations we are glad to have, and the plan can be built around what you need. The standard position is that the ovaries stay.
What recovery is actually like
For most people it is surprisingly straightforward. Recovery is significantly faster and less painful than removing endometriosis, and that operation is not a bad one compared with much of surgery.
There are parts people do not expect. Pelvic floor muscle spasm is common afterwards. There is usually some bleeding around two to three weeks. And toward the end of the first month most people are simply exhausted, more so than after endometriosis surgery.
What it fixes, and what it does not
A hysterectomy fixes symptoms that come from the uterus: bleeding, cramping, blood clots, the low back pain carried by the nerves that serve the uterus, the effect adenomyosis has on the pelvic floor muscles, and the pressure fibroids put on the organs around them.
It does not fix endometriosis. Bowel symptoms, bladder symptoms, most pain with sex, and pain that sits anywhere other than the center of the pelvis will not improve because the uterus has gone. That disease is outside the uterus and it stays where it is.
This is why endometriosis is often removed during the same operation, so the symptoms coming from outside the uterus are dealt with at the same time as the ones coming from inside it.
Who should not have one
Everyone considering this deserves a long conversation with someone who has seen a lot of patients go through it, so that what it will mean for your life is clear before anything is decided.
The simple version is that you should have a hysterectomy if it fixes the symptoms that are getting in the way of your life. The people who should not have one are those whose symptoms it will not help, and those for whom it would close off where they want their life to go, particularly if that includes pregnancy.
What it costs
Our professional fee is avg $3,500. Varies ($2,500–$7,000 max) by surgical complexity. The facility bills your insurance separately for hospital care, anesthesia, labs and imaging. Full fee detail →