About the Uterus
The uterus is a muscular organ in the pelvis. The opening of the uterus is the cervix.

Sometimes, there are problems with the uterus. A woman may have pain or heavy bleeding. Growths or cancer also can occur.

Conditions Affecting the Uterus
Hysterectomy may be done to treat conditions that affect the uterus. Some are benign (not cancer). Others are cancer.

Uterine Fibroids
Uterine fibroids (myomas) are the most common type of growth found in a woman's pelvis. They are benign and can be a number of sizes. Most are small and don't cause symptoms or need to be treated.

If fibroids grow, they may cause pain. They may press against the bladder and other pelvic organs. Fibroids that press against the lining of the uterus may cause irregular or heavy bleeding.

Abnormal Uterine Bleeding
Abnormal uterine bleeding is irregular, heavy or severe bleeding from the uterus. It may be caused by fibroids or by hormonal changes. It also may be caused by infection of the uterus or cancer.

Treatment is aimed at the cause of the bleeding. Hormone therapy may help control the bleeding.

Cancer
Over time, diseases of the cervix can develop into cancer. They can progress quickly or develop slowly over years. It depends on the person and the extent of the disease.

Pelvic Support Problems
The pelvic organs (bladder, uterus, rectum and intestines) are supported by muscles, ligaments and fascia (tough sheets of tissue). The ligaments and fascia may be weak and not able to support these organs. This may occur because of obesity, chronic cough or stretching in childbirth. This can allow the pelvic organs to sag or even stick out through the opening of the vagina.

Endometriosis
Cells like those lining the uterus also may grow on the ovaries, fallopian tubes and other pelvic structures. This is called endometriosis. Patches of endometriosis may bleed at the menstrual period or at other times. The blood may build up in cysts. Endometriosis may cause scarring, adhesions, pain or infertility.

Pelvic Pain
There are many causes of pelvic pain. It may take time to diagnose the problem. One source may be irritation of the pelvic organs, which may cause adhesions or scarring. This may be a result of endometriosis, infection or injury. Pelvic adhesions most often affect the surface of the uterus, the tubes and ovaries, and the intestines.

About Hysterectomy
There are three types of hysterectomy:

• Partial (or subtotal)
• Complete (or total)
• Radical

The ovaries and fallopian tubes may be removed at the same time. This is called a salpingo-oophorectomy.

Risks
As with any surgery, problems may occur. These could include:

• Thrombophlebitis (blood clots in the veins or lungs)
• Severe infection
• Bleeding after surgery
• Bowel blockage
• Injury to the urinary tract
• Problems related to anesthesia
• Death

After Surgery
The length of stay in the hospital after hysterectomy varies by the type done. You can expect to have some pain for the first few days. Normal activities, including sex, can be resumed in about six weeks in most cases. Meanwhile, don't put anything in the vagina.

Physical
After hysterectomy, a woman's periods will stop. She can no longer get pregnant. The ovaries still produce eggs. But, because the eggs are not fertilized, they dissolve in the abdomen.

Emotional
Many women have a brief emotional reaction to the loss of the uterus. This response depends on a number of factors:

• How well they were prepared for the procedure
• Timing of the procedure
• Reason for having it
• Whether the problem is cured

Hysterectomy and Sex
Some women may notice a change in their sexual response after a hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.

However, some women have a heightened response. This may occur because they no longer have to worry about getting pregnant and may be relieved of discomfort.

Finally ...
Hysterectomy is just one way to treat uterine problems. It is major surgery. Before you decide whether it is right for you, find out as much as you can.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.