Abdominal hysterectomy is a surgical procedure in which the uterus is removed through an incision in the lower abdomen. One or both ovaries and fallopian tubes may also be removed during the procedure. Before surgery, there are two main decisions that need to be made about the procedure: whether the cervix should be removed and whether the ovaries and tubes should be removed. If the ovaries are removed, a woman may need to decide if she should take estrogen replacement therapy.
A standard abdominal hysterectomy includes removal of the entire uterus and cervix. However, there are situations in which the entire uterus is not removed. A subtotal hysterectomy refers to a procedure in which the cervix is left in place, while the top of the uterus is removed. A subtotal hysterectomy may be done if difficulties arise during surgery, making removal of the cervix complicated. Women who undergo subtotal hysterectomy must continue to have routine cervical smears for cervical cancer. Some women continue to have menstrual bleeding since the retained cervix is attached to a small remaining portion of the uterus.
Removing the ovaries: The ovaries may be removed during hysterectomy, a procedure known as an oophorectomy. Oophorectomy is not always required; the decision depends upon several considerations.
Premenopausal women may decide to keep the ovaries to provide a continued, natural source of hormones, including estrogen, progesterone, and testosterone. These hormones are important in maintaining sexual interest and preventing hot flushes and loss of bone density. On the other hand, women who have menstrual cycle-related migraines or severe premenstrual syndrome (PMS) or endometriosis may have an improvement in symptoms when hormone levels are reduced by removing the ovaries. Postmenopausal women are often advised to have their ovaries removed because of a small risk of developing ovarian cancer at some point during their lifetime. The benefits of removing or keeping ovaries should be discussed with the doctor before a decision is taken.