The type of operation and approach taken will depend on the reasons for the surgery. There are five types of hysterectomy:
Supracervical or Subtotal Hysterectomy
In a Supracervical or Subtotal Hysterectomy, only the uterus is removed. The cervix remains in place. There are pros and cons to removing the cervix and most surgeons have an opinion either way. Usually it is entirely patient choice, except where there is cervical cancer or pre-cancerous cells, then obviously the cervix will be removed. For me the question of should I have my cervix removed was relatively simple.
A total hysterectomy means the removal of the uterus and the cervix. There is a misconception that a Total Hysterectomy is the removal of the ovaries as well, but this is not correct. Where possible, the ovaries are left in place, as surgical menopause has serious immediate and long term health implications.
Hysterctomy (total or subtotal) and Bilateral Salpingo-Oopherectomy.
This is where the uterus, fallopian tubes and ovaries are all removed. This option is usually only recommended where there is cancer or pre-cancer or for severe chronic pain due to the menstrual cycle. It is also sometimes performed as a treatment for Pre-Menstrual Dysphoric Disorder, a severe form of PMS.
Because the ovaries are removed, the patient goes into instant surgical menopause, which can be more than a little unpleasant and has huge implications for life after hysterectomy. After the removal of the ovaries, the body no longer makes its own estrogen, and the hormone levels drop suddenly, which can often cause severe menopause symptoms. Longer term, low estrogen has been shown to increase the risk of heart disease and bone density loss. Therefore some women choose to have hormone replacement therapy (HRT) to ease the symptoms of menopause. There are risks involved in HRT as well however, including raising your risk of breast cancer, strokes and blood clots.
The most invasive type of hysterectomy and includes the removal of the uterus, cervix, fallopian tubes, ovaries, the upper part of the vagina and the associated pelvic ligaments and all the surrounding lymph nodes. A radical hysterectomy is performed where the woman has cancer of the cervix, ovaries, fallopian tubes or uterus.
Hysterectomy with prophylactic bilateral salpingectomy
This is the removal of both fallopian tubes (but not the ovaries) with the uterus. Most doctors recommend removing the fallopian tubes because current research shows that ovarian cancer often starts in the fallopian tubes. Therefore, removing the fallopian tubes reduces the risk of ovarian cancer, even when the ovaries are retained.
Once it has been decided which type of hysterectomy is required, the next decision is which surgical type of hysterectomy should you have.