• Total hysterectomy. This type of hysterectomy removes the uterus and cervix. The ovaries and fallopian tubes may or may not be removed.

• Hysterectomy with bilateral salpingooophorectomy. This procedure removes the ovaries and fallopian tubes along with the uterus and cervix.
  
  
• Subtotal or partial hysterectomy. This surgery removes the uterus above the level of the cervix, so the cervix stays in place. The fallopian tubes and ovaries may or may not be removed.
  
  
• Radical hysterectomy. This extensive surgery is usually only recommended to treat some cancers of the uterus or cervix. The uterus, cervix, and surrounding tissue are removed as well as the upper vagina and usually the pelvic lymph nodes.

There are different ways to perform a hysterectomy. These surgical options include:

• Total abdominal, or open, hysterectomy. This is the classic form of hysterectomy, in which an abdominal incision allows the surgeon to see the pelvic organs easily and provides more operating space than is permitted by a vaginal hysterectomy. It is generally used for large pelvic tumors or suspected cancer. Expect to have a longer stay in the hospital and a longer recuperation time.
  
  
• Vaginal hysterectomy. With this type of hysterectomy, the surgeon removes the uterus and the cervix through an incision within the vagina. This surgical option is ideal if the uterus is not enlarged or has dropped as a result of uterine prolapse. Vaginal hysterectomy can be performed in two ways: entirely through the vagina; or using a laparoscope, a small, telescopelike device inserted into the abdomen through a small incision, enabling the surgeon to visualize the pelvic region. Standard vaginal hysterectomy and abdominal hysterectomy each take between one and two hours and are performed under general anesthesia.

  A laparoscope is often used if the ovaries also need to be removed. When a laparoscope is used, the procedure is called a laparoscopically assisted vaginal hysterectomy (LAVH). Though less invasive than a traditional hysterectomy, LAVH takes longer to perform than a standard hysterectomy, so you'll be under anesthesia longer. It also requires more surgical skill to perform.³³
  

• Laparoscopic supracervical hysterectomy (LSH). This newer type of hysterectomy also uses laparoscopic techniques to remove the uterus, but leaves the cervix intact, which some studies suggest may help reduce the complications associated with total hysterectomies, such as pelvic floor prolapse and urinary incontinence. LSH is less invasive and less traumatic for your body than a total hysterectomy. LSH also requires a shorter recovery period and hospitalization.

As with any form of surgery, risks associated with hysterectomy include postoperative infections, bleeding and problems related to anesthesia. Other risks are: blood clots in the legs, bleeding that may require a transfusion, a painful or ugly scar, injury of other structures in the pelvis and even death (although that risk is exceedingly small).

After Surgery
Regardless of the kind of operation you have, a hysterectomy is still major surgery, and you're going to need some time to recover. Most women go home the third day after an abdominal hysterectomy and the first or second day after a vaginal hysterectomy or LAVH. That doesn't mean going home to cleaning, cooking and driving kids to activities, however. It means going home to rest.

Complete recovery from an abdominal hysterectomy usually takes six to eight weeks, during which time you'll gradually feel your strength return and slowly be able to resume your normal activities. In the beginning, though, you'll need to avoid walking, laughing and anything else that challenges your abdominal muscles while they heal from the incision. Expect that going to the bathroom will be painful, and you shouldn't lift anything heavier than a magazine for the first two weeks after surgery. By the sixth week, most patients are recovered enough to resume such activities as having sex and taking a bath.

Recovery is usually much quicker from a vaginal hysterectomy, although it will still take some time. Remember, your body needs time to recover from surgery, even minor surgery.

Be sure to notify your health care professional immediately if you develop any of the following symptoms:

Shortness of breath or chest pain

After Recovery
Once you're recovered from the surgery, you're ready to begin your life without a uterus. For some women, this will be a relief from painful or disruptive symptoms. In fact, many women consider having had a hysterectomy the best thing they ever did. They find the freedom from menstrual problems, and no longer needing to worry about pregnancy, energizing. When University of Maryland researchers interviewed 1,200 women before and after their surgery, 96 percent said the hysterectomy had completely or mostly resolved the problems or symptoms they experienced before the surgery; 94 percent said the results of the operation were better than or about what they expected; and 85 percent said their health was better than before the hysterectomy.³⁴ The women also reported significant improvements in libido and frequency of sexual relations, enjoyment of sex, orgasm frequency and relief from painful intercourse.³⁵

Some women, however, face more challenging issues, including early menopause (if the ovaries were removed), changes in sexual desire and enjoyment, and discomfort.

If you were premenopausal (still menstruating) before the operation and have your fallopian tubes and ovaries removed, you can expect some symptoms of menopause, possibly including hot flashes and mood changes, as your body adjusts to different hormone levels.

You may feel a sense of loss after the surgery-a feeling that is entirely normal. Give it time. If you had still planned to have children, or had your uterus removed because of cancer or a severe illness, you may experience some depression. Don't hesitate to talk to your health care professional or to a mental health specialist about your feelings.³⁶