total hysterectomy
Meaning of total hysterectomy: The commonest misunderstanding in gynecology: total means the cervix as well, not the ovaries as well.
Definition of total hysterectomy
A total hysterectomy is surgery to remove the whole uterus together with the cervix, the narrow lower portion opening into the vagina. The word total refers to the uterus alone and says nothing about the ovaries or fallopian tubes, which come out only when that is planned as a separate step. Periods stop afterward and pregnancy is no longer possible.
What does total actually include?
| Operation | What is removed |
|---|---|
| Subtotal | The body of the uterus; the cervix is left in place |
| Total | The whole uterus including the cervix |
| Total with tube and ovary removal | The uterus, cervix, both tubes and both ovaries |
| Radical | The above plus supporting tissue, upper vagina and nodes |
Why does the fate of the ovaries matter more than the name suggests?
Because the ovaries, not the uterus, make the hormones. Removing both before natural menopause ends estrogen production abruptly, bringing hot flashes and sweats that arrive without any tapering, and shifting long-term risks to bone and heart. Leaving them means hormone production carries on as before even though periods have stopped, so menopause arrives later without its usual signal. Neither outcome follows from the word total, which is why the same phrase describes operations with very different consequences. The removal of both tubes and ovaries has its own name and is recorded separately in the operation note, and the more extensive radical hysterectomy is reserved for cancer of the cervix.
How is it done, and what changes afterward?
Three routes are used: through a cut in the lower abdomen, through the vagina with no external incision, and with keyhole instruments through several small openings. The choice turns on the size of the uterus, the reason for surgery and the presence of scarring from earlier operations. Common reasons include fibroids, heavy bleeding that has not settled with other measures, endometriosis, prolapse and cancer of the uterine lining. Once the cervix has gone there is no longer a cervix to screen, so routine cervical screening generally stops unless the operation was done because of cervical disease. This is the operation meant when the word hysterectomy is used without qualification.
Also known as
Used in a sentence
A total hysterectomy was performed for symptomatic fibroids, with both ovaries conserved.
Good to know
Total describes removal of the uterus and cervix and carries no implication about the ovaries, so hormonal consequences depend entirely on whether a separate removal of the tubes and ovaries was performed.
Word origin
Where “total hysterectomy” comes from
Hysterectomy joins the Greek hystera, meaning womb, with -ektome, a cutting out.