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Hysterectomy and

L’hystérectomie est un geste chirurgical qui consiste à retirer l’utérus.

Although this is not strictly speaking a treatment for endometriosis (which by definition is located outside of the uterus), hysterectomy is frequently associated with endometriosis surgery for women with adenomyosis and who no longer wish to become pregnant. In this context, a hysterectomy increases the chances of pain disappearing after the surgery.
Performing an isolated hysterectomy, however, without removal of the endometriosis lesions, does not usually result in effective treatment of pelvic pain.

Anatomical overview

The uterus is located in the center of the pelvis, behind the bladder and in front of the rectum. It is attached to neighbouring structures by fibro-conjunctive bands called ligaments:

  • round ligaments which ensure it is attached to the front
  • utero-sacral ligaments which attach it to the back
  • cardinal ligaments which fix it to the sides.
Schéma utérus profil
Fig1 : Anatomical relationships of the uterus and means of fixation


The uterus is connected to two fallopian tubes, the ends of which (the tubal pavilion) open towards the ovary, in order to capture the eggs. In a hysterectomy, the fallopian tubes are usually removed along with the uterus. This surgical procedure is called bilateral salpingectomy.

In contrast, the ovaries are not part of the uterus, but simply connected to it by fibrous bands (the utero-ovarian ligaments). During a hysterectomy, the ovaries can be preserved by cutting the utero-ovarian ligaments. This is referred to as a total hysterectomy with bilateral salpingectomy and preservation of the ovaries. Women retain normal ovarian activity and do not experience menopause ( no weight gain, hot flashes or other menopausal symptoms after surgery).

In other cases, the ovaries may be removed at the same time as the uterus, referred to as a total hysterectomy with bilateral adnexectomy(the term adnexa includes the fallopian tube and ovary on each side). In this case, menopause starts the day after surgery.

The uterus consists of a body, an isthmus and a cervix, the latter being visible at the base of the vagina. Hysterectomy is total, when the uterus is removed entirely with the cervix; this procedure requires circular incision of the vagina around the cervix, extraction of the uterus through the vagina, followed by closure of the vagina by suturing the previously cut vaginal borders.

Hysterectomie schéma
Fig2: Diagram showing the anatomical relationships of the uterus and the vaginal incision area in cases of total hysterectomy

The hysterectomy can be subtotal if the uterus is sectioned at the isthmus and the cervix kept. In this case, there is no incision of the vagina. Subtotal hysterectomy is rarely used in women with adenomyosis and/or endometriosis, due to possible lesions in the cervix or in the utero-sacral ligaments, which if left in place would render the surgical treatment incomplete, leading to risk of continued symptoms.

in numbers


of women undergoing surgery for pelvic endometriosis have a hysterectomy at the same time


Women annually have a hysterectomy performed several years after surgery for colorectal endometriosis and one or more pregnancies


of hysterectomies were performed at the same time as colorectal endometriosis surgery in the ENDORE randomized trial


Roman H, et al. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod. 2018 Jan 1;33(1):47-57.
Roman H, et al. Synthèse des stratégies et prise en charge chirurgicale de l’endométriose, RPC Endométriose CNGOF-HAS. Gynecol Obstet Fertil Senol. 2018 Mar;46(3):326-330.
Roman H, et al. Complications postopératoires immédiates dans un centre chirurgical multidisciplinaire exclusivement dédié à l’endométriose : une série de 491 patientes. Gynecol Obstet Fertil Senol. 2020 Jun;48(6):484-490.

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Last updated on May 4, 2021 @ 09:26