Hysterectomy is the definite cure for fibroids and involves removing all the fibroids along with the uterus. Following surgery, you will not have any more periods, and of course you cannot become pregnant. Hysterectomy is, therefore, only suitable for women who have completed their family, but there is no chance of a recurrence of the fibroids or need for further treatment (as there is with myomectomy or embolisation).

Although your periods will stop after hysterectomy, this does not mean that you will become menopausal. Provided your ovaries are not removed at the same time, there should be little difference in your "hormones" after surgery. Sometimes, however, it is in your best interests to remove the ovaries at the same time (eg. if they are diseased), and then you can usually take hormone replacement therapy afterwards to prevent menopausal symptoms.

Hysterectomy can be done a number of ways. In many respects, vaginal hysterectomy is the best and least traumatic procedure, and may be possible as long as your fibroids are not too large. Laparoscopic hysterectomy is done with the help of a telescope (as with laparoscopic myomectomy), and is generally indicated when there is the feeling that you may have adhesions (scar tissue) in your pelvis which would make vaginal surgery difficult. If your fibroids are very large, the only choice is abdominal hysterectomy.

If you undergo hysterectomy, there is also the choice of total or subtotal hysterectomy. In total hysterectomy, the entire uterus is removed, including the cervix; conversely, in subtotal hysterectomy, the uterus is removed but the cervix is not. While subtotal hysterectomy is an easier operation and may be associated with fewer complications, a purely vaginal route of surgery becomes virtually impossible if the cervix is to be conserved.

As in the case of myomectomy, hysterectomy is a major operation. However, despite the fact that the entire uterus is removed, problems are if anything less common than with myomectomy. For instance, the risk of bleeding and needing a blood transfusion are greater with abdominal myomectomy than abdominal hysterectomy; this is because the blood supply to the uterus is first tied off when doing a hysterectomy, whereas with myomectomy, the fibroids are removed while the blood supply to the uterus is flowing normally. Other complications (eg. infection, bruising) are also less likely with hysterectomy than myomectomy.

Click on the links below for further information:
Abdominal hysterectomy
Laparoscopic myomectomy
Vaginal hysterectomy