Hysterectomy

Written by: 
Dr Sheena Meredith

This page covers:

A hysterectomyThe surgical removal of the uterus (womb). is an operation to remove a woman's uterus The womb, where embryo implantation occurs and the growing foetus is nourished.(womb). Sometimes other nearby structures, such as one or both ovaries or Fallopian tubes may be removed at the same time.

A woman who has had her uterus removed is no longer able to get pregnant or have children. If the operation is performed before her menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle., it will also mean that her monthly periods (menstruation) will cease. A pre-menopausalRelating to the menopause, the time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. woman who has her ovaries removed during a hysterectomyThe surgical removal of the uterus (womb). will enter the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. early.

Hysterectomy is one of the most common gynaecological operations performed worldwide, though rates vary widely between countries.

In the USA, one in three women will have had her uterus removed by the time she reaches the age of 60. In the UK, around one in five women will have a hysterectomyThe surgical removal of the uterus (womb). at some time in her life. In contrast, rates in India are much lower: around 4 to 6 per cent of women have a hysterectomyThe surgical removal of the uterus (womb)..

The high level of hysterectomyThe surgical removal of the uterus (womb). operations in many countries, together with the wide variation in rates between countries, has caused controversy. Many women feel that they are not given sufficient information about the decision to have a hysterectomyThe surgical removal of the uterus (womb)..

Why are hysterectomies performed?

A hysterectomyThe surgical removal of the uterus (womb). may be recommended for a variety of reasons, including:

  • Fibroids
  • Endometriosis
  • Prolapse of the uterus
  • Heavy periods (known medically as menorrhagia)
  • Pelvic inflammatory disease
  • Cancer of the uterus, cervixAny neck-like structure; most commonly refers to the neck of the uterus., ovaries or Fallopian tubes
  • As an emergency - during surgery, for example, especially Caesarean section or as a result of complications of childbirth, such as uncontrollable bleeding or rupture of the uterus.

What types of hysterectomy are there?

There are three types of hysterectomyThe surgical removal of the uterus (womb)., depending on the extent of the surgery:

  • In a complete or total hysterectomyThe surgical removal of the uterus (womb). the whole of the uterus is removed, including the cervixAny neck-like structure; most commonly refers to the neck of the uterus. (the neck of the womb that protrudes into the upper part of the vagina)
  • In a partial or subtotal hysterectomyThe surgical removal of the uterus (womb). only the upper part of the uterus is removed and the cervixAny neck-like structure; most commonly refers to the neck of the uterus. is left in place in the vagina
  • In a radical hysterectomyThe surgical removal of the uterus (womb). the whole of the uterus including the cervixAny neck-like structure; most commonly refers to the neck of the uterus. is removed along with the upper part of the vagina, nearby lymph nodesSmall swellings along the lymphatic system that filter lymph, a fluid derived from the blood, and produce antibodies and a type of white blood cells, lymphocytes. and supporting tissues. A radical hysterectomyThe surgical removal of the uterus (womb). is sometimes called a Wertheim operation, after the surgeon who first performed this procedure. It is usually performed only for cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

Sometimes during the operation abnormalities of the ovaries are found, and the surgeon may remove one or both ovaries as well. This is called an oophorectomy. If you are already post-menopausalRelating to the menopause, the time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle., your surgeon may recommend that you have your ovaries removed during the hysterectomyThe surgical removal of the uterus (womb). anyway, so that there is no possibility that you could later develop ovarian cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

How is a hysterectomy performed?

Hysterectomy may be performed with a general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body. or under epiduralOn or over the dura mater, the outermost of the three membranes covering the brain and spinal cord. The epidural space is used for anaesthetising spinal nerve roots, for example during pregnancy. anaesthesia.

There are three main methods of performing the operation.

In an abdominal hysterectomyThe surgical removal of the uterus (womb). the surgeon removes the uterus through a cut (incision) in the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs.. This involves making an incision of 15 to 20 cm (6 to 8 inches) long running either horizontally along the pubic hair line or vertically downwards from the naval.

A second option is to remove the uterus through the vagina. In this case, the operation is called a vaginal hysterectomyThe surgical removal of the uterus (womb).. The incision is completely within the vagina and leaves no external scar. If the surgeon uses an instrument called a laparoscopeAn instrument with attached light source, usually connected to a camera, which allows the examination of the organs during keyhole surgery. to see inside the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. during a vaginal hysterectomyThe surgical removal of the uterus (womb)., the operation is called a laparoscopic-assisted vaginal hysterectomyThe surgical removal of the uterus (womb). (LAVH).

In a third method the surgeon performs the operation entirely by laparoscopic surgery. This is called a laparoscopic hysterectomyThe surgical removal of the uterus (womb).. The surgeon makes several small cuts, usually no more than 1.5 cm (0.6 inches) long, in the abdominal wall just underneath the naval and through these inserts the laparoscopeAn instrument with attached light source, usually connected to a camera, which allows the examination of the organs during keyhole surgery. and associated instruments; in the course of the operation, the uterus is removed through these cuts. In some centres robotic surgery may be used to aid laparoscopic hysterectomyThe surgical removal of the uterus (womb)..

Preparing for surgery

An abdominal hysterectomyThe surgical removal of the uterus (womb). is a major operation and before operating your surgeon will need to check that you are fit enough to undergo surgery. As well as a complete physical examination and routine bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. tests, you may have various tests including:

Possible complications

Rarely, a hysterectomyThe surgical removal of the uterus (womb). may cause damage to adjacent organs, including injury to the bowel, bladderThe organ that stores urine. or ureters. Nerve injury, prolapseDisplacement of an organ below its normal site. and urinary tract infectionInvasion by organisms that may be harmful, for example bacteria or parasites. may also occur.

General complications such as infectionInvasion by organisms that may be harmful, for example bacteria or parasites. or excessive bleeding may occur with any operation.

Recovering from surgery

You will usually need to stay in hospital for between 1 and 4 days after a hysterectomyThe surgical removal of the uterus (womb)., depending on the type and extent of your operation.

Immediately after an abdominal hysterectomyThe surgical removal of the uterus (womb). you will not be permitted to drink fluids: you will have an intravenous dripA means for the continuous injection into a vein. to maintain your fluid balance until you are able to start drinking again. You will also have a urinary catheterA tube used either to drain fluid from the body or to introduce fluid into the body. in place for the first day or so.

You can expect to have some pain from the incisions, and will usually be given strong medication to relieve this while you are in hospital. As you recover, the pain will become manageable with over-the-counter analgesicsAnother term for painkillers.. You will probably also feel bloated and may have abdominal discomfort due to increased intestinal gas for a few days.

Tip: Select loose clothing to take with you into hospital - it will be more comfortable to wear after the operation

An abdominal hysterectomyThe surgical removal of the uterus (womb). is a major operation and you can expect it to take 6 to 8 weeks, and sometimes as long as 3 months, before you feel fully recovered. Vaginal hysterectomyThe surgical removal of the uterus (womb). involves less trauma and recovery is generally faster.

Either way, when you go home, you will need plenty of rest, and will be advised to avoid strenuous activity and not to lift anything heavy for six to 12 weeks. You will not be able to drive for around 6 weeks after your operation, so it helps to plan ahead for this. You will need someone at home to take over shopping, cooking and housework.

Tip: Do not expect to lift anything heavier than a 1 litre (32 fl oz) milk carton for
6 weeks after the operation

Whichever sort of operation you have, you can expect to have a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-stained vaginal discharge that will probably persist for days or even weeks. You should be able to take baths, go swimming and have sex after around 6 weeks. Sex after hysterectomyThe surgical removal of the uterus (womb). is quite safe and need be no less enjoyable than before. Hysterectomy does not affect the ability to have an orgasm.

Gentle exercise helps

While you are still in hospital, once you have had the catheterA tube used either to drain fluid from the body or to introduce fluid into the body. removed, you will probably be shown how to do gentle exercises to maintain your muscleTissue made up of cells that can contract to bring about movement. tone, bowel and bladderThe organ that stores urine. control and to prevent later prolapseDisplacement of an organ below its normal site. (slippage of organs). Pelvic floor exercises are an important part of this.

The exact time it takes for you to be able to resume normal activities will depend on the procedure you had and how well you recover, as well as on the type of work you do. It is important to take light exercise as early as you can and to increase the amount you do gradually as you recover.

Tip: Get yourself moving gently as soon as you can - this will also help to avoid constipation due to inactivity

Gentle walking is ideal to begin with. Start with about 10 minutes daily and build up to around 45 minutes per day by around 6 weeks after the operation.

After-effects

If you are a pre-menopausalRelating to the menopause, the time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. woman, having a hysterectomyThe surgical removal of the uterus (womb). means that your periods will cease. If your ovaries are removed during your hysterectomyThe surgical removal of the uterus (womb)., you will also undergo a premature menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle.. Your doctor can prescribe hormone replacement therapyThe administration of female hormones in cases where they are not sufficiently produced by the body. Abbreviated to HRT. and other medication to counteract the symptoms.

After a hysterectomyThe surgical removal of the uterus (womb)., you will no longer be able to get pregnant and, if you wanted to have children, will face infertility (see the quick guide Infertility). While some women find this upsetting, for others the absence of periods and the freedom from having to use contraceptionA means of preventing pregnancy. is welcome.

Similarly, while some women mourn the loss of their uterus as a symbol of their femininity, others find that their quality of life overall, and their sex life, is greatly enhanced because symptoms such as pain or bleeding are abolished.