Your doctor may recommend you have a hysterectomy if you have cancer of your womb or ovary, or some cancers of the cervix.
You may also be offered a hysterectomy for the following conditions if other treatments, such as medicines and other surgery, haven’t worked.
- Endometriosis – a condition in which cells that usually line your womb grow outside your womb.
- Adenomyosis – a type of endometriosis in which cells that usually line your womb grow in the womb muscle instead.
- Enlarged or painful fibroids – non-cancerous growths of muscle and fibrous tissue in your womb.
- Irregular or heavy menstrual bleeding.
- Uterine prolapse – when your womb drops out of position into your vagina.
A hysterectomy involves removing your womb. However, there are different types of hysterectomy depending on how much of the rest of your reproductive system can be left in place. The different types include the following.
- Total hysterectomy – this involves removing your entire womb and cervix (where your womb opens up into your vagina).
- Subtotal (also known as partial or supracervical) hysterectomy. This involves removing the top part of your womb but leaves your cervix in place. This isn’t carried out as often as total hysterectomy and isn’t usually recommended for cancers affecting your reproductive system.
- Total hysterectomy with salpingo-oophorectomy – this involves removing your fallopian tubes and ovaries in addition to your womb and cervix.
- Radical hysterectomy – this involves removing your womb and cervix, the tissue surrounding your cervix and your pelvic lymph nodes.
Some doctors recommend also having your fallopian tubes removed if you’re having a hysterectomy, as it may help to reduce your risk of developing ovarian cancer in the future. Your surgeon can discuss this further with you.
It’s possible to have all of these types of hysterectomy either through your vagina, through your abdomen or as keyhole surgery. The type of hysterectomy your doctor recommends and the method of doing it will depend on a number of factors. These include the reason why you’re having the operation and your personal situation, as well as what type of hysterectomy your doctor has most experience in.
After a hysterectomy, you won't have any more periods and you won’t able to become pregnant. If your ovaries are also removed, you will go through the menopause. If you have a sub-total hysterectomy, which leaves your cervix in place, you should continue having cervical screening (smear) tests. You won’t need to have smear tests if you have the other types of hysterectomy.
A hysterectomy is a major operation. So, it’s important to discuss with your gynaecologist what will happen before, during and after your operation, and to consider all the pros and cons. You may want to prepare a few questions about the risks and benefits of the procedure, and alternatives to it. This will help you decide whether a hysterectomy is the right choice for you.
- A hysterectomy may help to improve or get rid of your symptoms. For example, if you have a hysterectomy to remove large fibroids, you may no longer experience pain and heavy bleeding.
- Having a hysterectomy means you’ll no longer need to worry about using other forms of contraception, which you may feel to be a benefit.
- You won’t be able to have children after a hysterectomy, which might be important to you. And, depending on the type of the hysterectomy you have, you may go through the menopause.
- Some women may feel a sense of loss of their femininity after having a hysterectomy. You may also feel less interested in sex after hysterectomy. On the other hand, some women feel more relaxed about having sex if hysterectomy has improved their symptoms. For more information, see our section below on having sex after a hysterectomy.
- As with all operations, there are some complications associated with having a hysterectomy. These include haemorrhage, infections, blood clots, and a bad reaction to the anaesthetic.
Before the operation
Your gynaecologist will explain how to prepare for your hysterectomy.
A few weeks before your procedure, you’ll be asked to go for a pre-operative check to make sure you’re fit enough for the surgery. You’ll need to have your blood pressure and heart rate checked, and you may be asked to have an ECG. You’ll also need to have blood tests. If you smoke, you’ll be asked to stop, as smoking increases your risk of chest infections.
On the day
You’ll be admitted to hospital on the day of your operation. The operation is usually done under general anaesthesia, so you’ll need to fast (not eat or drink anything) for at least six hours beforehand. You may be allowed clear fluids until a couple of hours before your operation, but make sure you follow any instructions that you’re given.
You may be asked to wear compression stockings and have an injection of an anticlotting medicine to help prevent blood clots in your legs.
You’ll meet your gynaecologist, and they’ll ask you to sign a form, to give your consent for the procedure to go ahead.
There are various ways that a hysterectomy can be done.
- A vaginal hysterectomy is performed with a cut through your vagina.
- An abdominal hysterectomy is done with a single, large cut in your abdomen (tummy).
- A laparoscopic hysterectomy uses special surgical instruments inserted into your abdomen through several tiny cuts. This is also known as keyhole hysterectomy.
Most hysterectomies are done under general anaesthesia, which means you’ll be asleep during the operation. You might be able to have the operation under epidural anaesthesia depending on your situation. This means you’ll have an injection in your back that numbs your body from your waist down.
There will be several healthcare professionals involved in your operation. These usually include your gynaecologist, anaesthetist and nurse.
A vaginal hysterectomy usually takes about an hour, and you normally only need to stay in the hospital for a short time.
Your gynaecologist will make a cut in the top of your vagina and will remove your cervix and womb through the cut. You won’t have visible scars with a vaginal hysterectomy. Your gynaecologist will then close the cut in your vagina using dissolvable stitches and may place a tampon-shaped dressing (known as a pack) in your vagina. The pack helps stop the wound from bleeding. It will be removed before you leave the hospital.
Your gynaecologist may not be willing to carry out a vaginal hysterectomy if there are any issues that would make your surgery too difficult or dangerous.
An abdominal hysterectomy usually takes about an hour. It may take longer if you’re having a radical hysterectomy. Exactly how long your operation takes will depend on what you’re having it for.
Your gynaecologist will make a horizontal cut, about 10cm long, across your lower abdomen (tummy), just below your bikini line. It’s possible your gynaecologist may need to make a vertical cut from your belly button or above down to your bikini line instead. This may be if you have a large womb or if you’re having the operation because you have, or may have ovarian cancer.
Your gynaecologist will take your womb out through the cut in your abdomen. He or she will close the cut with stitches, staples or glue and will cover it with a dressing. The dressing is usually removed after about 24 hours. If you have stitches, you’ll need to have these removed after five to 10 days, unless they’re dissolvable.
For this operation, your gynaecologist will make a number of small cuts, about 1cm long in your abdomen. They will then pass a tiny camera, followed by the surgical instruments for the operation, through these cuts in your abdomen to reach your womb. Your gynaecologist will usually remove your womb through a cut in the top of your vagina.
You’ll probably wake up feeling a little tired and drowsy after your operation. This is normal, and your nurse will look after you. The following points are some of the things you may expect while you’re recovering in hospital.
- You’ll need to rest until the effects of the anaesthetic have passed, and you may need pain relief to help with any discomfort as the anaesthetic wears off.
- You’ll have a catheter to drain urine for up to 24 hours after surgery, or sometimes longer. If you find it difficult to pass urine after this time, you may need to keep the catheter in for longer.
- You should be given compression stockings to wear, and you may also be offered injections to prevent blood clots in your legs (known as deep vein thrombosis, or DVT).
- You may have a drip in your arm, to give you fluids. It will be removed as soon as you’re able to eat and drink. This is usually the day after the operation. It’s best to have tea or water first, and then have something to eat.
- You’re likely to be able to remove the dressing covering your wound the day after your operation. This is also when you’ll be able to wash and have a shower or bath.
- You may not have any bowel movements for a few days after your operation. This may cause you to have painful trapped wind. Drinking plenty of water and having a gentle walk around, once you feel able to get out of bed, normally help to start bowel movements again, and reduce wind.
Your nurse will give you advice about getting out of bed, bathing and your diet. They will encourage you to get up as soon as you can. You’ll also see a physiotherapist, who will show you simple exercises you can do to help your recovery. Being mobile is important, because it reduces your risk of complications, including DVT.
You may be able to leave the hospital the day after a vaginal or laparoscopic hysterectomy, but you may need to stay in for longer after an abdominal hysterectomy. Discuss with your gynaecologist how long they think you’ll need to stay in hospital after your operation. Before you go home, your nurse will advise you about caring for your wounds and may arrange a date for a follow-up appointment.
If you have clips or non-dissolvable stitches, you can usually have these taken out by a practice nurse at your GP surgery. This should be about five to seven days after your hysterectomy. If you’ve had dissolvable stitches, these won’t need to be removed. They’ll disappear in a few weeks or longer, depending on the type you have.
The length of time it takes to recover after an abdominal hysterectomy will be different for every woman. It can take up to a couple of months to recover fully. It's important to follow your gynaecologist's advice.
You may have some pain in your lower abdomen for a few weeks after your operation. You’re likely to be prescribed painkillers before leaving the hospital. Make sure you take any painkillers as your doctor has recommended. You’ll be able to move around sooner with no pain, and this will help with your recovery.
Vaginal bleeding and discharge
It's normal to have some bleeding or a brownish or pinkish discharge from your vagina for up to two weeks after your operation. Use sanitary towels rather than tampons because this will help to reduce the risk of infection. If you have any concerns or you have a vaginal discharge that is bright red, heavy or smells unpleasant, contact your gynaecologist or hospital. It could be a sign of an infection.
You’ll need to take it easy for a few days after your operation, because you’re likely to feel more tired than usual. You can lift light items such as a kettle, but don't lift anything heavier in the first week or so. Gradually increase your activities over several weeks. If you live on your own, it may be helpful to ask a friend or relative to stay with you for the first few days while you recover.
Try to start some gentle exercise such as walking once you’re back at home, and gradually increase how much activity you do, over time. By two to three weeks after your operation, you should be able to walk for up to about an hour. By this time, you should also be able to swim, provided that you don’t have any bleeding. If a physiotherapist has given you exercises to do, try to continue with these. But avoid contact sports for about six weeks.
You may want to wait until your scar has fully healed before you start having sex again. This will probably take between four and six weeks. It’s normal to experience some dryness or discomfort, especially if you had your ovaries removed as well as your womb. A vaginal lubricant usually helps. However, you should contact your GP if you have bleeding or pain after having sex. See our question below on having sex after a hysterectomy for more information.
You should be able to drive two to six weeks after the operation. But, if you're in any doubt, contact your motor insurer so that you're aware of their recommendations, and always follow your gynaecologist’s advice.
It’s important that you can comfortably wear a seatbelt and do an emergency stop. If you need to travel, consider how you feel and if you’ll be comfortable. Also bear in mind access to medical facilities if you go abroad.
Returning to work
Some women feel able to return to work after about three to four weeks. Other women take up to eight weeks or more to return to work. It depends on how well you are recovering, as well as the type of job you have and how physical it is. If you had a laparoscopic hysterectomy, you may be able to return to work sooner. See our question below on returning to work for more information.
It’s normal to feel a little emotional or depressed after a hysterectomy. But there are things you can do to help yourself feel better.
- Talk with a friend or family member about your feelings, and seek counselling if you feel you need it.
- Have plenty of rest.
- Exercise regularly, as soon as you are fit to do so.
- Eat a healthy and balanced diet.
- Try to maintain a positive outlook. It’s normal to feel a bit down as you’re recovering, but focus on the positives – such as how your symptoms may improve now that you’ve had the operation.
Side-effects are the unwanted effects you may expect to get from having the operation. They’re generally only temporary.
Side effects of a hysterectomy include the following:
- pain in your abdomen
- vaginal bleeding or blood-stained vaginal discharge
- if you had an abdominal or laparoscopic hysterectomy, you may have numbness, tingling or itching around your wounds, as well as a sensation of pulling around your stiches.
Complications are problems that can occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Some other complications that might occur after a hysterectomy include the following.
- A wound or urinary infection, for which you’ll need to take antibiotics. See our section below on how to know when you have an infection for more information.
- Secondary premature ovarian failure. It’s possible that even if you don’t have your ovaries removed as part of your hysterectomy, your ovaries may stop working soon after your operation. This means you’ll go through the menopause.
- Damage to some of the other organs in your abdomen – including your bowels, bladder and ureters (the tubes that carry urine from your kidneys to your bladder). This can cause you to lose control of your bladder or bowel (incontinence).
- Pelvic prolapse (when your vagina or other organ in your abdomen drops out of position).
How can I tell if I've developed an infection? How can I tell if I've developed an infection after hysterectomy?
If you start to feel unwell, are in pain and have a fever, it may be a sign that you have an infection. If your wounds become red and inflamed, this can also mean you may have an infection. If you have any of these symptoms, you should contact your GP or gynaecologist.
You will have some pain and discomfort after a hysterectomy, and you’ll be given painkillers to help with this. You may need to take these for a few weeks. But, as time goes on, you should gradually feel better.
If the pain gets worse and you feel unwell or develop a fever or other symptoms you may have a wound, vaginal or urinary infection. It's important to contact your GP or gynaecologist if you have any of the following symptoms.
- Your wounds are red, tender and hot, and there is a heavy or smelly discharge coming from them.
- Your vaginal bleeding doesn’t go away and is heavy and has a bad smell, or restarts again.
- You have a burning or painful sensation when you pass urine, or feel like you need to pass urine more than normal.
Your GP or gynaecologist will ask about your symptoms and examine you. You’ll be prescribed a course of antibiotics if you do have an infection.
Your gynaecologist will advise you about when you can go back to your usual activities. Some women feel ready after two weeks, but for others it may take eight weeks, or longer. It will be different for every woman, and will depend on a number of things, including how well you’re recovering.
The time it takes to recover from a hysterectomy will depend on your general health. It will also depend on whether or not you have any complications as a result of the operation. Many women find that they are able to go back to work between four and eight weeks after their surgery, but it can take longer than this to make a full recovery.
It’s also important to consider the kind of job you have. For example, you shouldn’t do any heavy lifting until about four to six weeks after your hysterectomy. So, if your job involves this type of activity, you will probably have to wait longer before you're able to return to work.
Your GP or gynaecologist will be able to give you an idea of when you can go back to work. If your employer has an occupational health adviser, he or she may be able to make recommendations about how to gradually return to your usual duties at work.
You may want to start having sex again after your scar has fully healed, which should take between four and six weeks. You may experience some dryness or discomfort, but a lubricant can help.
It takes time for your body to heal and recover from a hysterectomy. It’s best to wait until about six weeks after your operation before you have sex, which will allow time for your scar to heal. It’s then safe to have sex as long as you feel comfortable. If you have any discomfort or dryness, you may find a vaginal lubricant helps. Ask your pharmacist for advice, as some products are more suitable than others.
Having a hysterectomy can affect women in different ways. Some women feel more sexual pleasure after a hysterectomy because they don’t have the discomfort of the problem that led to them having the operation.
Most women find that they are still able to have an orgasm, but the sensation may be different to how it was before the operation. As your womb is removed in the operation, you will no longer feel womb contractions that you may have felt previously during orgasm. Pelvic floor muscles span the base of your pelvis and exercises that work these may help to improve your sexual satisfaction.
You may have a sense of loss after having your womb removed, and this may make you feel like not having sex. It can help to talk to your partner about how you’re feeling, and you may also wish to talk to a counsellor.
You may also find you have a lower sex drive if you had your ovaries removed in your operation. This is because your ovaries produce chemical substances called hormones that play a part in sexual pleasure.
If you have any sexual problems after your operation, talk to your GP or gynaecologist for advice.
Will having a hysterectomy bring on the menopause? Will having a hysterectomy bring on the menopause?
It depends on whether or not you have your ovaries removed during the procedure. If your ovaries are removed, you’ll go through the menopause. If your ovaries aren’t removed, you shouldn't get any menopausal symptoms after your hysterectomy.
The menopause occurs when your ovaries stop releasing eggs, which means you will stop having periods. Your ovaries also stop producing the hormone oestrogen. This causes the symptoms of the menopause, including hot flushes, night sweats, breast changes, vaginal dryness and difficulty sleeping.
If you had a hysterectomy but didn't have your ovaries removed, they should continue to work until you go through the menopause naturally. However, having a hysterectomy can sometimes make the menopause start sooner. This is called premature menopause or premature ovarian failure, and it sometimes happens if the blood supply to your ovaries is reduced as a result of the operation.
If your ovaries have been removed, your gynaecologist or GP may advise you to have hormone replacement therapy (HRT). This will replace the oestrogen that your ovaries are no longer producing and so reduce the symptoms of the menopause. HRT is available as tablets, skin patches and a skin gel.
Ask your GP or gynaecologist for more information on HRT and whether it's suitable for you.
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