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Abdominal hysterectomy

An abdominal hysterectomy is an operation to remove your womb (uterus) through a cut in your abdomen (tummy).

You will meet the gynaecologist (a doctor who specialises in women’s reproductive health) carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

There are a number of reasons why you may be offered a hysterectomy, these may include the following. 

  • Irregular or heavy menstrual bleeding, but only if other treatments haven’t worked.
  • Endometriosis. A condition in which cells that usually line your womb grow elsewhere in your abdomen.
  • Adenomyosis. This is a benign condition in which cells that usually line your womb grow in the womb muscle causing painful, heavy periods.
  • Cancer of your womb, ovary, fallopian tube or cervix (neck of the womb).
  • Fibroids (non-cancerous growths of muscle and fibrous tissue in your womb) that are painful, cause bleeding or are very enlarged.
  • Pelvic organ prolapse. This is when your womb, rectum or bladder drops out of position into your vagina.

An abdominal hysterectomy involves removing your womb through a cut in your abdomen. There are different types of hysterectomy.

  • Total hysterectomy involves removing your entire womb and your cervix.
  • Subtotal (also known as partial or supracervical) hysterectomy in which the top part of your womb is removed but your cervix is left in place.
  • Total hysterectomy with oophorectomy is when your entire womb, cervix and one or both ovaries are removed.
  • Radical hysterectomy is when your womb, cervix, part of your vagina, surrounding ligaments and occasionally your lymph nodes are removed.

You may be able to have the operation done with keyhole surgery.

Your ovaries may or may not be left in place depending on why you’re having a hysterectomy. Your ovaries produce oestrogen so if you have them removed, you will immediately go through the menopause. There is some evidence to show that having your fallopian tubes removed during a hysterectomy may reduce your risk of ovarian cancer, even if your ovaries aren’t removed. It’s important to discuss this with your gynaecologist before the operation. See our frequently asked questions for more information.

After a hysterectomy you won't have any more periods or be able to become pregnant.

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Abdominal hysterectomy
How the operation is carried out
An image showing the location of the womb and surrounding structures

Details

  • Preparation Preparing for an abdominal hysterectomy

    Your gynaecologist will explain how to prepare for your procedure. For example if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

    The procedure is usually done under a general anaesthetic, so you will be asked to follow fasting instructions. This means not eating, typically for about six hours beforehand. However, it’s important to follow your gynaecologist’s advice. It may be possible to have the operation done under epidural. This injection is given into the space that surrounds your spinal cord and numbs your body from the waist downward.

    Your gynaecologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form. This process is usually done in the clinic prior to your admission.

    You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as wearing compression stockings. Usually, you will also be given antibiotics before your surgery.

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  • Alternatives What are the alternatives to abdominal hysterectomy?

    A hysterectomy will usually only be recommended if other treatments, such as medicines or other surgery, are unsuitable or haven't worked for you. For example, if you have fibroids or problem periods, you may be able to have other, less invasive treatments such as a uterine artery embolisation (blocking off the blood supply to your fibroids) or myomectomy (this involves removing tissue from the muscle in the wall of your womb). Speak to your gynaecologist for more information.

    Alternative hysterectomy techniques to an abdominal hysterectomy are:

    • vaginal hysterectomy – the procedure is done through your vagina
    • keyhole hysterectomy – the procedure is done through small cuts in your abdomen and often in combination with vaginal hysterectomy

    Ask your gynaecologist for advice about which surgery will be most suitable for you.

  • The procedure What happens during an abdominal hysterectomy?

    The operation usually takes about an hour unless you’re having a radical hysterectomy, which takes about two hours. However, this may vary depending on why you’re having a hysterectomy as this will determine the complexity of the surgery.

    Your gynaecologist will probably make a horizontal cut (between 10 and 16cm long) across your lower abdomen, just below your bikini line. It may be necessary for your gynaecologist to make a vertical cut from your belly button down to your bikini line instead, for example, if you have a particularly large womb or if you’re having the operation because you have or may have ovarian cancer. Your gynaecologist will discuss this with you before the operation.

    Your gynaecologist will take your womb out through the cut in your abdomen. Stitches (which may be dissolvable), metal clips or glue will be used to close the cut and the area will be covered with a dressing.

  • Hysterectomy operation on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including hysterectomy operations.

  • Aftercare What to expect afterwards

    You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

    You will have a catheter to drain urine for up to 24 hours after surgery. If you find it difficult to pass urine after this time, you may need to keep the catheter in for longer particularly if you had an epidural for pain relief.

    You may also find that you don't have any bowel movements for a few days after the procedure and this can cause you to have painful wind. You may be offered a mild laxative to help ease this. Having a gentle walk around will also help once you feel able to get out of bed. Your nurse will give you advice about getting out of bed, bathing and your diet. You may see a physiotherapist who can explain some exercises that you can do to help your recovery.

    You’re likely to be able to take off the dressing on your wound after about 24 hours. The clips or stitches will usually be taken out by your practice nurse at your GP surgery about five to seven days after your operation. However, dissolvable stitches are being used more often now as they don’t need to be removed and there is less risk of infection. The amount of time your dissolvable stitches will take to disappear depends on what type you have – it may be anything from a few days to a few weeks.

    You will probably stay in hospital for up to four days. Before you go home, your nurse will advise you about caring for your wounds and may arrange a date for a follow-up appointment.

  • Recovery Recovering from an abdominal hysterectomy

    The length of time it takes to recover after an abdominal hysterectomy will be different for every woman, and it can take up to a couple of months to recover fully. It's important to follow your gynaecologist's advice. Most women are able to return to work between four and eight weeks after the operation but it will depend on the type of job you have and how physical it is.

    If you had a keyhole procedure, you will probably be able to return to your usual activities sooner than if you had open surgery. See our frequently asked questions for more information.

    You may have some abdominal or back pain for a few weeks after your operation. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    You will need to take it easy for a few days and you’re likely to feel more tired than usual. If a physiotherapist has given you exercises to do, try to continue with these. You can lift light items, such as a kettle, but don't lift anything heavy 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 steadily increase how much activity you do. You can go swimming about two to three weeks after your hysterectomy.

    You will probably be able to drive three to six weeks after the operation but if you're in any doubt about driving, 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 will be comfortable. Also bear in mind access to medical facilities if you go abroad.

    It's normal to have some bleeding from your vagina for up to three weeks after the procedure. Use sanitary towels rather than tampons to help 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 as you may have an infection – see our frequently asked questions for more information.

    Although you will stop having periods after a hysterectomy, you may notice monthly changes in your breasts, such as feeling lumpy or tender. These will continue until the age at which your periods would have stopped naturally. You may feel emotional or depressed, and this can take some time to improve. You may find it helps to talk to a friend or family member about how you’re feeling.

    Wait until your scar has fully healed before you start having sex again. This will probably take between four and six weeks. See our frequently asked questions for more information.

    As your wound heals you may be more aware of your lower abdomen and how it feels.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with an abdominal hysterectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your gynaecologist to explain how these risks apply to you. Your gynaecologist should be able to tell you his or her specific rates of side-effects and complications.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the operation. Side-effects of an abdominal hysterectomy include:

    • pain, swelling and bruising in your abdomen
    • bleeding or blood-stained vaginal discharge
    • numbness, tingling or a burning sensation around your scar

    If your ovaries have been removed during the operation, you will have menopausal symptoms such as hot flushes, night sweats and vaginal dryness.

    You will also have a permanently visible scar – this will be red and slightly raised to start with, but should soften and fade over time. This usually settles after about six to 12 months.

    Complications

    Complications are when problems occur during or after the procedure. 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).

    Specific complications of an abdominal hysterectomy, this may include the following.

    • Blood loss. You may need further treatment, such as a second operation, to stop the bleeding.
    • Damage to other organs and tissues in your abdomen, particularly your bowel, bladder and ureters (the tubes that carry urine from your kidneys to your bladder). This can cause incontinence or a need to urinate frequently.
    • A wound or urinary infection. You will need to take antibiotics to treat this.
    • Premature ovarian failure. There is a risk that your ovaries won’t work properly because they receive some of their blood supply through the womb.
    • A blood clot. These develop most commonly in the leg. 
  • FAQs FAQs

    How can I tell if I’ve developed an infection after abdominal hysterectomy?

    Answer

    If you start to feel unwell and develop a fever after your operation, you may have an infection. Your wound may become red and inflamed and there may be discharge coming from it. If you have any of these symptoms, contact your GP or gynaecologist.

    Explanation

    You will have some pain and discomfort after an abdominal hysterectomy. You will 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 less pain.

    If the pain gets worse and you feel unwell or develop a fever, you may have a wound or urinary infection. It's important to contact your GP or gynaecologist if:

    • your wound becomes red, tender and hot
    • you have a heavy or unpleasant smelling discharge coming from your wound
    • you have a burning feeling when you urinate, or feel like you need to urinate very frequently

    Your GP or gynaecologist will ask about your symptoms and examine you. He or she will then be able to advise you about a suitable treatment. Treatment is usually with antibiotics.

    How soon can I return to work after abdominal hysterectomy?

    Answer

    Your gynaecologist will advise you when you can go back to your usual activities. Some women feel ready after two weeks but for others it may take longer, possibly up to eight weeks. It will be different for every woman and will depend on a number of things including how well you’re recovering.

    Explanation

    The time it takes to recover from an abdominal hysterectomy will depend on your general health and whether you developed any complications as a result of the operation. Most 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 also depends on what kind of job you have, for example you shouldn’t do any heavy lifting until about six weeks after your hysterectomy. Therefore, 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.

    I’ve heard about ‘enhanced recovery’ for hysterectomy – what is this?

    Answer

    Enhanced recovery is a basic set of principles that aims to reduce the time it takes to recover from certain surgical procedures. It’s only appropriate for elective surgery – this means you have had time to think about the operation in advance and it isn’t being done as an emergency.

    Explanation

    Enhanced recovery, also called ‘fast track’, ‘rapid’ or ‘accelerated recovery’, is designed to reduce how much you’re affected physically and emotionally by an operation. It has mainly been found to be effective for colorectal (bowel) surgery but there is some evidence that it may also be useful for improving how well you recover after a hysterectomy.

    There are four key parts to the enhanced recovery programme, which means there are a number of differences compared with standard care when you have surgery. Enhanced recovery emphasises more specific planning and preparation before your operation. For example, you will be advised to get as fit and healthy as possible so that your body is able to deal with the operation as well as possible. Usually when you have an operation you won’t be able to eat or drink anything for about six hours beforehand, but enhanced recovery care recommends you can drink clear fluids, such as water or diluted cordial, until two hours before your operation.

    With enhanced recovery you’re more likely to be offered a minimally invasive technique, such as keyhole surgery, or if this isn’t an option, your gynaecologist will make the cut as small as possible. If it’s possible, your gynaecologist will use an epidural or regional anaesthesia – this blocks pain from the area but you will stay awake. Rather than general anaesthesia, which means you will be asleep during the operation.

    A very important aspect of enhanced recovery is pain management. Treating any pain effectively will mean you’re able to get up and start moving around as soon as possible after your operation. This may be as early as the same day that you had it. This is known as early mobilisation and is another key area of this type of care. Moving around reduces your risk of a blood clot and prevents your muscles from losing too much strength.

    You will be encouraged to drink something as soon as you feel able and to eat within 24 hours. This is different to traditional care in which you would probably only be able to take sips of drinks for a few days after your operation.

    Enhanced recovery also involves having a clear plan for when you leave hospital, including what follow-up care you will have. This is particularly important for ensuring that the length of time you spend in hospital is as short as possible.

    Enhanced recovery care isn’t available in all hospitals or for all procedures, and it isn’t suitable for everyone. Ask your gynaecologist for more information.

    Will having a hysterectomy affect my sex life?

    Answer

    It's natural to worry that a hysterectomy might affect your sex life. This will depend on a number of factors, including the type of operation you have.

    Explanation

    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 an abdominal 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. You may find that you have some loss of libido (sex drive) and a sense of loss after having your womb removed. It can help to talk to your partner about how you’re feeling, and you may also wish to talk to a counsellor.

    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.

    If you had your ovaries removed in the operation, this can potentially affect your sex life and result in an early menopause. Your ovaries produce several hormones that play a part in sexual pleasure. You may be offered hormone replacement therapy (HRT) to help with menopausal symptoms that occur after a hysterectomy, which can include a loss of interest in sex.

    If you have any sexual problems after your operation, talk to your GP or gynaecologist for advice.

    Will having an abdominal hysterectomy bring on the menopause?

    Answer

    It depends on whether or not you have your ovaries removed during the procedure. If your ovaries are removed, you will have the symptoms of the menopause. If you don't have your ovaries removed, you shouldn't get any menopausal symptoms after your hysterectomy.

    Explanation

    The menopause occurs when your ovaries stop releasing eggs, which means you will stop having periods. Your ovaries will also stop producing the hormone oestrogen. This causes the symptoms of the menopause, including hot flushes, night sweats, vaginal dryness and difficulty sleeping.

    If you have a hysterectomy but don'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.

  • Resources Resources

    Further information

    Sources

    • Uterine artery embolisation (UAE) for the treatment of adenomyosis. National Institute for Health and Care Excellence (NICE), March 2013. www.nice.org.uk
    • Hysterectomy. The American College of Obstetricians and Gynecologists. www.acog.org, published August 2011
    • Laparoscopic radical hysterectomy for early stage cervical cancer. National Institute for Health and Care Excellence (NICE), May 2010. www.nice.org.uk
    • Parker WH, Feskanich D, Broder MS, et al. Long-term mortality association with oophorectomy compared with ovarian conservation in the Nurses’ Health Study. Obstet Gynecol 2013; 121(4): 709–716. doi: 10.1097/AOG.0b013e3182864350
    • Welcome to the Hysterectomy Association. The Hysterectomy Association. www.hysterectomy-association.org.uk, accessed 4 June 2013
    • Uterine fibroids. BMJ Best Practice. www.bestpractice.bmj.com, published May 2013
    • Heavy menstrual bleeding. National Institute for Health and Care Excellence (NICE), January 2007. www.nice.org.uk
    • Hysterectomy. eMedicine. www.emedicine.medscape.com, published October 2012
    • Recovering well. Information for you after an abdominal hysterectomy. Royal College Obstetricians and Gynaecologists. www.rcog.org.uk, published July 2010
    • Be breast aware. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published September 2006
    • Personal communication, Mr Robin Crawford, Consultant Gynaecological Oncologist, Cambridge University Hospitals NHS Foundation Trust, August 2013
    • The menopause. Women’s Health Concern. www.womens-health-concern.org, published November 2012
    • Having a hysterectomy. Macmillan Cancer Support. www.macmillan.org.uk, published January 2013
    • Consent advice no. 4. Abdominal hysterectomy for benign conditions. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published May 2009
    • Johns Hopkins Medicine Health Library. Hysterectomy. www.hopkinsmedicine.org, accessed 5 June 2013
    • Menopause. BMJ Best Practice. www.bestpractice.bmj.com, published October 2012
    • Premature ovarian failure. BMJ Best Practice. www.bestpractice.bmj.com, published October 2012
    • Hysterectomy. Women’s Health Concern. www.womens-health-concern.org, published June 2012
    • ERAS – enhanced recovery after surgery. Royal College of Nursing. www.rcn.org.uk, published 23 October 2011
    • Enhanced recovery in gynaecology. Scientific impact paper no. 36. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published February 2013
    • Enhanced recovery programme. NHS Institute for Innovation and Improvement. www.institute.nhs.uk, published 2008
    • Guidelines for implementation of enhanced recovery protocols. Association of Surgeons of Great Britain and Ireland. www.asgbi.org.uk, published December 2009
  • Related information Related information

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    Reviewed by Polly Kerr, Bupa Health Information Team, August 2013.

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