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Hysterectomy

A hysterectomy is an operation to remove your womb (uterus).You might also have your cervix removed, and some women have their fallopian tubes and ovaries taken out too. Hysterectomy is a treatment option for several gynaecological conditions (conditions that affect your reproductive system).

An image showing the location of the womb and surrounding structures

About hysterectomy

Your hysterectomy will be done by a gynaecologist (a doctor who specialises in women’s reproductive health).

Your doctor may offer you a hysterectomy if you have cancer of your womb or ovarian cancer. Your doctor may also recommend a hysterectomy to treat some types of cancer of the cervix.

If other treatments such as medicines and other surgery haven’t worked, you may also be offered a hysterectomy for the following conditions.

  • Endometriosis. This is when the cells that usually line your womb also grow outside it. Endometriosis can cause problems if you’re trying to get pregnant and sometimes causes long-term pain in the lower part of your tummy.
  • Adenomyosis. This is when cells that usually line your womb grow into the womb muscle instead. It can cause heavy and long periods, and cramping pain in the lower part of your abdomen.
  • Large or painful fibroids. Fibroids are growths of muscle and fibrous tissue in your womb. They can cause heavy periods and fertility problems.
  • Irregular or heavy menstrual bleeding (periods).
  • Uterine prolapse. This is when your womb has dropped down from its normal position into your vagina.

You’ll meet the doctor doing your procedure beforehand. It may be different from what’s described here as it will be designed to suit your individual needs.

Types of hysterectomy

There are different types of hysterectomy. A hysterectomy can be done by making a cut in your abdomen to access your womb (abdominal hysterectomy) or through several small cuts known as laparoscopic hysterectomy (or ‘key hole’ surgery). It can also be done by inserting special medical instruments into your womb through your vagina (vaginal laparoscopy). See our Procedures section below for more information.

Most women have what’s known as a total hysterectomy. This is when the womb and cervix are removed. Subtotal hysterectomy is when only the womb is removed. During a hysterectomy, your doctor may also remove one, or both, of your fallopian tubes and ovaries.

The type of hysterectomy you have, and how it’s done, will depend on why you’re having it, what your symptoms are and what your general health is like. Other factors also play a part, such as whether you’re overweight, the size of your womb and whether you’ve had an operation in the same area before. Talk to your doctor about the options that are open to you, and the pros and cons of each.

It’s important to note that if you have a hysterectomy which leaves your cervix in place, you should carry on having cervical screening (smear) tests. You won’t need to have smear tests if you have the other types of hysterectomy.

Deciding on hysterectomy

A hysterectomy is a major operation and for many women is a big decision to have to make. For some women it’s a huge relief, whereas for others it’s a painful and life-changing decision.

So, it’s important to talk to your doctor about 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.

Here we outline some things to think about if you’re considering a hysterectomy.

  • Having a hysterectomy comes with certain side-effects and risks. See our Side-effects and Complications sections below for more information. Remember that all operations come with an element of risk, so it’s important to weigh this up against the benefits of having the operation.
  • If you have a hysterectomy, you won’t be able to have children, which might be important to you.
  • If you have your ovaries taken out as well as your womb, you’ll start to go through the menopause immediately. You may experience symptoms and other effects of the menopause. For more details about these, see our information on the Menopause.
  • For some women, a hysterectomy can cause the feeling of a loss of their femininity and a change in the way they see themselves. It’s important to consider how these emotions may make you feel.

Preparing for a hysterectomy

Before the operation

Your doctor will explain how to prepare for your operation. 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. It’s also a good idea to be as fit and healthy as you can before the operation, so that you recover well and quickly. That means losing weight if you’re overweight, eating healthily and making sure that any other health conditions, such as high blood pressure, are well controlled.

You’ll need to have a pre-op check a week or two before the operation. These checks are to make sure that you’re well enough for the operation to go ahead as planned. You’re likely to have:

  • your blood pressure and pulse measured
  • blood tests
  • an ECG (electrocardiogram) – this is a test to check that your heart is healthy
  • If you have diabetes, your doctor may do a blood test called HbA1c to check how your blood sugar levels have been over the last weeks or months. They’ll want to make sure that your diabetes is under control before surgery. They’ll discuss this with you and outline a plan to help manage your blood sugar levels before surgery.

On the day

You’ll usually go into hospital on the day of your operation. Depending on what type of hysterectomy you have, and how the operation is done, you could be in hospital for between one and four days.

The operation can be done under general anaesthesia, or using a spinal or epidural anaesthetic. For a general anaesthetic you’ll be asleep throughout the operation. For a spinal anaesthetic or an epidural, you’ll be awake, but you’ll feel numb from the waist down.

Having an anaesthetic can make you sick so it's important that you don't eat anything for six hours before your operation. You may be able to drink up to two hours before your surgery, but your anaesthetist or doctor will tell you what you need to do. If you have any questions, just ask.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may also need to have an injection of an anti-clotting medicine as well as, or instead of, wearing compression stockings.

Your nurse or doctor will discuss with you what will happen before, including any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

Alternatives to hysterectomy

For conditions like fibroids and endometriosis, there are alternative treatments. For example, if you have fibroids and you want to have children, your doctor may suggest a myomectomy. This is when the fibroids only are taken out and your womb left intact. If you have endometriosis, your doctor may suggest medicines or hormone treatments. However, hysterectomy is usually offered when other treatments have been tried, but haven’t worked. If you have cancer of your ovary or womb, then hysterectomy is likely to be offered as the first choice of treatment.

Whatever your situation, talk to your doctor about the treatment choices available to you.

Hysterectomy procedure

A hysterectomy operation usually takes between one to two hours, but exactly how long it takes will depend on why you’re having it and the type of operation.

Before the operation starts, you’ll probably be given antibiotics via a drip or straight into your vein. This can help to prevent an infection after the operation.

Vaginal hysterectomy

Once you’ve had your anaesthetic, your doctor will put special instruments inside your vagina to hold it open, so that they can see everything clearly. They make a cut in the top of your vagina and take out your cervix and womb through the cut. They close the cut in your vagina using dissolvable stitches and may put a gauze dressing inside, about the size of a large tampon. This helps to stop the wound bleeding. It’s taken out before you leave hospital.

Sometimes your doctor may use laparoscopic instruments during your operation. This is called a laparoscopic-assisted vaginal hysterectomy. This means making some small cuts in your abdomen and putting in a thin rigid piece of equipment (with a camera to help your doctor see) and other special instruments. Using these, your doctor can cut out your womb and cervix, which are then taken out through your vagina.

Abdominal hysterectomy

Your doctor makes a cut, about 10cm long, across your lower abdomen (tummy). The cut is just below your bikini line and above your pubic hair. Sometimes, for example if you have cancer, the cut is made from your tummy button (navel) down to your bikini line instead. Your doctor makes cuts inside your abdomen to take out your womb and sometimes your cervix. They may also take out your ovaries and fallopian tubes at the same time, depending on the reasons for your operation. Your doctor will make sure that any bleeding has stopped and then use stitches, clips, staples or glue to close your wound. You’ll have a dressing put on to cover the wound.

Your doctor may put a thin tube called a drain inside your wound. It helps to drain away any blood or fluid that builds up. Once any bleeding has stopped your nurse will take this out.

Laparoscopic hysterectomy

Laparoscopy is sometimes called ‘key-hole surgery’. Your doctor makes one or more small cuts in your lower abdomen. This usually includes one in your tummy button (navel).

A tube is put into one of the cuts and through this your doctor will put carbon dioxide (a gas). This gently inflates your abdomen, so that your doctor can see better. A thin rigid piece of equipment with a camera is put in through one of the cuts and special surgical instruments cut out and remove your womb and cervix.

Aftercare for hysterectomy

You’ll need to rest until the effects of your anaesthetic have worn off. Having a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

You’re likely to have some pain and discomfort in your lower abdomen for a few days after your operation. If you’ve had a laparoscopic hysterectomy you may have some pain in your shoulder too. Ask your nurse for painkillers if you need them.

You may have a catheter in for about 24 hours after your operation. This drains urine through a tube and into a bag. Once you’re able to get up and go to the toilet easily, your nurse will take it out. If you have problems passing urine, it may stay in for a few days.

When you wake up from the anaesthetic you may have a drip in your arm to give you fluids. This usually stays in place until you’re able to drink, and you’re drinking enough.

Some women get trapped wind after their operation. This happens because your bowels slow down. You can ease any discomfort by getting up and walking around. You may find that having peppermint water helps to ease your symptoms. The discomfort should go once your bowels are back to what’s normal for you.

You may need to keep wearing compression stockings to keep your blood flowing. Getting out of bed and moving around is a good idea. You may not feel like it, but it will help prevent other problems later, such as blood clots in your legs or lungs.

You’ll probably have some bleeding from your vagina for up to two weeks after your operation. This is usually like a light period, and can be red or brown. Some women have little or no bleeding straight after their operation, but then have a sudden gush of blood or fluid after about 10 days. This usually stops quickly, but if it doesn’t, or you have any heavy bleeding, speak to your doctor or GP. Wear a sanitary pad, rather than using a tampon, until any bleeding stops.

You should be able to have a shower the day after your operation, but avoid having a bath for around a week. You can take off any dressings then. After your bath or shower, make sure you dry your wounds by patting them gently with a clean disposable tissue. Keeping scars clean and dry will help them to heal.

If you’ve had a vaginal hysterectomy, you won’t have any wounds on the outside of your body. Any stitches inside your vagina may come out after a few days or weeks – this is normal.

If you’ve had an abdominal or laparoscopic hysterectomy, you’ll have some visible wounds. If you have dissolvable stitches, you won’t need to have these removed – they should disappear after some time.

Before you go home, your nurse will advise you about caring for your wounds and may arrange a date for a follow-up appointment. You’ll need to arrange for someone to drive you home.

Recovering from a hysterectomy

Recovery after a hysterectomy is different for every woman, and will depend on whether you’ve had a vaginal, abdominal or laparoscopic procedure:

  • If you’ve had a vaginal or laparoscopic hysterectomy, you can gradually return to your usual daily activities after a week or two. Don’t lift anything heavy or do any strenuous housework (like vacuuming) for three to four weeks. You should be able to go back to work between two and six weeks after your operation, depending on your job and how well you feel. It can take two to four weeks before you feel comfortable enough, and are safe enough, to drive.
  • If you’ve had an abdominal hysterectomy, you can gradually return to your usual daily activities over a few weeks, but if you have any pain, ease off for a few days. Don’t lift anything heavy or do any strenuous housework (like vacuuming) for three to four weeks. You should be able to go back to work between three and eight weeks after your operation, depending on your job and how well you feel. It can take three to six weeks before you feel comfortable enough, and you’re safe enough, to drive.

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.

Your doctor is likely to suggest that you do pelvic floor exercises as part of your recovery. Your pelvic floor muscles help to hold your abdominal organs in the right place and keep your bladder and bowel closed. So, it’s important to make sure they work well after your operation. You doctor or nurse will tell you what you need to do and how often.

It’s a good idea to wait until your wounds have fully healed before you have sex. This will probably take between four and six weeks. If you have vaginal dryness or discomfort, a vaginal lubricant usually helps. See our FAQs, below for more information.

Contact the hospital or your GP if you develop any of the following symptoms when you’re at home.

  • The symptoms of a urine infection. This includes feeling like you need to pee urgently and often, pain or discomfort when you’re passing urine and smelly and cloudy urine.
  • Heavy or smelly bleeding from your vagina. If you’re also feeling unwell and have a temperature (fever), this could be a sign that you have an infection at the top of the vagina.
  • Sore, red skin around your scars. This could mean you have a wound infection.
  • Abdominal pain that’s severe or getting worse, along with being sick, a fever and not feeling like eating. This could be a symptom of damage to your bladder or bowel from the operation.

Side-effects of a hysterectomy

Side-effects are the unwanted, but mostly temporary effects you may get after having the operation.

Side-effects of a hysterectomy include the following:

  • feeling tired and emotional
  • pain and discomfort
  • bleeding from your vagina

Complications of a hysterectomy

Complications are problems that can occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Some of the possible complications and risks after a hysterectomy include.

  • Heavy (excessive) bleeding.
  • A wound or urine infection.
  • Damage to some of the blood vessels or organs in your abdomen – including your bowel, bladder and ureters (the tubes that carry urine from your kidneys to your bladder).

See our Recovery section, above for more information on when to seek help.

FAQ: When can I have sex after a hysterectomy? Will it feel different?

Whatever type of hysterectomy you’ve had, it’s a good idea to wait until your wounds have completely healed before you have sex. This usually takes between four and six weeks. If you find sex uncomfortable and your vagina is dry, then using a vaginal lubricant usually helps. After a hysterectomy, most women can have an orgasm, although it might feel different from before.

Having a hysterectomy affects women in different ways, so it’s difficult to say for sure how, or if, it will affect your sex life. Some women who have a hysterectomy for non-cancerous conditions, like fibroids or endometriosis, find that they feel generally better and sex feels better afterwards. However, around one or two out of every 10 women feel that sex is more painful after a hysterectomy, and the way that an orgasm feels changes.

Some women who have a hysterectomy for cancer do find that their sex life changes. This is particularly true for women who have their ovaries taken out as well as their womb, because this affects their sex hormones. This can mean you feel less like having sex and sex can be uncomfortable because your vagina can be dry.

It’s not uncommon to not feel like sex after a major operation or cancer treatment. You may feel stressed, tired and low, and have a lot to cope with. It’s important to talk to your partner, if you have one, and let them know how you’re feeling. Take things at a pace that’s right for you.

Any problems with sex usually get better as you recover and feel better. If they don’t, then talk to your GP, practice nurse or your doctor. They may be able to help you get some support or counselling.

FAQ: Will having a hysterectomy bring on the menopause?

If you have your ovaries taken out, as well as your womb, you’ll go through the menopause after your hysterectomy.

You would naturally go through the menopause between the age of 45 and 55, when your ovaries no longer have eggs to release each month. Your hormone levels change and the amount of oestrogen and progesterone in your body falls. This means your periods stop and you may get other symptoms too, such as hot flushes, sweats and mood changes.

If you have a hysterectomy but don't have your ovaries removed, they’re likely to continue to work until you go through the menopause naturally. But, there is some research that shows that in younger women, having a hysterectomy (without ovaries being taken out) can sometimes make the menopause start sooner. Doctors don’t know whether it’s the operation that causes this, or the condition that leads to needing the hysterectomy. Talk to your doctor about the benefits and risks of the operation for you.

If you have your ovaries taken out, your body will go straight into the menopause. If you’re young, then this can mean going through the menopause many years before you naturally would. If you wanted a family and are unable to have one because of the surgery, this can be particularly hard to cope with.

Your doctor should speak to you about the effects of the menopause and possible treatments, including lifestyle changes and hormone replacement therapy (HRT) before you have a hysterectomy. Your doctor’s there to give you the information you need to make a decision that’s right for you, so don’t hesitate to ask if you have questions.

Details

  • 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.

  • Other helpful websites Other helpful websites

    Further information

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    Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, March 2018
    Expert Reviewer, Mr Robin Crawford, Consultant Gynaecological Oncologist
    Next review due March 2021

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