Hysterectomy

A hysterectomy is an operation to remove your womb (uterus). It can be a treatment option for several different medical conditions. After a hysterectomy, you’ll no longer have periods and you won’t be able to get pregnant.

About hysterectomy

You might have a hysterectomy operation for the following health conditions.

• Painful, frequent, or heavy periods.
• Fibroids – non-cancerous growths of muscle and fibrous tissue in your womb.
• Endometriosis – when the cells that usually line your womb also grow outside it.
• Adenomyosis – when cells that usually line your womb grow into the womb muscle instead.
• Prolapse of your womb – when your womb has dropped down from its normal position.
• If you have womb cancer, cervical cancer or ovarian cancer, vaginal cancer, or fallopian tube cancer.

For most of these conditions, you’ll usually try other treatments first. But if they don't work, or if your symptoms are severe, your GP may refer you to a gynaecologist for further investigation and treatment. A gynaecologist is a doctor who specialises in women’s reproductive health.

Your gynaecologist will talk to you about your treatment options, including any possible alternatives and the benefits and risks of having a hysterectomy. They’ll explain exactly what will happen before, during, and after the procedure.

Take your time before you make a decision whether to have a hysterectomy. It can sometimes be a major operation, depending on your circumstances. While some people find an end to their symptoms following a hysterectomy a huge relief, others struggle coming to terms with having their womb removed. Be sure to ask your doctor if you have any questions.

Types of hysterectomy surgery

There are three main ways to do a hysterectomy operation.

• Abdominal hysterectomy. Your surgeon will make a cut in your tummy (abdomen) to reach your womb.
• Vaginal hysterectomy. Your surgeon will carry out the operation through your vagina.
• Laparoscopic hysterectomy (keyhole surgery). Your surgeon will use a camera and instruments that they’ll insert through small cuts in your tummy.

There are also different types of hysterectomy.

• In a total hysterectomy, both your womb and cervix are removed.
• In a subtotal hysterectomy your womb is removed but your cervix is left in place.
• A radical hysterectomy involves removing surrounding tissues in addition to your womb and cervix.
• An oophorectomy or salpingo-oophorectomy involves removing one or both ovaries and fallopian tubes. You may have this at the same time as your hysterectomy.

Whichever type you have, you won’t have periods and you’ll no longer be able to get pregnant after a hysterectomy.

The type of hysterectomy you’re offered and how it’s done will depend on a number of things. These include why you’re having it, how severe the problem is, and whether you have any other health conditions. Talk to your doctor about your options, and what would be best for your particular circumstances.

Menopause after hysterectomy

If you have your ovaries removed as well as your womb, you’ll go through the menopause straight after the operation. This is called a surgical menopause. If you have a hysterectomy without having your ovaries removed, you may still go through the menopause earlier than usual.

You may decide to take hormone replacement therapy (HRT) to manage some of the symptoms of menopause. Normally, people take both oestrogen and progesterone (progesterone protects the womb). Since your womb is removed in a hysterectomy, you won’t need to take progesterone, only oestrogen. Your doctor will talk to you about the menopause and the treatments available to help with symptoms.

Cervical screening after hysterectomy

If your cervix is removed as part of your hysterectomy, you’ll no longer need cervical screening (‘smear’) tests after the operation. If you have a hysterectomy that leaves your cervix in place, you should carry on having cervical screening tests.

Preparing for a hysterectomy

Before the operation

Your doctor will give you information about how to prepare for your hysterectomy operation. For example, if you smoke, they’ll ask you to stop. Smoking increases your risk of complications during and after your surgery. It can also slow your recovery.

You may need to have some tests, such as blood tests and an electrocardiogram (ECG) before your operation. This is to make sure that you’re well enough for the operation to go ahead as planned.

How long you need to stay in hospital depends on what type of hysterectomy you have, and how the operation is done. It may be a day or two after vaginal or laparoscopic surgery, but it may be longer if you’re having a hysterectomy to remove cancer. Your surgeon will advise you before the procedure. Make sure you arrange for someone to drive you home after your operation.

On the day

You’ll usually need to stop eating and drinking around six hours before your hysterectomy operation. You may be able to continue drinking water up to two hours beforehand. Follow any instructions your hospital gives you.

At the hospital, you’ll be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may have an injection of an anti-clotting medicine too.

You’ll meet your surgeon before the procedure. They’ll check if you’re happy to go ahead and ask you to sign a consent form.

Hysterectomy procedure

If you’re having an abdominal or a laparoscopic hysterectomy, you’ll usually have it under general anaesthesia. This means you’ll be asleep during the operation. For a vaginal hysterectomy, you’ll have a spinal anaesthetic, epidural, or a general anaesthetic. With a spinal anaesthetic or epidural, you’ll be awake but you’ll feel no pain from the waist down.

Abdominal hysterectomy

If you have an abdominal hysterectomy, your surgeon will make a cut across your lower tummy (abdomen). The cut may be along your bikini line. Sometimes your surgeon will make the cut from your belly button down to your bikini line instead. Your surgeon will then remove your womb and any other parts – such as your cervix, ovaries, and fallopian tubes – through the cut.

At the end of the operation, they’ll close your wound with stitches or clips.

Vaginal hysterectomy

In this method, your surgeon will insert instruments into your vagina to do the operation. They’ll make a cut around the lower part of your womb to take out your cervix and womb. They’ll then attach your vagina to ligaments in your pelvis using stitches.

Laparoscopic hysterectomy

Laparoscopy is sometimes called ‘keyhole surgery’. In this procedure, your surgeon will make three small cuts in your lower tummy. They’ll gently inflate your abdomen using carbon dioxide gas. This will allow your surgeon to see inside your tummy more clearly. Your surgeon will then insert surgical instruments with a tiny camera to remove your womb and cervix. Or they’ll use robotic instruments that they’ll control at a nearby console.

Aftercare for hysterectomy

In hospital

You’ll be in a recovery room once you wake up after your hysterectomy operation. You’ll need to rest until the effects of your anaesthetic have worn off. You’ll usually feel sleepy after a general anaesthetic and you might find it difficult to think clearly. This should pass within 24 hours. You might have some discomfort as the anaesthetic wears off but you'll be offered pain relief.

You’ll have a catheter in overnight after your hysterectomy operation. This drains urine through a tube and into a bag. Your nurse will remove it the next day, once you’re able to get up out of bed and move around. You may also have a drip to give you fluids and pain medication. After a vaginal hysterectomy, you may have a gauze pack inside your vagina to control bleeding for the first 24 hours. A nurse will remove this before you go home.

You’ll be able to start eating and drinking as soon as you feel ready. Eating and drinking can help you get back to normal and feel ready to go home.

Going home

Your healthcare team will monitor you and tell you when you can go home. This might be within the first 24 hours for a vaginal or laparoscopic hysterectomy, but it can be after two or three days. It’s likely to be between three and five days following an abdominal hysterectomy.

You won’t be able to drive straightaway, so you’ll need someone to take you home.

Caring for your wounds

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 should be able to have a shower or bath and remove any dressings the day after your operation. Pat your healing wounds to dry them.

If you’ve had a vaginal hysterectomy, you won’t have any wounds on the outside of your body. Stitches inside your vagina will be dissolvable, but you may notice them come out on their own after a few days or weeks. This is normal. They should completely dissolve after five to six weeks.

Often, any stitches you have will dissolve on their own and you won’t need to have them removed. But sometimes with an abdominal or laparoscopic hysterectomy, you may have stitches or staples that need to be removed. This can usually be done by the practice nurse at your GP surgery around five to seven days after your operation.

Recovery from hysterectomy

It usually takes a few weeks to recover from a hysterectomy operation but this is different for everyone. It may take longer. Although you need to rest, it will help with your recovery to start doing some gentle exercise and get back to your normal activities. Build up your activity slowly and gradually. Don’t lift anything heavy or do any strenuous activity for at least three to four weeks after having a hysterectomy.

Having sex

You can have sex six weeks (or more) after your hysterectomy operation, once all your wounds (inside and out) heal. You won’t need to use contraception to prevent pregnancy after a hysterectomy. But you will still need to use condoms to protect against sexually transmitted infections (STIs).

Pelvic floor exercises

It’s important to do pelvic floor exercises as part of your recovery, to strengthen these muscles. Your pelvic floor muscles help to hold your abdominal organs in the right place and keep your bladder and bowel closed. You may see a physiotherapist before you’re discharged from hospital, who will show you how to do these. Or ask your surgeon when you can start to do pelvic floor exercises.

Going back to work

When you go back to work will depend on the type of job you do, how physical it is and how well you feel. It might be two to three weeks after surgery if you’re feeling well and there are no complications from your surgery. But it can take longer for some people, especially if your job is more physical. You’ll usually recover faster following a vaginal or laparoscopic hysterectomy than an abdominal hysterectomy.

Driving

If you’ve had a vaginal or laparoscopic hysterectomy, it can take two to four weeks before you feel comfortable and safe enough to drive. If you’ve had an abdominal hysterectomy, this may take longer. Check with your motor insurance provider in case they have specific conditions for driving after surgery.

Side-effects of a hysterectomy

Hysterectomy side-effects can include the following.

• Pain and discomfort in your lower abdomen for some weeks after your operation but it should improve as you recover. Your nurse will provide you with some painkillers to manage this.
• Pain in your shoulder following a laparoscopic hysterectomy. It’s caused by the gas used to inflate your tummy irritating a nerve. You can take painkillers to manage this.
• Trapped wind. This is caused by your bowel temporarily slowing down, and it can feel uncomfortable. Walk around as much as you can as it will help.
• Light bleeding or spotting from your vagina for up to six weeks after your operation. Wear a sanitary pad, rather than using a tampon, until any bleeding stops.

Complications of a hysterectomy

Complications are problems that can occur during or after the operation. Some of the possible complications after a hysterectomy are as follows.

• Heavy bleeding (more than would normally be expected after hysterectomy). This is more common after abdominal hysterectomy.
• Infection of your wound. The skin around your scars may become very red and sore.
• Vaginal infection following vaginal hysterectomy. You may have a fever, foul-smelling discharge from your vagina and pain in your pelvis.
• A urine infection. You may need to pee urgently and more often, have pain, or discomfort when you’re peeing and smelly or cloudy pee.
• Damage to blood vessels or organs in your abdomen, including your bowel, bladder, or tubes that lead from your kidneys to your bladder (ureters). It can cause loss of sensation in your bladder, needing to pee more often, and constipation. If you have severe or worsening pain, vomiting, and a fever, seek medical attention.
• Deep vein thrombosis (DVT) – a blood clot in a vein in your lower leg. This may cause your leg to become red, swollen, and painful. It can be dangerous if it travels to your lungs (pulmonary embolism).

Contact the hospital where you had your hysterectomy if you develop any problems. You should seek urgent medical attention if you have severe pain, or signs of an infection, or DVT.

Sepsis (adults)

Sepsis is an extremely rare life-threatening complication of hysterectomy that can develop if you get an infection. Sepsis is a medical emergency. Call 999 or go to A&E immediately if you have any of the following symptoms.

• Slurred speech, confusion, difficulty making sense.
• Extreme shivering or muscle pain.
• Passing no pee (urine) during a day.
• Severe difficulty breathing, feeling breathless, or breathing very fast.
• It feels like you’re going to die.
• Skin changes, such as your skin looking blue, pale, or blotchy, or a rash that does not fade when you roll a glass over it.