What is hysterectomy?

Hysterectomy is the surgical removal of the uterus. Hysterectomy is performed for a variety of benign conditions that have not responded to conservative management, including heavy menstrual bleeding, symptomatic uterine fibroids, chronic pelvic pain and uterine prolapse. Hysterectomy is also performed for cancer of the uterus (including cervical cancer) and ovaries.

What are the different types of hysterectomy?

There are various types of hysterectomy. The type you have depends on why you need the operation and how much of your womb and surrounding reproductive system can safely be left in place.

The main types of hysterectomy are:

Total hysterectomy – The womb and cervix (neck of the womb) are removed. This is the most commonly performed operation. A total hysterectomy is usually the preferred option over a subtotal hysterectomy because removing the cervix means that there is no risk of you developing cervical cancer later.

Subtotal hysterectomy – The main body of the womb is removed, leaving the cervix in place. This procedure is not performed very often. If the cervix is left in place, there is still a risk of cervical cancer developing and regular cervical screening will still be required.

Total hysterectomy with bilateral salpingo-oophorectomy – The womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed. The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there is a significant risk of further problems – for example, if there is a family history of ovarian cancer.

Radical hysterectomy – The womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue.

What are the different ways to carry out a hysterectomy?

Vaginal hysterectomy– The womb is removed through a cut in the top of the vagina. A vaginal hysterectomy can either be carried out under a general anaesthetic (where you will be unconscious during the procedure), or spinal anaesthetic (where you will be numb from the waist down). A vaginal hysterectomy is usually preferred over an abdominal hysterectomy because it is less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.

Abdominal hysterectomy– The womb is removed through a cut in the lower abdomen. An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it is not possible to remove it through your vagina. It may also be recommended if your ovaries need to be removed.

Laparoscopic hysterectomy (keyhole surgery) – The womb is removed through several small cuts in the abdomen. Nowadays, a laparoscopic hysterectomy is the preferred treatment method for removing the organs and surrounding tissues of the reproductive system. Laparoscopic hysterectomies are usually carried out under general anaesthetic.

What are the complications of a hysterectomy?

Being fit and healthy before you have an operation reduces your risk of developing complications. It is very rare for serious complications to occur after having a general anaesthetic (1 in 10,000 anaesthetics given).

Surgical risks are:

Bleeding As with all major operations, there is a small risk of heavy bleeding (haemorrhage) after having a hysterectomy. If you have a haemorrhage, you may need a blood transfusion.

Ureteric damage The ureter (the tube which carries urine from the kidney to bladder) may be damaged during surgery, which happens in around 1% of cases. This is usually repaired during the hysterectomy.

Bladder or bowel damage In rare cases, damage to abdominal organs such as the bladder or bowel can occur.

Infection There is always a risk that an infection will develop after an operation. This could be a wound infection or a urinary tract infection. These aren’t usually serious and can be treated with antibiotics.

Thrombosis A thrombosis is a blood clot that forms in a vein and interferes with blood circulation and the flow of oxygen around the body. The risk of developing blood clots increases after having operations and periods of immobility. You will be encouraged to start moving around as soon as possible after your operation. You may also be given an injection of a blood-thinning medication to reduce the risk of clots.

What to expect after hysterectomy?

A hysterectomy is a major operation. You can be in hospital for up to 2-5 days following surgery.

After having a hysterectomy, you may wake up feeling tired and in some pain. This experience is normal after this type of surgery. You will be given painkillers to help reduce any pain and discomfort. If you feel sick after the anaesthetic, we will be able to give you medicine to help relieve this. You may have a drip in your arm and a catheter (a small tube that drains urine from your bladder into a collection bag).

The day after your operation, you will be encouraged to take a short walk. This helps your blood to flow normally, reducing the risk of complications developing, such as blood clots in your legs (deep vein thrombosis). A physiotherapist may show you how to do some exercises to help your mobility. After the catheter, has been removed, you should be able to pass urine normally. Any stitches that need to be removed will be taken out five to seven days after your operation.

The length of time it will take before you are well enough to leave hospital will depend on your age and your general level of health.

If you have had a vaginal or laparoscopic hysterectomy, you may be able to leave between one and two days later. If you have had an abdominal hysterectomy, it will usually be up to three days before you are discharged.

After a hysterectomy, you will experience some vaginal bleeding and discharge. This may last up to six weeks. Visit your GP if you experience heavy vaginal bleeding, start passing blood clots, or have an offensive-smelling discharge.

If your ovaries are removed, it is likely you will experience severe menopausal symptoms after your operation. These may include hot flushes, anxiety, tearfulness and sweating.

It takes about six to eight weeks to fully recover after having an abdominal hysterectomy. Recovery times are often shorter after a vaginal or laparoscopic hysterectomy.

When can I start my normal activities?

Returning to work Your ability to return to work will depend on how you feel and what sort of work you do. If your job does not involve manual work or heavy lifting, it may be possible to return after four to six weeks.

Driving Don’t drive until you’re comfortable wearing a seatbelt and can safely perform an emergency stop. This can be anything from between three and six weeks after your operation.

Exercise and lifting Walking is always recommended, and you can swim after your wounds have healed. Don’t try to do too much, because you will probably feel more tired than usual. Don’t lift any heavy objects during your recovery period.

Sex After a hysterectomy, it’s generally recommended that you don’t have sex until any vaginal discharge has stopped and you feel comfortable and relaxed.