Hysterectomy

What is a hysterectomy?

A hysterectomy is major surgery to remove the uterus (womb).

There are different types of hysterectomy. In a total hysterectomy, the cervix (the lower part of the uterus near the vagina) is also removed. In a subtotal hysterectomy, the uterus is removed without the cervix.

If you have a hysterectomy you might also have an oophorectomy and/or a salpingectomy. This means the ovaries or fallopian tubes (or both) are also removed.

Your doctor will talk to you about the best option for you.

Why might I need to have a hysterectomy?

There are different reasons why your doctor may recommend a hysterectomy. It may be because you have:

• cancer of the uterus, cervix, tubes or ovaries
• heavy menstrual bleeding that hasn’t improved with other treatments
• fibroids (non-cancerous lumps) in the uterus
• a prolapsed uterus
• severe chronic (ongoing) pelvic pain — for example, due to endometriosis or adenomyosis
• pelvic inflammatory disease

Rarely, you might need an emergency hysterectomy if you have uncontrolled bleeding from your uterus that can’t be stopped in any other way. This can happen after childbirth.

Considering a hysterectomy

It can be a big decision to have a hysterectomy. If your situation is not urgent, it’s important to take time to think about what it will mean for you. Ask your doctor why they recommend a hysterectomy and what risks and benefits you can expect.

Your doctor will probably recommend other treatments first, such as medicines or other surgical procedures. A hysterectomy is usually only considered when other treatments aren’t available or haven’t worked for you. Keep in mind that you won’t have periods anymore. Remember that you can’t become pregnant after you’ve had a hysterectomy, so before you have one, you should be completely sure that you’ll never want to become pregnant.

Types of hysterectomy surgery

Hysterectomy surgery may be:

• abdominal — where the uterus is removed through a cut in your abdomen
• vaginal — where the uterus is removed through your vagina
• laparoscopic — where a camera and instruments are passed through small cuts in your abdomen to help remove the uterus

You can discuss with your doctor the best type for you.

You will usually have a general anaesthetic, and the operation takes about an hour.

A hysterectomy is a common and safe procedure. However, as with any surgery, there are risks that you should discuss with your doctor.

Risks include:

• bleeding
• infection of the surgical wound
• urinary tract infection
• blood clots
• injury to organs near the uterus, such as the bladder, ureters or bowel
• reactions to the anaesthetic

Recovering from hysterectomy surgery

After having a hysterectomy, you’ll be in hospital for 3 to 5 days.

You may have light vaginal bleeding for up to 2 weeks after surgery. Pain should settle down within a week after a vaginal or laparoscopic hysterectomy. It usually takes a bit longer for pain to settle after an abdominal hysterectomy.

Your health team will advise you not to lift heavy objects or do anything physically demanding for 4 to 6 weeks. You may be off work for 2 to 6 weeks, depending on your job. It’s important to avoid having penetrative (vaginal or anal) sex for 6 to 8 weeks while the area heals.

Contact your doctor if:

• your wound becomes red or more painful
• you notice a bad-smelling discharge
• your bleeding is heavier than a typical period
• you have a fever or feel sick
• you’re having trouble passing urine (wee) or bowel motions (poo)

What can I expect after a hysterectomy?

Some people find a hysterectomy very difficult emotionally, and worry about their sexuality or loss of fertility. Others find they feel much better after the operation, especially if pain or troublesome symptoms have gone.

A hysterectomy will stop your periods, but it won’t put you into menopause, as your ovaries will keep producing hormones. However, if your ovaries are removed too, you will go into menopause suddenly. Your doctor might suggest you take menopausal hormone therapy (MHT – also sometimes called hormone replacement therapy, or HRT).

If your cervix is not removed, you will need to continue having cervical screening tests. If your cervix is removed, your doctor will tell you whether you need to continue screening, depending on your individual circumstances.