Hysterectomy

Hysterectomy is an operation that involves removing a woman’s uterus or womb. There are many different reasons why a woman may need a hysterectomy. These reasons, as well as the woman’s needs and wishes, will determine how the operation is done.

Key points:

  • Hysterectomies are carried out to treat conditions that affect the female reproductive system, including bleeding problems, endometriosis, uterine fibroids, prolapse or cancer.
  • Many of these problems can be treated without needing to have a hysterectomy and in most cases, a hysterectomy is only done when other treatments are not working.
  • After a hysterectomy, you’ll no longer be able to get pregnant and you’ll no longer have periods.
  • A hysterectomy may also involve the removal of the ovaries and/or fallopian tubes.

Why do I need a hysterectomy?

The most common reasons for a hysterectomy include:

  • Abnormal vaginal bleeding that is not controlled by other treatment methods.
  • Severe endometriosis (when cells like the inside lining of the uterus grow outside the uterus).
  • Uterine fibroids (benign tumors) that have increased in size, are painful or are causing bleeding.
  • Long-term severe pelvic pain related to the uterus but not controlled by other treatment.
  • Uterine prolapse (when your uterus "drops" into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements.
  • Cervical or uterine cancer or abnormalities that may lead to cancer.

Many of these problems can be treated without needing to have a hysterectomy and in most cases, a hysterectomy is only done when other treatments are not working.

Types of hysterectomy

Depending on the reason for the surgery, all or only part of the uterus may be removed. Discuss with your surgeon what the best option for you is. The main types of hysterectomy include:

  • Subtotal hysterectomy – where the main part of the uterus is removed, but the lower part of the uterus, called the cervix is left behind.
  • Total hysterectomy – where all of the uterus is removed including the cervix.
  • Extended hysterectomy – an extended hysterectomy refers to the removal of the uterus and the tissue around the uterus. Usually the ovaries and fallopian tubes will also be removed during this operation. Sometimes part of the bladder or bowel may also need to be removed. The most common reason for this operation is when a woman has cancer of the cervix, uterus or ovaries.

(Image source: Mayo Clinic, 2017)

How is a hysterectomy done?

There are several different ways that a hysterectomy can be performed.

Abdominal hysterectomy

A hysterectomy can be performed through a cut in the woman’s lower abdomen (tummy). This is usually by making a sideways cut just above the pubic bone, like a caesarean section scar. Sometimes a vertical cut from the pubic bone to the umbilicus or tummy button is needed.

  • The main advantage of this operation is that it is easier to see the uterus and the nearby organs such as the fallopian tubes and ovaries, which sometimes need to be removed during the operation.
  • The main disadvantage is that the cut or incision takes about 4–6 weeks to heal.

Vaginal hysterectomy

A hysterectomy can also be performed through the woman’s vagina.

  • Not every woman is suitable for this type of operation. Especially if she has not had any children or if the uterus is very big. This operation can be slightly more difficult than an abdominal hysterectomy but the recovery from this operation is much faster.

Laparoscopic hysterectomy

A laparoscopy is a procedure where a telescope, also called a laparoscope, and operating instruments are inserted through 3 or 4 small cuts in a woman’s abdominal wall and the uterus is removed using these instruments. Often the upper part of the uterus is removed using the laparoscope and a vaginal hysterectomy is performed to remove the lower part. This is called a laparoscopic assisted vaginal hysterectomy.

A laparoscopic hysterectomy is easier to recover from mainly because there are a few small cuts instead of one bigger cut. The operation does take longer than an abdominal hysterectomy and is usually performed by surgeons that specialise in laparoscopic surgery.

What are the risks and complications of hysterectomy?

All operations carry some risks. Talk to your surgeon so you understand what is involved and are aware of any complications you may face. Some possible complications include:

Bleeding and infection

Any operation that involves cutting has the risk of bleeding or infection. The possibility of needing a blood transfusion will be discussed with you before the operation. Antibiotics are often used at the beginning of the operation to decrease the chances of an infection afterwards.

Anaesthetic complications

Modern anaesthetics are very safe. Although it is rare, some people can have reactions to the anaesthetic medications. It is likely you will also have an appointment with the anaesthetist who will be looking after you during the surgery. They will discuss the type of anaesthesia you will be receiving and the risks associated with this.

Damage to surrounding organs

The uterus is surrounded by other organs, which need to be gently pushed aside so the surgeon can operate. Endometriosis, infection and cancer can cause the bladder or bowel to be stuck to the uterus, ovaries or fallopian tubes. The surgeon needs to be very careful in these situations to make sure that these organs are not damaged. The chance of problems like this happening in other situations is very low.  

After the operation

You will usually stay in hospital for 2-4 days and go home only after your bladder and bowels are working properly and any pain is under control.

When you get home, it is easy to overdo things, so it is important to rest as much as possible. Resting also decreases the chance of getting an infection in your wound.

If you have stitches, these will usually stay in place for about a week.

You should not drive for at least 24 hours after an anaesthetic. Some insurance companies will not allow you to drive for 4 or 6 weeks after an abdominal hysterectomy. Others may require your doctor to say you are okay to drive. To drive safely you need to be able to sit in the car comfortably, make an emergency stop, wear your seatbelt and look over your shoulder to park.

You should avoid having sex for about 4-6 weeks to allow the scar inside to heal properly. If sex is still uncomfortable after a couple of months you should talk to your doctor.

How do I know if there is a problem?

When you go home you will usually be given written instructions about who to call if you are worried. Most hospitals will have this information in different languages, so remember to ask if reading English is difficult for you. Some of the things to look out for are:

  • Feeling hot and cold, or feeling like you have the flu. This can mean an infection somewhere.
  • Burning or stinging when you pass urine or passing small amounts of urine often means that you could have a bladder infection.
  • Increasing vaginal bleeding or a smelly discharge can be due to an infection at the top of the vagina where the uterus has been removed from the vagina.
  • A red, painful or swollen scar may be due to a wound infection.
  • Pain inside your tummy or loss of appetite or vomiting could be due to a problem with your bladder or bowel.
  • Painful or swollen legs may be due to a blood clot in the legs. This is uncommon but serious and you should call your doctor immediately.
  • Remember if something does not seem right but you are not sure, then call your GP or the hospital.

What can I do to help myself?

A bit of planning can be very useful:

Before the operation

  • If you smoke, then stop for as long as you can before the operation.
  • Lose some weight if possible.
  • If you have medical problems such as diabetes or heart disease try to have these under good control before the operation.
  • Learn about your operation and ask your doctor if there is anything you do not understand and need to have explained more clearly.

After the operation

  • Speak to your friends and family and arranged for them to help if they can.
  • Do not plan to do too much afterwards. You must give your body a chance to heal.

Learn more

Information for you after an abdominal hysterectomy Royal College of Obstetricians and Gynaecologists
Information for you after a vaginal hysterectomy Royal College of Obstetricians and Gynaecologists

References

  1. Bretschneider, C. E., Jallad, K., & Paraiso, M. F. R. (2017). Minimally invasive hysterectomy for benign indications: An update Minerva Ginecologica, 69(3).
  2. Zigras, T., Lennox, G., Willows, K., & Covens, A. (2017). Early Cervical Cancer: Current Dilemmas of Staging and Surgery Current Oncology Reports, 19(8).
  3. Ayeleke, R. O., Mourad, S., Marjoribanks, J., Calis, K. A., & Jordan, V. (2017). Antibiotic prophylaxis for elective hysterectomy Cochrane Database of Systematic Reviews. 
Credits: Health Navigator Editorial Team. Reviewed By: Jeremy Tuohy, Researcher & Clinician, University of Auckland Last reviewed: 27 Jul 2017