Hysterectomy

What is a hysterectomy?

A hysterectomy is a surgical operation to remove the womb (aka uterus), which can be performed for several clinical reasons. After a hysterectomy, periods cease, and it’s no longer possible to become pregnant or have children, so it’s undertaken only after we’ve tried other treatments first.

What are the different types of hysterectomy surgery?

Removing only the womb but leaving the cervix behind is known as a partial hysterectomy, and when both are removed, it’s called a total hysterectomy. Sometimes, the ovaries and fallopian tubes are removed along with the womb and cervix, and this is known as a radical hysterectomy.

Reasons for hysterectomy

Fibroids

One of the most common reasons I perform hysterectomy surgery is for heavy and painful periods caused by uterine fibroids. Fibroids are benign growths that develop from the muscle tissue of the uterus. Some fibroids can grow to considerable size and cause heavy and painful periods, and if other treatments have failed to help, hysterectomy can be a good option.

Endometriosis

Some women suffer dreadfully from endometriosis, and if endometrial tissue is growing within the wall of the womb (adenomyosis), it can cause severe pain with each menstrual cycle and also heavy periods. Hysterectomy involves removing the womb, and whilst it can’t cure a person of endometriosis, it may help to improve some of the symptoms.

Pelvic inflammatory disease

Some women suffer from persistent pelvic pain despite treatment, and a hysterectomy and removal of the fallopian tubes may be necessary to treat the problem.

Heavy periods

Sometimes, a hysterectomy may be offered as a last resort if other treatments and procedures have failed to reduce the burden of very heavy periods.

Cancer

Endometrial and cervical cancer are often treated with surgery, and I refer my patients who are found to have cancer to specialist cancer surgeons.

Uterine prolapse

A womb prolapse may occur after the weakening of the tissues that support the womb, which may occur after childbirth.

How common are hysterectomies?

Around 55,000 hysterectomies are carried out each year in the UK, which equates to around 1 in 5 women undergoing hysterectomy surgery in their lifetime.

How is a hysterectomy performed?

Hysterectomy surgery involves an overnight hospital. I carry out the procedure under a general anaesthetic. An incision is made across the lower tummy in the bikini line, much like that for a caesarean section, and a catheter is placed into the bladder to drain urine, which is then removed the following day.

After the uterus (womb) has been removed, the incision is stitched closed, and the operation takes around an hour. You’ll then spend a couple of hours in recovery whilst you gently wake up, and then you’ll be taken back to your hospital room. There will be a dressing over the wound and you will have a drip in your arm to give you fluids. Any pain will be well-controlled with pain medication.

The day after your surgery, you will be encouraged to get up and walk, and when you’re ready, you can go home. Sometimes, an extra day in the hospital may be needed.

Some women may experience a little bloating, constipation, or very light vaginal spotting that should quickly cease.

What are the risks of hysterectomy surgery?

Hysterectomy is a very routine procedure, and whilst we do all we can to minimise the chances of complications, no surgery can ever be risk-free.
Hysterectomy risks include:

  • Blood loss and blood clots
  • Damage to the bladder or bowels
  • Infection
  • Problems relating to a general anaesthetic
  • Longer-term risk of pelvic prolapse

How long does it take to recover from a hysterectomy?

If you’ve had an abdominal hysterectomy, you will need to spend a period of time recovering at home. Some women may be able to return to a desk-based job after a month, but if your work involves a lot of activity, it may be eight weeks or more before you can return to work. Most women could expect to be back driving 2-3 weeks post-surgery.

I encourage walking after a hysterectomy to reduce the risks of blood clots and to help your bowels get moving. You can return to your usual exercise routine at around four weeks and impact activity from around six weeks.

I advise waiting for six weeks before having sex after a hysterectomy to ensure sufficient healing has taken place.

Will I gain weight after hysterectomy?

A study has shown that some women may gain a little weight post-hysterectomy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851125/
This is by no means inevitable. Rest and reduced activity are necessary parts of recovery post-hysterectomy, which may explain why some women may put on a little weight.

Will the hysterectomy make me menopausal?

Hysterectomy surgery doesn’t remove the ovaries, so they will continue to produce hormones post-surgery, although there is evidence to suggest that following a hysterectomy, the ovaries may stop producing hormones earlier than expected.

Will sex be different after a hysterectomy?

Some women have concerns that a hysterectomy might negatively impact their sex lives. Unless your hysterectomy involves removing the ovaries (which is not the case for most women), you won’t enter menopause. Women who have the cervix removed along with the womb may experience slightly less natural lubrication during sex, but for many, this is barely noticeable. Some women feel that orgasm is less satisfying after the removal of the cervix, whilst data from studies suggests it makes no difference. Many women with fibroids or endometriosis who undergo hysterectomy, report having a better sex life after surgery.

After careful discussion, I aim to support your wishes about whether to conserve or remove the cervix during hysterectomy, but sometimes, it becomes apparent during the procedure that it’s not possible to preserve the cervix.

Prolapse after hysterectomy

Hysterectomy can affect the pelvic floor because of the changing anatomy and nerve supply. The vagina remains after hysterectomy, and prolapse of the vault of the vagina can occur when the ligamentous structures that hold up the vault weaken.

Will I still need a smear test after a hysterectomy?

If your hysterectomy involves the removal of the cervix, then typically, you will no longer need to attend smear tests. If, for any reason, you’ve not had an up-to-date smear before the surgery, a vault smear test (where cells are taken from the top of the vagina) may be recommended six months after your surgery. If you’ve had a sub-total hysterectomy (i.e. you still have your cervix), you will need to continue to have smears when called for them.