Hysterectomy

Specialty of Obstetrics & gynaecology

What is a hysterectomy?

A hysterectomy is a surgery that involves removing the uterus (womb), meaning you are no longer able to get pregnant post-surgery. There are different types of hysterectomy, and the type that you would be recommended would depend on why you require a hysterectomy.

The procedure is a big operation using general anaesthetic with extensive recovery periods, and is recommended after other less invasive procedures have been tried.

Why would you have a hysterectomy?

There are a number of different reasons why a woman would have a hysterectomy which include:

  • Endometriosis – a condition where uterine lining tissue develops outside of the uterus, causing pain, heavy periods and infertility.
  • Cancer of the cervix, uterus or ovaries
  • Non-cancerous tumours (fibroids)
  • Chronic pelvic pain
  • Heavy periods
  • Uterine prolapse – when the uterus moves from its correct position into the vaginal canal.

For non-cancerous illnesses a hysterectomy would only be offered if all other treatment options had been tried first.

What does a hysterectomy involve?

There are different types of hysterectomy, and the type you have depends on why the surgery is needed.

The types of hysterectomy include:

  • Subtotal hysterectomy – the upper section of the uterus is removed, but the cervix is left in place.
  • Total hysterectomy – the most common of hysterectomy procedures where the womb and cervix are removed.
  • Radical hysterectomy – the uterus, surrounding tissue, fallopian tubes, ovaries, lymph glands, fatty tissue and a section of the vagina are all removed. This type is nearly always only done if cancer is present.

If you have a total or radical hysterectomy, immediately after surgery you will experience what is called surgical menopause, no matter what age you are. This is because your ovaries will have been removed, and the hormones they released will no longer be present.

Symptoms of menopause include:

  • Fatigue
  • Hot flushes
  • Sleep problems
  • Vaginal dryness

There are three ways for a hysterectomy to be carried out:

  1. Open surgery – the lower abdomen is cut open across the belly, and the uterus is removed via this incision.
  2. Vaginal hysterectomy – the uterus is removed via a cut made in the vagina. This cut is closed and rarely results in scarring.
  3. Laparoscopic (keyhole) hysterectomy – the uterus is removed via a number of very small incisions in the abdomen.

Compared to open surgery, a vaginal and laparoscopic hysterectomy require shorter hospitals stays and result is less pain and scarring, as well as a decreased chance of infection. However, not all women are suitable candidates for these less invasive procedures, and sometimes open surgery is the best option. This may be due to a presence of scar tissue from prior surgeries, or obesity.

How to prepare for it

Prior to undergoing a hysterectomy it is important to make sure that you are well-hydrated, have eaten lightly the day before, and usually have stopped consuming food and drink after midnight the night before surgery. Most hysterectomies will require a stay in the hospital, but it is recommended that transport home is pre-arranged as you would be unable to drive for up to two weeks post-surgery.

As a hysterectomy is a big procedure, it is important that you feel comfortable and have asked as many questions as possible to address concerns you might have. The doctor will have set expectations and given a thorough explanation of the procedure too.

Post-operative care

Once you have woken up from the effects of the anaesthetic it is normal to feel tired and experiencing some pain. Painkillers will be given to reduce any discomfort.

Your wound will have dressing over it, and if you have had open surgery, a drainage tube will be inserted beneath the wound to drain any blood from the wound for a day or two.

A few days after surgery, you will be encouraged to try and walk, as this helps to get the blood flowing normally around your body.

Hospital stays and recovery times for the different types of hysterectomy are as follows:

  • Open surgery – up to 5 days in hospital with a 6 to 8 week recovery period.
  • Vaginal hysterectomy – 1 to 4 days in hospital with a 2 week recovery period.
  • Laparoscopic hysterectomy – 1 to 4 days in hospital with a 2 week recovery period.

Patients are advised not to drive until it is comfortable wearing a seatbelt and can perform an emergency stop safely. Heavy lifting and sexual intercourse should be avoided too until scars are healed.

It is also important that patients are reminded of the fact that contraception is no longer required, however, barrier methods such as condoms still need to be used to be protected against sexually transmitted infections (STIs). 

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