What is a hysterectomy?

A hysterectomy is a procedure to remove your uterus (womb). Your cervix (neck of your womb) is usually also removed. Your fallopian tubes and ovaries may need to be removed at the same time.

What are the benefits?

There are common reasons for having an abdominal hysterectomy:

• Heavy or painful periods.
• Fibroids, where part of the muscle of your womb becomes overgrown.

The following are less common reasons for having an abdominal hysterectomy:

• Endometriosis, where the lining of your womb grows outside your womb.
• Adenomyosis, where the lining of your womb grows into the muscle of your womb.
• Chronic pelvic inflammatory disease, where inflammation of your pelvis leads to chronic pain and, sometimes, heavy periods.

A hysterectomy may cure or improve your symptoms. You will no longer have periods.

Are there any alternatives?

• Uterine prolapse – Symptoms may be improved by doing pelvic floor exercises.
• Heavy periods can be treated using a variety of non-hormonal and hormonal oral (by mouth) medications. Other alternatives include an IUS (intra-uterine system - an implant containing a synthetic form of the hormone progesterone that fits in your womb) or 'conservative surgery' to remove the lining of your womb.
• Fibroids – Depending on the size and position of fibroids, you can take medication to try to try to shrink them and control the symptoms. Other treatments include surgery to remove the fibroids only (myomectomy) or to shrink the fibroids by reducing their blood supply.
• Endometriosis and adenomyosis can be treated using a variety of non-hormonal and hormonal oral (by mouth) medications. Another alternative is an IUS (intra-uterine system - an implant containing a synthetic form of the hormone progesterone that fits in your womb). Endometriosis may also be treated with conservative surgery to remove the lining of your womb.
• Chronic pelvic inflammatory disease can be treated with painkillers and antibiotics.

What will happen if I decide not to have the procedure or the procedure is delayed?

Your doctor will monitor your condition and try to control your symptoms.

You may feel that you would prefer to put up with your symptoms rather than have a procedure. Your gynaecologist will tell you the risks of not having a procedure.

Sometimes your gynaecologist may need to leave your cervix behind. This is called a subtotal hysterectomy. Some patients ask their gynaecologist for a subtotal hysterectomy. You can discuss this with your healthcare team before the procedure.

If you experience any of the following symptoms, contact your healthcare team:

• Changes to your monthly bleeding pattern if you have periods.
• Increased abdominal (tummy) swelling.
• Worsening pain that needs more medication than you are currently taking.

What does the procedure involve?

The procedure is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The procedure usually takes about an hour.

They will make a cut on your abdomen, usually on your 'bikini' line or downwards from your belly button (and in some cases from above your belly button).

Your gynaecologist will remove your womb and fallopian tubes, usually along with your cervix, through the cut. To remove your cervix, they will also need to make a cut at the top of your vagina.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Regular exercise should help you prepare for the procedure, help you recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you may need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

General complications of any procedure

• Feeling or being sick. Most women have only mild symptoms and feel better within 1 to 2 days.
• Bleeding during or after the procedure. The healthcare team will try to avoid the need for you to have a blood transfusion, but you will be given one if you need one.
• Developing a hernia in the scar.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Acute kidney injury.
• Venous thromboembolism (VTE). This is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of COVID-19 (coronavirus) symptoms for at least 7 weeks before the procedure.

Specific complications of this procedure

• Pelvic infection or abscess.
• Vaginal cuff dehiscence, where the cut at the top of your vagina opens.
• Developing an abnormal connection (fistula) between your bowel, bladder or ureters and your vagina.
• Damage to structures close to your womb such as your bladder or ureters (tubes that carry urine from your kidneys to your bladder), bowel and blood vessels. Your gynaecologist will usually notice any damage and repair it during the procedure. However, damage may not be obvious until after the procedure and you may need another procedure.
• Developing a collection of blood (haematoma) inside your abdomen where your womb used to be. Sometimes a haematoma will drain through your vagina, usually causing bleeding similar to a period for up to 6 weeks.

Long-term problems

• Developing a prolapse (a bulge of your vagina caused by internal structures dropping down).
• Continued bleeding from your cervix, if you have a subtotal hysterectomy. If the bleeding does not stop, your cervix may need to be removed.
• Difficulty or pain having sex.
• Tissues can join together in an abnormal way.
• Passing urine more often, having uncontrolled urges to pass urine or urine leaking from your bladder when you exercise, laugh, cough or sneeze.
• Feelings of loss as a hysterectomy will make you infertile.
• Going through menopause even if your ovaries are not removed.

Consequences of this procedure

• Pain.
• Scarring of your skin, which can be unsightly. Your wound usually heals neatly.
• You will no longer have periods or be able to get pregnant.

What happens after the procedure?

You will be able to go home when the healthcare team decides you are medically fit enough, which is usually after 3 to 5 days.

You will be able to go home when the healthcare team decide you are medically fit enough, which is usually after 2 to 3 days.

Returning to normal activities

Rest for 2 weeks and continue to do the exercises that you were shown in hospital.

You can return to work once your doctor has said you are well enough to do so (usually after 6 to 8 weeks, depending on your type of work). You should be feeling more or less back to normal after 3 months.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most women make a good recovery and return to normal activities.

Summary

A hysterectomy is a major procedure usually recommended after simpler treatments have failed. Your symptoms should improve.

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