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.

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?

Possible complications of this procedure are shown below. Some may be serious and can even be life threatening (risk: 3 in 10,000 in the first 6 weeks).

General complications of any procedure

• feeling or being sick
• bleeding
• 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
• chest infection

Specific complications of this procedure

• pelvic infection or abscess
• vaginal cuff dehiscence
• developing an abnormal connection (fistula) between your bowel, bladder or ureters and your vagina
• damage to structures close to your womb
• developing a collection of blood (haematoma) inside your abdomen

Long-term problems

• developing a prolapse
• continued bleeding from your cervix, if you have a subtotal hysterectomy
• your pain may continue
• 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

Consequences of this procedure

• pain
• scarring of your skin, which can be unsightly
• 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.

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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