What is a hysterectomy?

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

What are the benefits?

There are common reasons for having a hysterectomy:

• Heavy or painful periods not controlled by other treatments.
• Fibroids, where the muscle of your uterus becomes overgrown.

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

The following are less common reasons for having a hysterectomy:

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

Are there any alternatives?

The alternatives to a hysterectomy depend on the cause of the problem:

• Heavy periods can be treated using a variety of non-hormonal and hormonal oral (by mouth) medications. Other alternatives include an IUS or ‘conservative surgery’ where only the lining of your uterus is removed (endometrial resection).
• Fibroids – Depending on the size and position of fibroids, you can take medication to try to control the symptoms. Other treatments include surgery to remove the fibroids only (myomectomy) or uterine artery embolisation to reduce the blood flow to the fibroids.

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.

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 90 minutes.

Your gynaecologist will make a small cut, usually on or near your belly button, so they can insert an instrument in your abdominal cavity to inflate it with gas (carbon dioxide). They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen. Your gynaecologist will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the procedure.

Your gynaecologist may need to place instruments through your vagina to help them remove your uterus.

They will make a cut around your cervix at the top of your vagina so they can remove your uterus and cervix.

If the video doesn't load, try this Laparoscopic Hysterectomy.

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.
• 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.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Developing a hernia in the scar.
• 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

Keyhole surgery complications

• Surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide), which settles quickly and is not serious.
• Damage to structures such as your bowel, bladder or blood vessels when inserting instruments into your abdomen. If an injury does happen, you may need open surgery. About 1 in 3 of these injuries is not obvious until after the procedure.
• Developing a hernia near one of the cuts used to insert the ports.
• Conversion to an abdominal hysterectomy. Open surgery can increase your risk of some complications such as VTE, bleeding and infection.
• Making a hole in your uterus or cervix with possible damage to a nearby structure during placement of the manipulator. You may need another procedure.
• Gas embolism. This is when gas (carbon dioxide) gets into the bloodstream and blocks a blood vessel.

Hysterectomy complications

• Pelvic infection or abscess.
• Damage to structures close to your uterus. 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 an abnormal connection (fistula) between your bowel, bladder or ureters and your vagina.
• Developing a collection of blood (haematoma) inside your abdomen where your uterus used to be. Sometimes a haematoma will drain through your vagina, usually causing bleeding similar to a period for up to 6 weeks.
• Vaginal cuff dehiscence, where the cut at the top of your vagina opens.

Long-term problems

• Developing a prolapse (a bulge of your vagina caused by internal structures dropping down).
• Continued bleeding from your cervix. If the bleeding does not stop, your cervix may need to be removed.
• 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 even if your ovaries are not removed.

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 the same day or after 1 to 2 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 4 to 6 weeks, depending on your type of work). You should be feeling more or less back to normal after 2 to 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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