What is a hysterectomy?
Hysterectomy means the removal of the uterus (womb). A hysterectomy may or may not be combined with the removal of the Fallopian tubes and one or both ovaries. Removal of a tube and ovary is called salpingo-oophorectomy, removal of both tubes and ovaries is called bi-lateral salpingo-oophorectomies (BSO for short).

There are different types of hysterectomy, which are described according to which organs are removed.

A total hysterectomy is the most common operation and this means removal of the uterus and cervix (neck of the womb).

A sub-total hysterectomy means the removal of the body of the uterus, leaving the cervix behind.

A radical hysterectomy involves the removal of the uterus, cervix, a small portion of the upper part of the vagina and some soft tissue from within the pelvis. A radical hysterectomy is only performed in cases of cancer of the cervix by gynaecologists who have received special training.

When is a hysterectomy necessary?
Up to one in five women will undergo a hysterectomy during their lifetime so it is a relatively common operation. A hysterectomy is nearly always necessary if a diagnosis of cancer of the cervix or cancer of the uterus is made and is usually recommended if there is ovarian cancer.

However, most hysterectomies are performed in women who do not have cancer but where bleeding or pain from the uterus is causing them so much difficulty that they wish to undergo surgery. In such cases, a hysterectomy is only appropriate for a woman who does not wish to have children in the future.

A hysterectomy is usually an option for women with fibroids, endometriosis, pelvic inflammatory disease or heavy periods with no explanation. If a woman has a prolapse of the uterus, then a hysterectomy may be performed as part of the prolapse repair operation.

How is a hysterectomy performed?
Hysterectomy is a major surgical procedure and is performed under general anaesthesia.

In addition to the different types of hysterectomy, there are different ways by which a gynaecologist might perform the operation. This will be influenced by the reason for performing the hysterectomy in the first place, the size of the uterus and the experience and preference of the individual gynaecologist.

Abdominal hysterectomy is the most common method and is performed through an approximately six inch scar made across the lower abdomen.

A vaginal hysterectomy is performed through the vagina and will leave no visible external signs that the woman has had an operation.

In a laparoscopically assisted vaginal hysterectomy (LAVH) the gynaecologist uses keyhole surgery in combination with surgery through the vagina in order to complete the operation

How will I feel after a hysterectomy?
Strong painkillers are prescribed for the first few days following surgery. A woman is encouraged to be mobile within 24 hours of surgery and can expect to be eating and drinking during this time also. Most women stay in hospital for between three and five days following a routine hysterectomy.

It is advisable to plan four to six weeks of convalescence following a hysterectomy although the recovery time will vary from one woman to the next. The recovery time is often shorter if a vaginal hysterectomy or LAVH has been performed compared to an abdominal hysterectomy. The recovery time is longest following a radical hysterectomy.

The emotional response after a hysterectomy will vary widely from one woman to the next, often depending on the reason for the operation. Occasionally, there will be a feeling of relief that the monthly pain and inconvenience of periods is a thing of the past with the sensation that she can now get on with her life in a more positive manner. Women who have been diagnosed with cancer are frequently and very understandably anxious that the surgery will have been successful and may be concerned about the necessity of other forms of treatment aimed at preventing a recurrence.

For some women there is a sensation of loss, that the place where their children developed and were born from is now gone forever. Whatever the emotional response, it is advisable that the woman talks it over with someone in whom she can confide, whether it is a relative, her gynaecologist, nurse or a friend.

What are the risks of having a hysterectomy?
No operation is free of risk. A hysterectomy is a major operation that most women undergo without experiencing complications. If a woman is overweight, then losing weight before her hysterectomy will make the surgery easier and will reduce the likelihood of post-operative complications.

Complications do occur from time to time and these include:

heavy bleeding at the time of surgery.

following surgery, infection involving the wound or bladder (cystitis) may require antibiotic treatment.

surgical damage to the bladder or ureters (the narrow tubes that carry urine from the kidneys to the bladder).

an uncommon but serious complication is the development of a blood clot in the veins of the leg (venous thrombosis).

Will a hysterectomy affect my sex life?
Most women do not experience an adverse effect on their enjoyment of sex. Often the reverse is true with an improvement in their sex life especially if bleeding was prolonged and the uterus was causing pain during intercourse. Most women are able to have intercourse again six weeks after their hysterectomy.

Will I need to start Hormone Replacement Therapy after a hysterectomy?
If a woman has not gone through the change of life (menopause) and her ovaries have been removed at the time of the hysterectomy, then HRT will usually be recommended. If the ovaries have not been removed, then they will continue to produce the female hormone oestrogen and HRT is not necessary.

Will I need to have cervical smears performed (Pap smears) after a hysterectomy?
If there was no cancer present before the hysterectomy and the cervix has been removed, then there is no need for further smears to be performed. If a sub-total hysterectomy has been performed then it is necessary to continue in the cervical smear screening programme.

Are there alternatives to hysterectomy?
In the presence of certain cancers, there is seldom a realistic alternative to hysterectomy. For non-cancerous conditions a hysterectomy is usually offered when tablet treatment or other surgical procedures have been tried and have not been successful.

For women with heavy periods with no explanation, surgical techniques that aim to remove or destroy the lining of the womb (endometrial ablation) can provide relief of symptoms without resorting to major surgery. It must be remembered that a hysterectomy or endometrial ablation procedure is only suitable for a woman who does not wish to become pregnant in the future.

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