Hysterectomy - removal of the uterus

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).

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.

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.