Hysterectomy
Surgical removal of the uterus for selected gynaecological conditions when other options are unsuitable
What is hysterectomy?
A hysterectomy is the removal of the uterus. Once it is done you will no longer have periods and cannot become pregnant, and both of those are permanent. It is a decision worth taking slowly, and no reputable surgeon will hurry you into it.
How much is removed varies. A total hysterectomy takes the uterus together with the cervix, which is the usual operation. A subtotal leaves the cervix in place, and if you keep it you keep having cervical smears. The ovaries are a completely separate decision from the uterus: keeping them means your own hormones continue and the menopause arrives at its natural time, while removing them before the menopause brings it on immediately and the question of hormone replacement has to be settled before the operation and not after it.
There are three routes in. Through a cut in the abdomen, through the vagina with no external cut at all, or with keyhole instruments through several small cuts. Your surgeon chooses based on the size and mobility of the uterus, previous operations you have had, and what else needs doing at the same time. The vaginal and keyhole routes mean less pain and a faster return to normal, and they are not possible for everyone.
What it involves
The operation is done under a general anaesthetic, so you are asleep from start to finish and remember none of it. You will be asked not to eat for about six hours beforehand, and you will be seen by the anaesthetist on the morning of surgery.
Most hysterectomies take between one and two hours. A drip goes into your arm and a catheter into the bladder, and stockings and an injection are used to reduce the risk of clots. Keyhole surgery uses gas to lift the abdominal wall, which can leave shoulder-tip pain for a day or two afterwards as it disperses. Where the operation is done through the vagina, a pack may be left in place for a few hours and the catheter usually comes out the next morning.
This is an Inpatient operation. Expect one to two nights in hospital after a vaginal or keyhole hysterectomy and two to three after an open one. You will be got out of bed on the same day or the next morning, because moving early is what keeps the lungs clear and the clot risk down.
Recovery
Full recovery takes six to eight weeks whichever route was used, and the inside heals more slowly than the outside looks. Expect to feel genuinely tired for the first fortnight and to need an afternoon rest well into the second month.
Light vaginal bleeding and discharge are normal for up to six weeks as the internal stitches dissolve, and a brief increase at around ten days is usual. Nothing goes into the vagina during that time: no tampons, no douching and no sex until about six weeks, because the top of the vagina is healing and needs to be left alone. Avoid lifting anything heavier than a full kettle for six weeks and build walking up gradually from the first week.
Most women return to desk work at three to four weeks after keyhole or vaginal surgery and at six weeks after an open operation, and to physical work later. Driving is usually possible at two to four weeks after keyhole surgery and four to six after an open one, once you can brake hard without flinching. Your surgeon will see you at about six weeks and will go through the laboratory report on what was removed at that visit.
Questions about hysterectomy
Will I go through the menopause after this?
Only if your ovaries are removed as well. Removing the uterus alone stops your periods and ends fertility, and the ovaries carry on producing hormones, so the menopause arrives at its natural time, though on average a year or two earlier than it otherwise would. You will not have periods to signal it, so the hot flushes and night sweats become the marker. Where the ovaries are removed before your natural menopause, it begins immediately and tends to be more abrupt, and the plan for hormone replacement needs to be agreed before the operation and not afterwards. Ask your surgeon directly what is planned for your ovaries and why.
How long until I am back to normal?
Six to eight weeks for full recovery, whichever route was used, because the internal healing takes that long even when the outside looks fine. Most women return to desk work at three to four weeks after a keyhole or vaginal hysterectomy and at six weeks after an open one. Driving is possible at two to four weeks after keyhole surgery and four to six after open, once you can brake hard without flinching. Lift nothing heavy for six weeks, and expect real tiredness for the first two and an afternoon rest well into the second month. Light bleeding and discharge for up to six weeks are normal as internal stitches dissolve.
Will it change sex?
For most women it does not, and a good number find sex better afterwards because the bleeding, pain or pressure that prompted the operation has gone. Nothing goes into the vagina for about six weeks while the top of it heals, and after that most couples resume normally. The vagina is shortened slightly where the cervix is removed and that is rarely noticeable. Where the ovaries are removed, the fall in hormones can cause dryness and reduced desire, and both are treatable. Some women describe a change in the sensation of orgasm. Raise any of this at your follow-up; it is a routine conversation and there is usually something to be done.
Other obstetrics & gynaecology treatments
Delivery of a baby through surgery when vaginal delivery is not advisable or safe
InpatientManagement of non-cancerous growths in the uterus, based on symptoms, size, location and reproductive plans
Day CareTalk to a care coordinator about hysterectomy
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one