Hysterectomy: your questions answered

What is a hysterectomy?

A hysterectomy is an operation to remove your uterus (womb). It’s one of the more common gynaecological operations performed in the UK, and one of the most common types of surgery had by women and those assigned female at birth. As well as the uterus, a hysterectomy may involve removal of the fallopian tubes, ovaries or cervix.

Around 55,000 hysterectomy operations are carried out in the UK each year. This means about one in five women will have a hysterectomy at some point. The most common age to have one is between 40-50, however they are often carried out on women outside of this age group.

Why do I need a hysterectomy?

Your gynaecologist might suggest a hysterectomy for various reasons. These can include:

• Periods that are heavy, painful or frequent
• Fibroids (non-cancerous growths in the womb)
• Prolapsed womb
• Cancer of the vagina, cervix, uterus, fallopian tubes or ovaries

A hysterectomy is a major operation that takes a while to recover from. It will only be recommended if you’ve tried alternative treatments and they haven’t worked for you.

Should I have a hysterectomy?

There are many reasons to have a hysterectomy, but the decision will always be informed by your personal circumstances and choices, too. If your gynaecologist thinks this could be the right treatment option for you, they will talk you through all the pros and cons, as well as any alternatives, allowing you to make an informed decision that’s right for you.

What are the different types of hysterectomy?

A hysterectomy will always involve removing the womb. However, depending on your personal circumstances and the reason you’re having the operation, your gynaecologist may also recommend removing the fallopian tubes, ovaries or cervix. So, you might have:

• Total hysterectomy: This surgery involves the removal of your womb and cervix
• Subtotal hysterectomy: A subtotal hysterectomy involves removing the main body of your womb, but not your cervix
• Total hysterectomy with bilateral salpingo-oophorectomy: This involves removing your womb and cervix, and the removal of your fallopian tubes (salpingectomy) and ovaries (oophorectomy)
• Radical hysterectomy (for cervical cancer): During this procedure, your consultant will remove your cervix, both ovaries, uterus, fallopian tubes, the top two centimetres of your vagina, and the tissue surrounding your cervix. They will also remove your pelvic lymph glands because cervical cancer can spread to these quickly

Hysterectomies also differ depending on how the surgery is performed. There are three ways a hysterectomy can be performed:

• Abdominal hysterectomy: Where your womb is removed through a cut in your tummy
• Laparoscopic (keyhole) hysterectomy: Where small cuts are made in your tummy and then your womb is removed through your vagina
• Vaginal hysterectomy: Where your womb is removed through your vagina

What happens to your body when you have a hysterectomy?

One of the most significant consequences of a hysterectomy is that you will no longer have periods or be able to get pregnant.

If you have your ovaries removed as well as your womb, and have not yet gone through the menopause, you will experience surgical menopause after your operation. If you keep one or both of your ovaries, you may still go into menopause earlier than you would have otherwise.

Some women find themselves in a low mood after a hysterectomy. This can be for many reasons. Some women feel a sense of loss because they are no longer able to get pregnant.

What is recovery like after a hysterectomy?

A hysterectomy is a major operation and there will be a recovery period before you feel back to normal. You could be in the hospital for up to five days. Your length of stay will depend both on the type of operation you have and on your personal circumstances. The same factors will affect how long it takes you to recover.

Recovery from an abdominal hysterectomy can take six to eight weeks, though it can be shorter after other methods. During this time, you are advised to rest as much as possible and avoid strenuous activities such as heavy lifting. If your job is not manual, you may be able to return to work after four to eight weeks.

Talk to your consultant about returning to driving. You may not be able to drive for as long as eight weeks. Before you get back behind the wheel, be sure to check with your insurance company as all policies are different.

What side effects should I expect after the operation?

Immediately after surgery, it’s normal to feel tired and in some pain. Your doctor or nurse will give you painkillers if you need them.

Some people find that they feel sick after the anaesthetic, but again your doctor or nurse can give you something to manage this. You’ll have some vaginal bleeding and discharge, which could last up to six weeks. You may also experience bowel disturbances including constipation and could develop a urinary tract infection. It’s a good idea to drink plenty of fluids and eat lots of fruit and high fibre foods to help with bowel and bladder movements.

Hysterectomy and mental health

Some women find themselves in a low mood after a hysterectomy. This can be for many reasons. Some women feel a sense of loss because they are no longer able to get pregnant.

If you are having a hysterectomy for a reason such as cancer, the experience can be particularly traumatic. If you are feeling sad or depressed after your operation, it’s important to talk to someone as soon as possible. Speak to your GP or consultant, who can recommend you to a support group or a mental health professional. Remember, you’re not the first person to feel this way, and help is available.

When can I have sex after a hysterectomy?

You should avoid having sex after a hysterectomy until your scars have healed and you are no longer having vaginal discharge. This will normally take four to six weeks.

Once you’re healed, sex is safe so long as you feel comfortable having it. You’ll no longer need to use contraception against pregnancy, however you should still use condoms to protect yourself from sexually transmitted infections.