Hysterectomy

What is a hysterectomy?

An operation to remove all, or part, of the womb (uterus).
Depending on the operation, a hysterectomy may be done through an abdominal incision (abdominal hysterectomy) or through a vaginal incision (vaginal hysterectomy). It usually does not involve removing healthy ovaries.

What is an oophorectomy?

An operation that involves the removal of one or both ovaries.
An oophorectomy may be carried out with a hysterectomy or separately.

When is a hysterectomy necessary?

The most common reasons for needing a hysterectomy are:

• Abnormal or painful menstrual bleeding and/or fibroids (approximately 75% of all hysterectomies are performed for these reasons)

Less common reasons include:

• Pelvic inflammatory disease
• Prolapse of the womb
• Endometriosis
• Tumours of the womb, cervix or ovaries

What are the risks of a hysterectomy?

For most women, having a hysterectomy will not cause any problems. However, some women may experience a slight fever or difficulty in emptying their bladder for a couple of days after the operation. Complications such as infection, bleeding and damage to the bowel or bladder are very rare.

Stopping smoking, eating a healthy, varied diet and taking regular exercise will help avoid the risk of any complications. You should stop taking the oral contraceptive pill or hormone replacement therapy at least 6 weeks before your operation.

Which operation will I need?

Depending on the diagnosis, I will recommend one of the following:

• Total abdominal hysterectomy – The removal of the entire womb including the cervix, but the ovaries are left in place.
  
• Total hysterectomy and bilateral oophorectomy – The removal of the entire womb, both fallopian tubes and both ovaries – followed by HRT if needed.
  
• Extended or radical hysterectomy – The removal of the entire womb, both fallopian tubes, the upper part of the vagina and the surrounding fat and lymph glands.
  
• Subtotal hysterectomy – Most of the womb is removed but the cervix is left in place. (No longer recommended as the Cervix can lead to problems of bleeding and discharge and may then need a 2nd operation to remove it.)
  
• Vaginal hysterectomy – Removal of the entire womb through the vagina. Used for various conditions, particularly prolapse. It means you do not need an abdominal operation and you should recover more quickly.
  
• Laparoscopically assisted vaginal hysterectomy – The surgeon carries out the upper part of the hysterectomy through a special telescope (laparoscope) inserted into a tiny cut in the abdomen; the entire womb is then taken out through a cut in the upper vagina.

What will having a hysterectomy involve?

Before the operation

You will normally be admitted to the hospital ward the day before the operation. You can still eat and drink until about 6 – 8 hours before your operation.

You may have your legs measured for support stockings to wear after your operation – this reduces the chances of blood clots forming in the veins of your legs.

You will be seen by a doctor who will review your history and examine you.

You will probably have a blood test and may have a chest x-ray and heart tracing (electrocardiogram) performed. The anaesthetist will visit you and ask some questions about your general health and check you over for the anaesthetic. If you have any concerns, this is the time to voice them to the anaesthestist.

On the day of the operation

You will be asked to shave the hair from the operation site (the nurse will show you what to do) and you should take a bath or shower. You will be asked to put on a theatre gown and support stockings (if these have been indicated).

The nurse will give you a ‘pre-med’ (tablets or an injection) which will help you relax.

After the operation

When you wake up you will find that a drip has been placed in your arm to give you fluids, and a small tube (catheter) may also have been inserted into your bladder to help it drain. You may also have a drainage tube coming from near the wound – this drains any excess fluids that come from your operation site.

A vaginal pack may sometimes be required. This will be removed the day after surgery.

As you recover, you will have your blood pressure and pulse taken regularly. If you are in pain then ask the nurse for painkillers.

You are likely to feel slightly uncomfortable but this will begin to get less over the next few days. You will be encouraged to sit up and get out of bed the day after your operation. The physiotherapist will visit you to explain simple breathing exercises to help with coughing and ‘wind’ and other exercises to help get your muscles back into shape.

The nurse will explain the wound dressings to you – the drainage tube is usually removed after a couple of days. A small amount of discharge from the vagina is perfectly normal. If any heavy bleeding occurs, tell the nurse.

After a day or so you will feel like eating and drinking again. The drip in your arm and the catheter into your bladder will be quickly and easily removed.

Depending on which type of hysterectomy you have had, you will be in hospital for a total of between 3 and 5 days and rarely more than 7 days. Otherwise your stitches or clips will be taken out before you leave hospital. Some stitches are put underneath the skin and these will dissolve naturally.

What happens when you leave hospital

You will be asked to return to my private clinic between 6 and 8 weeks after your operation to check how you are. If you have had any problems since leaving hospital or if you have any questions about your operation you should speak to me at this time.

Looking after yourself at home

Listen to your body and try and get out every day for a short walk. It is important that you do the exercises that the physiotherapist showed you.

Pelvic rocking, head raising and pelvic floor exercises are among those recommended. These exercises are very important for keeping your muscle tone as well as bowel and bladder control.

What you can and can’t do at home

You should get plenty of rest for the first 2 weeks after your operation but make sure you do the exercises regularly. Try to have a walk each day, never overdoing it and gradually increasing the distance.

After 3 or 4 weeks you can drive again – it is a good idea to have someone in the car with you for the first time. If your wound has healed then try swimming as it is an excellent way to tone muscles. However, don’t overdo it.

Be careful with housework. Do not lift anything heavy for 3 months. Try to do things sitting down and avoid standing for long periods.

Every woman is different in how long it takes to recover from the operation – in general you should be fine to do back to work any time after 6 – 12 weeks. Your doctor will advise you when you are fit enough to do so.

How you may feel after a hysterectomy

For a few days after the operation most women feel some discomfort but this eases as time passes. Most women, especially those who have had previous problems with their periods, feel a new lease of life after a hysterectomy.

Will I feel less of a woman?

Being feminine is not dependent on having a womb, cervix and regular periods so you should have no reason to feel this. Think of yourself as a whole – your appearance, thoughts and emotions all make up your femininity. Most women say to me it was the best decision they ever made!

Will I put on weight?

A hysterectomy does not in itself cause you to put on weight. However, because you feel better you may eat more – it is important to eat a healthy, well balanced diet and to take regular exercise.

Will my sex life be affected?

Although it is wise not to have full sexual intercouse until you have fully healed, you should not find that your sexual desire is altered in any way. Take things gently at first – occasionally you may find sex a little painful but this normally disappears. If you experience any problems then discuss it with your doctor sooner rather than later.

Will the scar be noticeable?

If you have had a vaginal hysterectomy you will not have a scar on your stomach – this is one of the advantages of this method. Abdominal hysterectomies involve a cut across the lower part of your stomach, along the bikini line. This usually heals very well and becomes totally invisible over time.

Will I get symptoms of the menopause (change of life)?

This will not happen unless you have had your ovaries removed. If your ovaries are removed, you will be offered hormone replacement therapy (HRT) which is a very effective way of treating any menopausal symptoms. Discuss this with your gynaecologist before your operation. Recent research suggests that even if the ovaries are left intact, they may fail sooner than expected leading to slightly earlier menopause.

Will I still need to have a cervical smear?

Generally no. The exception to this is when you have had a subtotal hysterectomy where the cervix is left behind or when your hysterectomy was done because of a tumour of the cervix. If this is the case, a special smear of the top of the vagina may be required at intervals. Ask your doctor if this applies to you.

HYSTERECTOMY CHECKLIST

A hysterectomy is a major event in a woman’s life. You may find this checklist useful as a reminder of the important things you should do and as a prompt to ask questions about the operation when you visit your doctor or gynaecologist.

Before the operation

• Stop smoking
• Take regular exercise
• Eat a varied diet
• Stop oral contraceptive pill 6 weeks before the operation

The operation

• What type of hysterectomy is being recommended for me?
• Will my ovaries be removed?
• If so, will I receive hormone replacement therapy afterwards?
• If so, what type?

After the operation

• Regular pelvic exercises
• Return to work
• Any untoward effects or problems
  (list these and tell your doctor at your next visit)

	Royal College of Obstetricians & Gynaecologists - Pelvix Floor Repair and Vaginal Hysterectomy for Prolapse (PDF Format) Royal College of Obstetricians & Gynaecologists - Abdominal Hysterectomy for Heavy Periods (PDF Format)