Hysterectomy surgery

Women usually have a hysterectomy due to one of the following conditions, if the symptoms are severe and/or reducing their quality of life, other treatment options have been unsuccessful and they don't want to become pregnant in the future:

Heavy periods

Heavy periods can often be caused by several different conditions, including uterine fibroids and endometriosis. 

Uterine fibroids

Uterine fibroids are non-cancerous growths made of muscle and fibrous tissue, which grow in or around your womb. They can cause heavy and/or painful periods, pelvic pain, constipation, frequent urination and pain during sex. A hysterectomy may be recommended if you have large fibroids that cause severe bleeding.

Endometriosis

Endometriosis occurs when cells that line your womb end up in other areas of your body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum.

It can cause heavy, irregular and/or painful periods, pelvic pain and infertility. A hysterectomy can be used to remove the tissue which is causing pain. 

Pelvic inflammatory disease (PID)

This is caused by a bacterial infection of your reproductive system. If detected early, it can be treated with antibiotics. However, if it spreads, it can damage the womb and fallopian tubes, causing long-term pain. 

Adenomyosis

This is a common condition where the tissue that normally lines your womb starts to grow within its muscular wall.

Prolapse of the womb

A prolapse occurs when the tissues and ligaments that support your womb become weak, causing it to drop down from its normal position. Symptoms can include back pain, a feeling that something is coming down out of your vagina, leaking urine (urinary incontinence) and difficulty having sex. It can often occur as a result of childbirth.

Chronic (long-term) pelvic pain

Pelvic pain that comes from the womb can be treated with a hysterectomy but is only recommended as a last resort. A hysterectomy is not an effective treatment for many types of pelvic pain, with pain persisting even after removal of the womb. 

Certain types of cancer

A hysterectomy can be used to treat cancer of the ovaries, fallopian tubes, womb or cervix (entrance to the womb), specifically if the cancer is advanced or has spread.

A hysterectomy is a major surgery and recovery takes a long time, which is why it's only recommended when other treatments have been unsuccessful and if you don't want to become pregnant in the future. If you do want to become pregnant in the future, talk to your doctor about alternative treatments. If you have cancer, you may still need to have a hysterectomy.

The surgery removes the womb but your doctor may also discuss the possibility of removing one or both of your ovaries and/or fallopian tubes, as well as your cervix. The decision on what to remove will depend on your doctor's recommendation, your personal preferences, your health and medical history. 

If you have cancer of the cervix, ovaries or womb, your doctor may recommend removing your cervix to prevent the cancer spreading. 

If your cervix is removed you will no longer need to attend cervical screening appointments.

Removing ovaries

If you have not gone through menopause, your ovaries will usually only be removed if you have a high risk of certain diseases eg if you have a family history of cancer of the ovaries or breast cancer. 

If you have gone through menopause or soon will, your ovaries may be removed even if you're not at high risk of certain diseases if there are benefits to the treatment of your current condition. If there are no clear benefits to removing your ovaries, they will be left in place as your ovaries release hormones which affect your sex drive and can help prevent conditions such as osteoporosis. 

If one of your ovaries is removed, you may go through menopause within five years of your surgery. If both of your ovaries are removed, you will start to go through surgical menopause immediately after your surgery and may want to consider hormone replacement therapy (HRT). HRT can replace some of the hormones that your ovaries would have produced to reduce some of the symptoms of menopause. However, HRT isn't suitable for everyone. 

There are different types of hysterectomy depending on what condition is being treated. Make sure you discuss with your surgeon exactly what will be removed during your hysterectomy. 

There are four main types of hysterectomy:

• Total hysterectomy where the womb and cervix are removed — this is the most common type of hysterectomy
• Subtotal hysterectomy where the main part of the womb is removed but the cervix is left in place — this is not very common
• Total hysterectomy with bilateral salpingo-oophorectomy where the womb, cervix, fallopian tubes and ovaries are removed — removal of the ovaries is called an oophorectomy; removal of the fallopian tubes is called a salpingectomy
• Radical hysterectomy where the womb and other surrounding tissues are removed, including the ovaries, fallopian tubes, part of the vagina, lymph glands and fat tissue — this is most often performed to treat cancer when other treatments (eg chemotherapy and radiotherapy) haven't been successful or aren't suitable

Many of the conditions which can be treated with a hysterectomy can also be treated with other, sometimes less invasive, approaches. 

Endometriosis can be treated with hormone therapy. Fibroids can be treated with surgery that leaves the womb in place. However, a hysterectomy may still be the most effective treatment in some cases, particularly when treating cancer. 

If you would like to avoid having a hysterectomy, speak to your doctor about your options. 

If you decide to have a hysterectomy, your doctor will advise you on the options most suitable for you, such as:

Vaginal hysterectomy 

This involves removing the womb and fallopian tubes and/or ovaries, if needed, through your vagina. You'll usually need to stay in hospital for 2–4 days.

Abdominal hysterectomy 

This involves removing the womb and fallopian tubes and/or ovaries, if needed, through a large cut in your abdomen. You'll usually need to stay in hospital for 3–5 days.

Laparoscopic hysterectomy 

This involves removing the womb and fallopian tubes and/or ovaries, if needed, through a small cut in your abdomen. Your surgeon will make 2–3 small cuts into your abdomen, through which a tube-like camera (laparoscope) will be passed so they can see your womb. Special surgical instruments will also be passed into your abdomen so your surgeon can remove your womb and other tissues, if needed. Recovery is faster than with an abdominal hysterectomy so you'll usually only need to stay in hospital for 1–2 days and will have smaller scars.

Our patients are at the heart of what we do and we want you to be in control of your care. To us, that means you can choose the consultant you want to see and when you want to see them. They'll be with you every step of the way.

All of our consultants are of the highest calibre and benefit from working in our modern, well-equipped hospitals.

Our consultants have high standards to meet, often holding specialist NHS posts and delivering expertise in complex subspecialty surgeries. Many of our consultants have international reputations for their research in their specialised field.

Before having any surgery, including a hysterectomy, it is important to be as fit and healthy as possible. This will help reduce any complications and reduce your recovery time. So try to exercise regularly, follow a healthy diet, lose any excess weight if you're overweight and quit smoking.

You'll have a pre-surgery consultation with a healthcare professional. During this time you'll be able to explain your medical history, symptoms and raise any concerns that you might have.

We'll also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. You may need to have tests to check for cancer, as this can affect the type of surgery you have. These tests may include: 

• Cervical cytology, also known as a Pap test or Pap smear — this detects abnormal cells or cancerous cells in your cervix
• Endometrial biopsy — this involves collecting some cells for testing in a lab and can detect abnormal cells in your womb lining or endometrial cancer
• Pelvic ultrasound — this detects the presence and size of endometrial polyps, fibroids or ovarian cysts

Any additional costs will be discussed before further tests are carried out. 

It's important to have all the information you need about your upcoming surgery as this can help you feel more comfortable and less anxious. So make sure you speak to your healthcare team and ask them any questions you have. This may include asking about: 

• Anaesthesia — there are several different types of anaesthesia (local, spinal and general); an abdominal hysterectomy is always performed under general anaesthesia so you'll be asleep during your surgery
• Medication — if you’re taking any medication or supplements, your doctor may tell you to stop taking them or change your dose in the days leading up to your surgery; make sure you follow your doctor’s instructions as it can be dangerous to stop taking or adjust your medication without medical advice
• Your hospital stay — the time needed to recover in hospital varies according to the type of hysterectomy you have and your general health
• Your recovery — it can take up to eight weeks to fully recover from a hysterectomy and you'll need to avoid certain activities during this time, which your healthcare team can advise you on; you may need to arrange for help at home 

At Spire Healthcare, we've tried to make your experience with us as easy and relaxed as possible. So if you would like more information on visiting hours, our food, what to pack if you're staying with us, parking and all those other important practicalities, please visit our patient information pages.

Our dedicated team will also give you tailored advice to follow in the run up to your visit.

To reduce the risk of infection, you'll be asked to shower using soap provided by your healthcare team the day before your surgery and the morning of it. Before your surgery, your back passage (rectum) may be cleaned using an enema and your vagina may also be cleaned (vaginal douche). 

Immediately before your surgery, you'll be given antibiotics directly into one of your veins (intravenous), which will also help reduce your risk of infection after surgery. You'll also have a thin tube passed into your urethra (urinary catheter) to empty your bladder. This catheter will stay in place throughout your surgery and for a short time after your surgery. Just before the surgery starts, your abdomen and vagina will be cleaned with a sterile solution. 

Vaginal hysterectomy procedure

During a vaginal hysterectomy, your surgeon will insert special instruments via your vagina to make a cut that will separate your vagina from your cervix. Your womb and cervix will be separated from the ligaments that hold them in place and removed through the opening of your vagina. 

The cut made at the start of your surgery will be sewn up using dissolvable stitches. This technique leaves no visible scars and usually takes about an hour.

After your surgery is complete, a gauze pack will be placed in your vagina for up to 24 hours to reduce the risk of bleeding. 

A vaginal hysterectomy can be performed under general anaesthetic, so you will be asleep during the surgery, or under local or spinal anaesthetic where you'll be awake. Spinal anaesthetic will numb your body from the waist down so you won't feel any pain. Local anaesthetic will numb the area where the surgery will be performed, so you won't feel any pain. 

Whenever possible, a vaginal hysterectomy is recommended instead of an abdominal hysterectomy as it is less invasive.

Laparoscopic hysterectomy procedure

A laparoscopic hysterectomy, also called a keyhole hysterectomy, involves removing your womb with the help of a long, thin telescope (laparoscope) passed through a small cut in your abdomen. This enables your surgeon to see what is going on inside your belly without making a large cut in your abdomen.

Several small cuts will be made into your abdomen — the laparoscope and special surgical instruments will be inserted through these cuts. Gas will be pumped into your abdomen to inflate the space around your womb before your surgeon removes it through the opening of the vagina. Dissolvable stitches will be used to seal the cuts.

This procedure is usually carried out under general anaesthesia.

Abdominal hysterectomy procedure

During an abdominal hysterectomy, your surgeon will make either a vertical or horizontal cut into your abdomen and remove the womb through this long cut. A vertical cut is usually made if there are large fibroids in your womb or for certain types of cancer. Stitches or metal clips will be used to close the cut and a sterile dressing will be placed over it. The operation usually lasts about an hour and is performed under general anaesthesia.

Your surgeon will put in a catheter to drain urine from your bladder into a bag beside your bed because most women have difficulty passing urine for a few days after a hysterectomy. 

During your recovery in hospital, you may also have a drip placed into one of your veins to deliver fluids and medication, if needed. A drainage tube will be placed in your abdomen through which blood from underneath your wound will drain out. Both the drip and drainage tube are usually needed for 1–2 days after your operation. 

Your doctor may recommend an abdominal hysterectomy if you have large fibroids in your womb or you have pelvic tumours, which can't be removed via your vagina. 

Aftercare

After your procedure, you'll be taken from the operating theatre to a recovery room, where you will come round from the anaesthesia under close supervision.

When you wake up, you may feel tired and experience some pain. You may feel nauseous and want to vomit — your nurse can give you medication to relieve these symptoms. You may also experience some discomfort and the urge to open your bowels. 

After you have spent some time in the recovery room, you'll be taken to your room or a comfortable area where you can rest and recuperate until we feel you’re ready to go home. 

Your healthcare team will encourage you to take a short walk after your surgery — this will help improve your blood flow and reduce the risk of blood clots. Your catheter will be removed before you leave hospital, after which you'll be able to urinate as normal. 

A physiotherapist may visit you while you’re with us and show you some exercises to do that will help speed up your recovery, such as pelvic floor muscle exercises.

If you have non-dissolvable stitches, these will be removed 5–7 days after your operation. 

Pain relief

You will feel sore after your operation and you may have some bruising and swelling, so we will give you pain relief medication while you’re with us.

We will provide you with a supply of all the medications your consultant recommends you take home with you when you leave hospital, which will last up to 14 days. 

Recovery time

The length of your stay in hospital will depend on which type of procedure you had as well as your overall health and fitness.

If you have had a vaginal or laparoscopic hysterectomy, you probably won’t need to stay in for more than four nights. With an abdominal hysterectomy you're likely to be with us for 3–5 days.

It takes 6–8 weeks to fully recover after an abdominal hysterectomy but it’s usually less after a vaginal or laparoscopic hysterectomy — recovery from a vaginal hysterectomy can, in some cases, be as short as just two weeks. If you live alone, you may want to arrange for a friend or family member to stay with you during the early stages of your recovery.

Whichever operation you have, you should take at least four weeks off work and rest as much as possible — if your work involves manual labour, you may need to take more time off work. You'll be able to walk around after a day or two but don’t lift anything heavy or do any sporting activities until you’re fully recovered.

It’s important to do your physiotherapy exercises regularly, as this will help build your abdominal muscles back up. Your physiotherapist will probably also recommend you get back to walking and swimming once your wounds have healed. 

Don't drive until you're comfortable wearing a seat belt — this could be up to eight weeks after surgery. Some car insurance companies require a certificate from your doctor stating that you're fit to drive.

Avoid sexual activity for at least six weeks and be aware that you might experience a temporary loss of interest in sex. This usually returns when you’re fully recovered and many women report that sexual activity and enjoyment actually improve after a hysterectomy.

Your surgeon will advise you when you can resume your normal activities. A full recovery can take up to 12 weeks.

If your ovaries were removed you may get menopausal symptoms such as hot flushes and vaginal dryness. Your doctor may recommend hormone replacement therapy to help with this.

Lifestyle after treatment

After your operation we will provide you with all the appropriate medication, physiotherapy exercises, advice on what you should and shouldn't do and any other follow-up support you need. 

Typically your consultant will want to see you after your treatment to see how you’re doing and a follow-up appointment will be made for you.

If both of your ovaries were removed during your hysterectomy, you'll go through surgical menopause immediately after your operation, no matter how old you are. You'll be offered hormone replacement therapy and will no longer need to use female contraceptives. If your ovaries weren't removed or only one ovary was removed, you may go through menopause within five years after your operation. 

• Bowel and bladder problems
• Emotional effects eg depression, anxiety 
• Menopausal symptoms eg hot flushes, night sweats, vaginal dryness
• Vaginal discharge

On rare occasions, complications following surgery can occur. The chance of complications depends on the exact type of operation you’re having and other factors such as your general health. Your consultant will talk to you about the possible risks and complications of your procedure and how they apply to you.

Complications include: 

• Blood clots and/or heavy bleeding
• Damage to your bladder, ureter or bowel during the course of the operation
• Early menopause 
• Infection
• Ovary failure where your ovaries stop working properly 
• Vaginal problems

If your procedure is performed under general anaesthesia, you may have a reaction to the anaesthetic. 

If you experience any of the following serious complications after a hysterectomy, you should call your doctor urgently: 

• Breathlessness or chest pain
• Difficulty urinating or opening your bowels
• Fever or chills 
• Heavy bleeding or unusual vaginal discharge
• Redness or discharge from the surgical cuts
• Severe pain