Hysterectomy: everything you need to know about removal of the uterus

A hysterectomy is a surgical procedure to remove a woman’s uterus, in order to treat a number of health problems that affect the female reproductive system.

Hysterectomy – removal of the uterus explained
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If you’ve been advised by your doctor that you need a hysterectomy, you may well have questions and concerns. What will it involve? Will it affect your hormone levels? How long will it take you to recover?

Dr Deborah Lee, sexual and reproductive healthcare specialist at Dr Fox Online Pharmacy explains everything you need to know about undergoing a hysterectomy including practical preparation and recovery tips:

What is a hysterectomy?

A hysterectomy is a surgical procedure in which the uterus (womb) is removed. It’s a common gynaecological operation, with around 27,000 women undergoing the procedure in the UK for benign conditions every year. Around 20 per cent of women have had a hysterectomy by the age of 55.

During a hysterectomy:

  • One or both fallopian tubes may also be removed (salpingectomy/bilateral salpingectomy).
  • One or both ovaries may also be removed (oophorectomy/bilateral oophorectomy).

    A bilateral salpingo-oophorectomy (BSO) is the term used if both tubes and both ovaries are also removed.

    There are medical reasons why it’s often in your best interest to leave your ovaries in place when you have your hysterectomy. Removal of your ovaries is likely to increase your cardiovascular risk over time. However, sometimes – for example, if there has been a family history of ovarian cancer – it may be better to remove them. Your surgeon will discuss these options with you.



    Types of hysterectomy

    There are several different methods a surgeon can use to remove the uterus:

    • Laparoscopic hysterectomy

    A traditional laparoscopic hysterectomy is performed using a laparoscope, which is a narrow, flexible tube containing a camera. The laparoscope is inserted into the pelvic cavity by making several small incisions, low down on the abdominal wall.

    In the past, a hysterectomy meant making one large incision across the lower abdomen, but now with laparoscopic surgery, there is no need to do this. This is also called ‘minimally invasive’ or ‘keyhole’ surgery.

    Once the laparoscope is inserted, the surgeon can visualise all the pelvic organs and tissues easily. Because there is less tissue damage, this results in a faster recovery time.

    A variation of this is a ‘robotic laparoscopic hysterectomy.’ This means a computer robot assists the surgeon with the procedure. The robot does not actually perform the surgery – it just provides the use of a 3D camera, and acts to hold various instruments in its arms, allowing the surgeon to be very precise. Some studies have shown robotic-assisted procedures have advantages, which result in a quicker recovery and a shorter hospital stay.

    A laparoscopic hysterectomy – with or without robotic assistance – is generally the first choice of hysterectomy, if this is considered suitable for you.

    Data suggest the number of laparoscopic hysterectomies across the UK has risen in recent years, and the number of abdominal hysterectomies has fallen.

    • Laparoscopic supracervical hysterectomy (LSH)

    This is also a type of hysterectomy procedure which is undertaken using a laparoscope. This operation specifically involves removing the body of the uterus only – the cervix is left behind.

    Leaving the cervix in place has advantages, as the cervix provides an anchor for the vaginal walls, as well as various pelvic muscles and ligaments. This is thought to reduce the future risk of prolapse.

    Laparoscopic hysterectomies are generally done under a general anaesthetic, meaning you are asleep for the procedure. The length of stay in hospital for these procedures is generally 24 hours, but may be up to three days.

    • Vaginal hysterectomy

    When a hysterectomy is done vaginally, there is no incision in the abdomen. The surgeon inserts a speculum as if you were having a smear or a swab taken, and the uterus is removed through your vagina.

    This is often a good option if the uterus is prolapsed (has dropped lower into the pelvis).

    A vaginal hysterectomy can be done under a general anaesthetic, meaning you are asleep for the procedure. Sometimes, you may be offered a local anaesthetic, meaning you’ll be awake, but won’t feel any pain. Alternatively, you may be offered a spinal anaesthetic – an injection in your spine that effectively numbs everything from the waist down.

    A vaginal hysterectomy is often preferred, as it involves a shorter stay in hospital – around three days – and recovery is usually quicker.

    • Transabdominal hysterectomy (TAH)

    This is performed by making an incision across your lower abdomen, above the pubic bone. Most commonly, this is a horizontal incision along your bikini line, but sometimes it has to done vertically from just below your belly button. It’s usually done under a general anaesthetic, meaning you will be asleep for the procedure.

    A TAH is usually done if the uterus is too large to be removed through the vagina – for example, if there are large fibroids. The usual length of stay in hospital is five days.



    Common reasons for a hysterectomy

    The most common reasons for undergoing a hysterectomy operation are:

    • Heavy periods – there are a range of treatments for heavy periods, which are recommended to try before resorting to a hysterectomy. However, if no cause can be found and treatments are unsuccessful, hysterectomy is an option.
    • Fibroids – benign swellings in the uterine wall.
    • Endometriosis/adenomyosis – often this condition causes very heavy, painful periods.
    • Prolapse – where the uterus has dropped low into the pelvic cavity and is causing pressure symptoms.
    • Severe pelvic infections – chronic symptoms which have not responded to treatment.
    • Cancer - of the cervix, endometrium, uterus, fallopian tubes or ovaries
    • Emergency postpartum hysterectomy – in the case of severe, uncontrollable bleeding after childbirth (rare)


      Preparing for a hysterectomy

      It’s common to feel anxious prior to a hysterectomy. Many women worry about their body, their pelvic function and how it might affect their sex life in the future. However, your feelings will vary depending on the reason for the surgery. Women who are fed up with very heavy periods and pelvic pain will see their hysterectomy as a great relief. Others may grieve for their loss of fertility, or worry they will feel less feminine.

      However, many research studies have concluded that hysterectomy greatly improves quality of life. In fact, after hysterectomy, many women report improvements in sexual desire and arousal, as well as reduced pain during sex, orgasm and increased overall sexual satisfaction.



      Hysterectomy preparation tips

      To prepare for a hysterectomy, read the following tips:

      • Get enough information

      Make sure you know about your pelvic anatomy and what is being done. Ask all the questions you need to. Don’t be embarrassed – the staff are all trained to help you.

      • The consent form

      You will be asked to sign a consent form for the operation. These forms are carefully written to list the common risks of the operation. Make sure you understand these fully. Again, ask questions. If there are things you are unhappy about, you must say so. You are entitled to a copy of your consent form to take home.



      Practical preparation for your hysterectomy

      These practical steps will help you feel more prepared and may reduce your recovery time:

      • Stop taking the pill

      Stop your contraceptive pill six weeks before the operation. However, there must be no chance of pregnancy when you arrive for surgery. So you must abstain from sexual intercourse or use another method, such as a condom, with care up until you are admitted for surgery.

      • Try to stop smoking

      Try to stop or cut down on smoking. It’s easier than you think! Stopping smoking will help your recovery enormously.

      • Plan your time off work

      Discuss this with your employer.

      • Stock up

      Buy pads and simple painkillers, such as paracetamol and ibuprofen.

      • Exercise

      Continue to exercise up until the day of surgery. Even short walks will help your physical fitness.

      • Eat a healthy, balanced diet

      If you are overweight or obese, even a small weight loss will help between now and the time of surgery. Healthy eating will help speed healing and recovery.

      • Try to stay calm

      Stress and anxiety add to the risks of the procedure and delay healing.



      Hysterectomy: the risks

      Although a hysterectomy is a safe procedure, there can be complications. A hysterectomy is only offered when other medical treatment options have been unsuitable, unsatisfactory or have failed. After a hysterectomy, around four in 100 women will experience a serious complication.

      Frequent hysterectomy risks

      Infections: these occur in around two per 100 women, for example, urinary tract infection (UTI), bladder infection (cystitis), chest infection (pneumonia) or a wound infection.

      • Bleeding: this occurs in around four in 100 women. Bleeding can be from the wound site, internally and/or from the vagina. Around 1 in 100 will need a blood transfusion.
      • Wound problems: the wound can gape or appear bruised.
      • Scarring: scars may be painful.
      • Shoulder tip pain: this is common because, during the procedure, gas is pumped into the abdominal cavity. This tends to travel upwards and irritate your diaphragm. It will gradually settle.

        Serious hysterectomy risks

        Damage to other structures: such as the bladder, ureters (the tubes that connect the kidneys to the bladder), bowel, nerves or blood vessels – this occurs in two in 100 women. These sorts of complications are more common with laparoscopic surgery. If they do happen, it may be necessary to do a laparotomy incision to repair the damage.

        Blood clots: deep vein thrombosis/pulmonary embolus. These occur in 1 in 100 women after surgery. Your risk is increased if you are diabetic, overweight/obese, have had a blood clot before or have a family history of blood clots, smoke, or are immobile. There are several ways to reduce the risk of a blood clot:

        • Wear venous compression stockings
        • Mechanical leg compression in theatre
        • Stop smoking
        • Mobilise as soon as possible
        • Possible use of blood thing agents, for example, enoxaparin


          Further surgery following hysterectomy

          Around one in 100 women need to go back to the operating theatre soon after their initial operation if there is a complication. This may mean a laparotomy (a 10-12 cm vertical incision from under your rib cage to your pubic bone). This type of incision is needed to perform most major abdominal surgery, because the surgeon needs the best access to your pelvic/abdominal cavity to be able to deal with the problem.

          Longer-term risks following a hysterectomy

          The following risks can occur following a hysterectomy operation:

          • Bladder problems

          It's common for women to develop bladder problems after a hysterectomy. This is because the bladder can drop lower down into the pelvis, called a prolapse. Symptoms include recurrent urinary infections, pressure symptoms, discomfort during sex or stress incontinence.

          • Hernias

          These are small lumps on the abdominal wall, which occur when the tissues under the skin have split apart and fat or muscle is bulging through.

          • Premature menopause

          If you have a hysterectomy and your ovaries are left behind, this is associated with an increased risk of your ovaries failing earlier than they would have done, without the hysterectomy. Also, by not having your uterus, you will no longer be having periods, hence you will not know that your periods have stopped due to menopause. It’s important to be aware of this.



          Recovery after a hysterectomy

          Following a hysterectomy, you will be given pain relief, such as paracetamol, ibuprofen, codeine or morphine. You should also drink plenty of fluids and you should be able to eat a small meal within 24 hours of surgery.

          You will be encouraged to get out of bed as soon as possible, to move around. This will be within 24 hours of surgery and regularly during your hospital stay. If you stay in the hospital for two to three days, you will see the physiotherapist for advice about mobilising, breathing and coughing.

          Most women with a laparoscopic hysterectomy will be home after 24 hours. Most other women will be home within three to five days.



          Hysterectomy recovery at home

          Follow these tip to help you recover from a hysterectomy operation as quickly as possible:

          • Mobility

          Try to keep active, although it may be uncomfortable to stand up for long periods. Do simple tasks little by little, and sit down if you feel you need to. You can feel very tired after major surgery. Accept help from friends and family. Gentle exercise is good for you, including walking up and down stairs. Do not perform strenuous exercise until six weeks after surgery. Avoid lifting anything heavy, such as heavy shopping or small children, until after this time.

          • Caring for your wound

          Once your scar has healed, the tissues underneath will be healed too, so you don’t need to worry about it. It may look red and prominent at first, but over the next six to 12 months, it will fade and look like a faint white line.

          • Keeping clean

          It's fine to have a bath. You can also use bath additives, like bubble bath.

          • Vaginal bleeding

          Vaginal bleeding is common and may continue for several weeks. It will tail off like the end of a period and then stop. Pads are preferable to tampons at this stage. Sometimes, you may see little pieces of suture material on your pad – don’t worry about this. If the discharge becomes heavier, gets very smelly or starts to contain red blood, see your GP, in case you have an infection.

          • Passing urine

          Make sure you empty your bladder completely each time you pass urine. Stand up and sit down, and try once more to make sure the last drops have gone! Urine that remains in the bladder can cause a urine infection. If you start having symptoms such as burning or stinging when you pass urine, or your urine starts to smell very strong, see your GP, as you may have an infection.

          • Healthy diet

          Try to eat a sensible, healthy diet. You need plenty of protein to aid healing, and plenty of fibre to avoid constipation. If you’re taking painkillers that contain codeine, these can cause constipation. Think ahead. If you’re on codeine-based painkillers for some days, you may well need to take a laxative at the same time. Speak to your GP about this. You also need to keep drinking plenty of fluids as dehydration can cause of constipation.

          • Going back to work

          In general, you should stay away from work for four to six weeks after a laparoscopic or vaginal hysterectomy, and six to eight weeks following an abdominal hysterectomy. The staff on the hospital ward will give you a sick note for this period, but if you are not well enough to go back after this, you will need to see your GP.

          • Driving

          You are not permitted to drive after a hysterectomy until you can safely do an emergency stop. This is generally around four weeks after surgery. It’s a good idea to check with your insurance company.

          • Having sex

          It’s pretty unlikely you will feel like having sex for a few weeks after surgery. Many women feel battered and bruised, and hardly ready for intimacy. However, your libido will gradually return. It’s generally advised to not have full penetration for eight weeks after surgery. This is because it’s not a good idea to put too much strain on the stitches at the top of the vaginal vault from full vaginal penetration. When you do first have sex, take it slowly and use plenty of lubricant.

          • Emotions

          Other people may not appreciate the emotional trauma of a hysterectomy, or the length of time it may take for you to feel back to normal. It’s important to talk about your feelings. You may find a local hysterectomy support group, or a hysterectomy support group online.

          • Hormone replacement therapy (HRT)

          For younger women (those under 40), HRT is often advised at hysterectomy. You may already be going through an early menopause, or you may be having your ovaries removed, which is a surgical menopause.

          Oestrogen has a lot of important physiological actions in your body and to be without it ten years earlier than most other women is not likely to be in your best interests. However, you will need to take advice about this from your gynaecologist and your GP.

          Older women may also wish to consider HRT after a hysterectomy. The relative benefits and risks need to be discussed with your gynaecologist and your GP.

          • Pelvic floor exercises

          Physiotherapists recommend a programme of exercises after a hysterectomy, to strengthen your pelvic floor.

          • Hysterectomy and cancer

          Some 10 per cent of hysterectomies are undertaken for cancer – of the cervix, uterus, fallopian tubes and ovaries. Cases of uterine cancer have been increasing in the UK, and one modifiable cause of uterine cancer is obesity.

          Women who are obese have higher levels of oestrogen. Over time, this can irritate the endometrium, causing an overgrowth and, eventually, this can cause endometrial cancer.

          It’s estimated that 34 per cent of uterine cancers could be prevented by losing weight. After smoking, obesity is the UK’s biggest cause of cancer. Leading a healthy lifestyle – that is, eating a healthy diet, losing weight, reducing alcohol intake and stopping smoking – will all help reduce your cancer risk.

          Also, if you’re aged 25 to 64, it’s important that you attend your cervical smear tests. A cervical smear will pick up cellular abnormalities before you develop cancer, meaning it might just save your life!



          Last updated: 18-12-19

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