A hysterectomy may be used as a treatment for heavy periods, long-term pelvic pain, fibroids (non-cancerous tumours) or certain types of cancer (e.g. cervical cancer, ovarian cancer, uterine cancer).
Hysterectomy is a relatively common operation with up to one in five UK women having this surgery by the age of 55. Because a hysterectomy is a major operation, with a lengthy recovery time, it is usually only considered when there are no other alternative treatments.
Depending on the reason for your treatment, one of several different types of hysterectomy may be recommended.
An abdominal hysterectomy is carried out through an incision in your abdomen which will be stitched after the operation leaving an external scar. This method is used to carry out:
- Total abdominal hysterectomy - where your uterus and cervix are removed but your ovaries are left in place.
- Total abdominal hysterectomy with bilateral salpingo-oophorectomy - where your uterus, cervix, ovaries and fallopian tubes are removed. (Hormone replacement therapy may be recommended if your ovaries are removed.)
- Sub-total hysterectomy - where your uterus is removed but your cervix is not. After this operation you’ll need to continue having routine smear tests.
A vaginal hysterectomy is carried out through an incision in the top of the vagina leaving no external scar. During the operation the uterus and cervix are removed through the vagina. The fallopian tubes and ovaries can also be removed at the same time if required. however a laparoscopy may be required to assist with this part of the operation.
This is also known as keyhole surgery. It uses instruments inserted through small incisions in the abdomen and/or vagina which allows the surgeon to view the area and remove the required tissue or organs.
This laparoscopic method may be used as an alternative to the methods described above, or in combination with these approaches depending on the exact treatment required. A ‘laparoscopic assisted vaginal hysterectomy’, for example, is carried out by some surgeons to assist with the vaginal hysterectomy procedure where other factors may complicate a traditional vaginal approach, such as needing to remove the fallopian tubes and ovaries.
A hysterectomy will only be carried out under a general anaesthetic (so you’ll be asleep).
The exact procedure will depend on the type of surgery you have agreed to have following discussions with the specialist; this may be an abdominal hysterectomy, a vaginal hysterectomy, or a laparoscopic hysterectomy.
After a hysterectomy we’ll help manage any pain or discomfort with painkillers. Depending on the exact nature of your operation, you may need to stay in hospital for up to 48 hours.
Hysterectomy recovery time will vary, but in all cases you’ll need to rest for a couple of weeks, avoid any heavy lifting and try not to become constipated throughout your recovery. You may not be able to drive for 4-6 weeks. If your ovaries are removed during the operation you may need to start hormone replacement therapy (HRT).
Overall, recovery time is usually shorter if you’ve had a vaginal or laparoscopic hysterectomy. Two to three months is the expected time to fully recovery from this surgery, following which you should be able to resume your normal, active and unrestricted lifestyle.
Most women who have a hysterectomy do not experience any complications; however, as with any surgical procedure there can be some risks including;
- Wound infection/bruising
- Delayed wound healing
- Deep vein thrombosis (DVT) or pulmonary embolism (blood clot)
Following a hysterectomy, you may experience some short-term side effects such as; changes in your bowel or bladder function (including a need to frequently pass urine or constipation); vaginal discharge (which may last a few weeks); menopausal symptoms (including hot flushes, sweating); and emotional effects (a sense of loss or sadness).
Endometrial ablation is a procedure which can help treat women who suffer with heavy periods. It is a minimally invasive treatment which is an alternative to a hysterectomy and which avoids hormonal medication.