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Hysterectomy

 
Hysterectomy is the surgical removal of a woman’s uterus (womb). It may also involve removal of other parts of the female reproductive system including the cervix, ovaries and fallopian tubes. 

Hysterectomy may be used to treat various conditions including: heavy or abnormal menstrual bleeding (periods); fibroids (non-cancerous growths or tumours) in the uterus; endometriosis; pelvic inflammatory disease; prolapse (when organs normally in the pelvis slip out of place); cancer of the uterus, cervix, or ovaries
Hysterectomy 1
A hysterectomy is a major surgical procedure and requires a long recovery time. It is usually considered only after other treatment options have been tried. Following hysterectomy, a woman will no longer have periods and she will no longer be able to have children. 

Before surgery

Prior to surgery several diagnostic and investigative procedures may be conducted. These will assist with deciding the type of hysterectomy required and the surgical method to be used. Investigations may include: 

  • Blood tests (to check for anaemia or iron deficiency)
  • Urine tests
  • Pap smear (cervical smear) to check for the presence of abnormal cervical cells or cervical cancer
  • Ultrasound scans (to assess the size of the uterus)
  • Hysteroscopy – where a small telescopic instrument with a camera at its tip is used to view the inside of the uterus
  • Endometrial biopsy – where a sample of the endometrium (lining) of the uterus is taken and analysed.

Surgery

The type of hysterectomy performed will depend on the condition being treated. Types of hysterectomy include: 

  • Subtotal/partial – removal of the uterus 
  • Total – removal of the uterus and cervix 
  • Extended (radical) – removal of the uterus, the cervix, the upper part of the vagina, and tissue surrounding the cervix (usually used in treating gynaecological cancers). In some cases, the ovaries (oophorectomy) and/or fallopian tubes (salpingectomy) may also be removed at the time of the hysterectomy. 
The ovaries are usually left in place as they produce oestrogen, which is a hormone responsible for normal function of the reproductive system. If the ovaries are removed, the woman will experience surgical menopause and may need to take hormone replacement medication.
 
A hysterectomy is usually performed under a general anaesthetic, but a spinal or epidural anaesthetic (where the area below the level of the waist is numbed via an injection into the back) may be used instead. There are three main ways a hysterectomy can be performed. 

Abdominal hysterectomy
The surgeon makes an incision in the lower abdomen. The uterus (and other structures if required) is removed through this incision. This method allows the surgeon to check surrounding tissue and organs in case further treatment is required. This is the usual method of choice for cases of large fibroids or cancer of the uterus, cervix, or ovaries. 
 
Vaginal hysterectomy
This is where the uterus is removed via the vagina without the need for an abdominal incision. An incision is made near the top of the vagina and the surgeon is able to work through this incision to remove the uterus and tie off blood vessels, ligaments, and the fallopian tubes. This is the usual method of choice for women who have a prolapsed uterus, as weakened structures supporting the vagina can be repaired at the same time.
 
Laparoscopically-assisted vaginal hysterectomy (LAVH)
Laparoscopy is a type of minimally-invasive (or keyhole) surgery.  With LAVH, a narrow fibre optic telescope (a laparoscope) is inserted into the abdomen through a small incision in the tummy button. The laparoscope has a camera at its tip, allowing the surgeon to view the internal organs on a television monitor during the surgery. Surgical instruments are inserted through two further small incisions in the abdomen. The uterus is freed, blood vessels, ligaments, and the fallopian tubes are tied, and the uterus removed through an incision at the top of the vagina. 

Recovery time will vary depending on the type of hysterectomy and the surgical method used. Hospital stays vary from about one or two days for the laparoscopically-assisted vaginal hysterectomy, to about four or five days for an abdominal radical hysterectomy.  

Complications

Possible complications following hysterectomy include: 

Rarely, the surgery can cause damage to the ureters (the tubes connecting the bladder and kidneys), bladder, or bowel.

It is common to feel emotionally down after any kind of surgery and this may be particularly so following a hysterectomy. Be sure to discuss any problems and concerns with your GP or with the surgeon at the follow up appointment.

Contact your doctor if you have any of the following signs or symptoms after the procedure: 

  • Bright red vaginal bleeding 
  • Pain or difficulty passing urine
  • Flu-like symptoms 
  • A temperature over 38 degrees Celsius 
  • Redness, pain or oozing at the incision site.

References

Mayo Clinic (2019). Abdominal hysterectomy (Web Page). Rochester, N: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/about/pac-20384559 [Accessed: 15/04/20] 
Mayo Clinic (2020). Vaginal hysterectomy (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/about/pac-20384541 [Accessed: 15/04/20] 
NHS Choices (2019). Hysterectomy (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/hysterectomy/ [Accessed: 15/04/20] 
O’Toole, M.T. (Ed.) (2017). Hysterectomy. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier. 
 

Last Reviewed – April 2020

 
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