Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.
Hysterectomy may be recommended to treat various conditions including: heavy or abnormal uterine bleeding; fibroids (non-cancerous growths or tumours) in the uterus; endometriosis
; pelvic inflammatory disease; prolapse (ie falling down or slipping out of place) of the uterus and/or vagina; cancer of the uterus, cervix or ovaries
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
- 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.
Following hysterectomy a woman will no longer have periods and she will no longer be able to have children. The ovaries are usually left in place as they produce oestrogen. If the ovaries are removed, the woman will experience menopause and may need to take hormone replacement medication.
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 (eg: 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 (eg: 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.
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. The choice of method will depend on the type of hysterectomy and the reason for the hysterectomy, as well as the preference of the surgeon and patient.
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.
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)
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. Carbon dioxide gas is used to inflate the abdomen to enable the internal organs to be more easily seen.
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 is removed through an incision at the top of the vagina.
During the post-operative recovery period there will be a drip in the arm or hand to provide fluid and medications. There may also be a tube (catheter) draining urine from the bladder. This will be removed 24 to 36 hours after surgery. There may be vaginal packing to help reduce vaginal bleeding. This is usually removed the first day following surgery. A thin tube to drain excess fluid and blood may be inserted into the abdomen during surgery. This is usually removed 24 to 36 hours after surgery. Any pain or discomfort will be managed with pain medication given orally as tablets or as an injection into the drip.
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.
Prior to discharge home the surgeon and/or nurse will advise on how soon to return to normal activities – again depending on the type of hysterectomy and surgical method used. With vaginal hysterectomy this may be as little as two weeks, and with abdominal hysterectomy it may be up to six to eight weeks. Full recovery from a hysterectomy can take up to several months.
It is usual to have a bloodstained discharge for a couple of weeks after the operation. Tampons should not be used until after this discharge has stopped.
Possible complications following hysterectomy include:
- Deep vein thrombosis (blood clots)
- Bladder function problem
- Adhesions (internal scar tissue).
Rarely, the surgery can cause damage to the ureters (the tubes connecting the bladder and kidneys), bladder, or bowel.
The surgeon will arrange a post-operative appointment to ensure healing is going well. This is usually about six weeks after the surgery.
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 GP if you have:
- Bright red vaginal bleeding
- Pain or difficulty passing urine
- Flu like symptoms
- A temperature over 38 deg C
- Redness, pain or oozing at the incision site.
Mayo Clinic (2016). Abdominal hysterectomy (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/home/ovc-20178788 [Accessed: 07/07/17]
Mayo Clinic (2015). Vaginal hysterectomy (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/home/ovc-20165324 [Accessed: 07/07/17]
NHS Choices (2016). Hysterectomy (Web Page). Redditch: National Health Service (NHS)
England. http://www.nhs.uk/Conditions/Hysterectomy/Pages/Introduction.aspx [Accessed: 07/07/17]
O’Toole, M.T. (Ed.) (2013). Hysterectomy. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Last Reviewed – June 2017