What Is A Hysterectomy?

Overview

A hysterectomy is a major surgery that removes your womb. This can be the whole womb (uterus) or part of the womb in those assigned females at birth. A hysterectomy is one of the most commonly performed surgeries in those assigned female at birth.¹

What are the reasons why you might have a hysterectomy?

You may have a hysterectomy if you have been diagnosed with one of the following:

• Having very heavy or/and painful periods
• Endometriosis
• Uterine fibroids
• Ovarian cancer
• Uterine cancer
• Pelvic organ prolapse
• Cervical cancer

Having a hysterectomy can relieve you of the symptoms that you are experiencing if you have been diagnosed with one of the conditions listed above.

Types of hysterectomy

What is a total hysterectomy?

A total hysterectomy is when a surgeon completely removes your uterus and the neck of your uterus (womb), which is known as the cervix.

What is a subtotal/ partial hysterectomy?

A partial hysterectomy only removes your uterus and not your cervix, unlike a total hysterectomy. A partial hysterectomy is also known as a supracervical hysterectomy.

What is a radical hysterectomy?

A radical hysterectomy removes your uterus, cervix and part of your vagina. You may have a radical hysterectomy if you have been diagnosed with certain types of cancer.

Indications for hysterectomy

Medical conditions

Uterine fibroids

Uterine Fibroids are non-cancerous (benign) tumours that grow in the following areas:

• On the smooth muscle tissue in your uterus
• In the muscle layer below the lining of your uterus
• Outside your uterus wall into the pelvis

Uterine fibroids are seen in the uteri of those of reproductive age.² By having a hysterectomy and thus having your uterus removed, the uterine fibroids can not come back, and this can relieve the symptoms uterine fibroids cause. These symptoms include the following:

• Having heavy and/or painful periods
• Having lower back pain
• Having the frequent need  to urinate
• Feeling constipated
• Having abdominal pain
• Experiencing pain during sex

Endometriosis

Endometriosis is when endometrium-like tissue starts growing in places in your body that are not your uterus.³ The endometrium is the inner lining of your uterus. Similar to uterine fibroids, you are usually only affected by endometriosis if you are of reproductive age.³ A common symptom of endometriosis is chronic pelvic pain, and for many who are assigned female at birth, a hysterectomy relieves this symptom. However, it is worth noting that, sadly, there is a minority of those assigned female at birth who have a hysterectomy and still experience this chronic pelvic pain due to endometriosis.⁴

Uterine cancer

Uterine cancer is a cancer that begins in your uterus; however, sadly, this can spread to other parts of your body. In uterine cancer, the cells in your uterus begin rapidly growing and dividing uncontrollably, forming a cancerous tumour. The most common form of uterine cancer is endometrial cancer. Treatment for uterine cancer is typically a hysterectomy, removing both the uterus, where the cancer is, and the cervix.

Non-medical reasons

Some individuals may opt for a gender-affirming hysterectomy, such as trans men, non-binary individuals, and intersex individuals.

Surgical procedure

Preoperative preparation

In the two weeks before your hysterectomy surgery, you will be invited to the hospital for a preoperative assessment. During this assessment, the doctor will need to check if you are fit for both surgery and general anaesthetic and ensure that you have no allergies to general anaesthetic. The doctor will also examine your medical history and any current medication you are on. You will also be asked to sign a consent form stating that you consent to the hysterectomy surgery being performed.

Different surgical approaches

Abdominal hysterectomy

An abdominal hysterectomy involves cutting through your abdominal wall to remove your uterus. Abdominal hysterectomy has previously been the preferred type of hysterectomy if you have a large uterus. However, over time, more minimally invasive surgeries, such as performing a hysterectomy via laparoscopy, have become more preferred. This is due to less invasive surgeries having a quicker recovery time, and those with minimally invasive surgeries report having less pain post-operation. Despite this, abdominal hysterectomy is the preferred surgical approach if you have uterine fibroids, uterine bleeding and endometriosis. ⁵

Vaginal hysterectomy

A vaginal hysterectomy removes the uterus and the cervix via an incision at the top of the vagina.

A vaginal hysterectomy is one of the most minimally invasive approaches to performing a hysterectomy and is usually conducted if you have a benign (non-cancerous) condition. The benefits of having a vaginal hysterectomy compared to other surgical approaches for a hysterectomy include:⁶

• Less pain
• A faster recovery period
• A quicker return to normal

Laparoscopic hysterectomy

A laparoscopic hysterectomy is also known as keyhole surgery. The surgeon will insert a small tube containing a small telescope, known as a laparoscope, and a very small video camera through a small incision in your abdomen. This gives the surgeon visuals on your internal organs and allows the surgeon to insert other instruments, via other small incisions on both your abdomen and vagina, to remove your uterus and cervix during the hysterectomy.

Compared to abdominal hysterectomies, vaginal and laparoscopic hysterectomies have been shown to have the following benefits:⁷

• Less blood loss
• Fewer infections in the abdominal walls
• A shorter stay in hospital
• A faster recovery time, allowing the patient to return to everyday activities quicker

Recovery and aftercare

Hospital stay

After the surgery, you can expect to wake up in the recovery area of the operating theatre. You will have received painkillers after you wake up to minimise the amount of pain you feel. Assuming that you have no postoperative complications, you can expect your stay in the hospital to be relatively short, approximately 1-3 days.

FAQs about post-operative care

What will my diet be like after my hysterectomy?

For the first few hours post-hysterectomy, you can expect fluids to be delivered to your body via a tube in your arm to your vein. After a few hours have passed, you can expect to drink on your own, and after 1-2 days, you can expect to be both eating and drinking normally.

When can I exercise after my hysterectomy?

You can expect to resume exercise and normal day-to-day tasks 6-12 weeks after your hysterectomy. However, it is advised that you avoid swimming until your wounds have fully healed.

When can I go back to work?

It is advised that you take between 6-12 weeks off work for rest and time to recover after your hysterectomy.

When will I be able to drive after my hysterectomy?

Typically, you can expect to drive 4-6 weeks post hysterectomy. You should not drive unless you can perform an emergency stop at ease without experiencing severe pain and are not relying on pain relief medication regularly.

When can I have sex after my hysterectomy?

You will receive stitches at the top of the vagina, where your cervix was, and this is the area that needs to heal before you resume sexual activity fully. This area, where the cervix was, usually heals 6 weeks post-hysterectomy.

Potential complications

Potential complications after a hysterectomy are listed below:⁸

• Injury to the gastrointestinal tract: injury to the small bowel, stomach, colon, or rectum is sustained
• Excessive bleeding
• Vaginal cuff dehiscence, where the cut at the top of your vagina reopens, meaning you will need another surgery
• Abnormal connection between your bladder, vagina, ureters and bowels, meaning that you will need another surgery
• Nerve injury
• Damage to the bladder
• Damage to the ureter
• General anaesthetic side effects
• Blood clots
• Infection: this can be a wound infection or a urinary tract infection
• Ovary failure
• Premature menopause
• Thrombosis

Alternatives to hysterectomy

Medication and therapies

Which medications and therapies can be used as an alternative to treat uterine fibroids?

The following can be used as an alternative to a hysterectomy to treat uterine fibroids:

• Taking oral progesterone
• Having progesterone via an injection
• Taking anti-inflammatory medicines
• Tranexamic acid
• Levonorgestrel intrauterine system (LNG-IUS)

More information about these alternative treatments can be found here.

Which medications and therapies can be used as an alternative to treat uterine endometriosis?

The following can be used as an alternative to treat endometriosis:

• Taking anti-inflammatory medications
• Taking the combined oral contraceptive pill
• Having hormone treatment

More information about these alternative treatments can be found here.

Which medications and therapies can be used as an alternative to treat uterine cancer?

Typically, chemotherapy and radiotherapy are used to treat uterine cancer, but this is usually combined with surgery. This surgery is typically a hysterectomy.

Conservative surgical options

Conservative surgery if you have endometriosis

If you have endometriosis, conservative surgery will cut out the endometriosis via keyhole surgery, or the endometriosis will be destroyed using either heat or a laser. This is an alternative option to a hysterectomy and keeps the womb (uterus) intact.

Conservative surgery if you have uterine fibroids

If you have uterine fibroids, an alternative treatment to a hysterectomy includes the following:⁹

• Uterine artery therapy with embolisation
• Laparoscopic myomectomy
• Fibroid myolysis

Emotional and psychological impact

After a hysterectomy, you may sadly experience some changes with your emotional state and well-being, including the following:¹⁰

• Anxiety
• Depression
• Insomnia
• Feeling irritable

Support and counselling

Seeking out counselling can help if you are having post-hysterectomy psychological problems and possible post-hysterectomy sexual problems. Talking to a counsellor has been shown to improve these issues if you experience them after a hysterectomy.¹¹

Summary

• A hysterectomy is a surgical procedure to remove the womb (uterus).
• A hysterectomy can be a total, partial, or radical hysterectomy.
• A hysterectomy may be performed if you have uterine fibroids, uterine cancer, and endometriosis, to name a few conditions.
• A hysterectomy has different approaches: vaginal hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy.
• There are potential complications after a hysterectomy, including bleeding, thrombosis, damage to the bladder and/or ureter.
• Emotional support is available via counselling after a hysterectomy.