Hysterectomy

A hysterectomy is an operation to remove your womb (uterus). It’s a treatment option for a number of different medical conditions affecting your reproductive system. After a hysterectomy, you’ll no longer have periods and you won’t be able to get pregnant.

About hysterectomy

Your hysterectomy will be carried out by a gynaecologist (a doctor who specialises in women’s reproductive health).

Your doctor may recommend a hysterectomy if you have one of the following conditions, especially if other treatments haven’t worked. These may include:

• painful, heavy or frequent periods
• fibroids – non-cancerous growths of muscle and fibrous tissue in your womb
• endometriosis – when the cells that usually line your womb also grow outside it
• adenomyosis – when cells that usually line your womb grow into the womb muscle instead
• prolapse of your womb – when your womb has dropped down from its normal position
• cancer of the womb, cervix or ovaries

Types of hysterectomy

There are three main ways to do a hysterectomy.

• Abdominal hysterectomy. Your doctor makes a cut in your abdomen (tummy) to reach your womb.
• Vaginal hysterectomy. The operation is carried out through your vagina, rather than your abdomen.
• Laparoscopic hysterectomy (‘keyhole surgery’). Several small cuts are made in your abdomen, for a camera and instruments to be passed inside. 

See our section on procedures for more information about these operations.

Most women have a total hysterectomy. This is when the womb and the cervix are removed. A subtotal hysterectomy is when only the womb is removed. During a hysterectomy, your doctor may also remove one or both of your fallopian tubes and ovaries.

The type of hysterectomy you have and how it’s done will depend on why you’re having it, your symptoms and your general health. Talk to your doctor about your options, and what would be best for you in your particular circumstances.

It’s important to note that if you have a hysterectomy which leaves your cervix in place, you should carry on having cervical screening (smear) tests. You won’t need to have smear tests if your cervix has been removed. 

Considerations for hysterectomy

A hysterectomy is a major operation and for many women is a big decision to have to make. For some women it’s a huge relief, whereas for others it’s hard to come to terms with the loss of their womb.

Here are some things to think about if you’re considering a hysterectomy.

• Like all operations, having a hysterectomy has certain side-effects and risks. For more information, see our sections on side-effects and complications. Weigh these up against the benefits of having the operation.
• If you have a hysterectomy, you won’t be able to have children in the future. This may be important to you.
• After having a hysterectomy, you won’t need to use contraception any longer. If your cervix was removed, you won’t need any more cervical screening (‘smear’) tests. But you’ll still be able to get sexually transmitted infections.
• If you have your ovaries taken out as well as your womb, you’ll start to go through the menopause immediately. You may experience symptoms and other effects of the menopause.
• For some women, a hysterectomy can cause the feeling of a loss of their femininity and a change in the way they see themselves. It’s important to consider how these emotions may make you feel.

Ask your doctor to explain the pros and cons of a hysterectomy in your particular circumstances.

Alternatives to hysterectomy

For conditions like fibroids and endometriosis, there are alternative treatments. For example, your doctor may suggest medicines or hormone treatments. If you have fibroids and you want to have children, you might be able to have a procedure called a myomectomy. This is when the fibroids are taken out and your womb is left intact. Hysterectomy is usually offered when other treatments have been tried, but haven’t worked. 

If you have cancer of your ovary or womb, then hysterectomy is likely to be offered as the first choice of treatment.

Whatever your situation, talk to your doctor about the treatment choices available to you.

Preparing for a hysterectomy

Before the operation

Your doctor will give you information about how to prepare for your operation. For example, if you smoke, they will ask you to stop. This is because smoking increases your risk of getting a chest and wound infection, which can slow your recovery. 

You’ll usually have an appointment for a pre-op check some time before the operation. This health check is to make sure that you’re well enough for the operation to go ahead as planned. It may include some blood tests.

Depending on what type of hysterectomy you have, and how the operation is done, you should prepare to be in hospital for between one and four days. Make sure you arrange for someone to be available to drive you home after your operation.

On the day

It's very important to follow any instructions you’re given about how to prepare for your procedure. These may include when to stop eating and drinking before your operation if you’re having a general anaesthetic. If you have any questions, just ask.

You should be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine as well as or instead of wearing compression stockings.

Your nurse or doctor will discuss with you what will happen, including any pain you might have. If you’re unsure about anything, ask. It’s important that you feel fully informed so you’re in a position to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.

Hysterectomy procedure

Before the operation starts, you’ll probably be given antibiotics via a drip or straight into your vein. This can help to prevent an infection after the operation.

The operation can be done under general anaesthesia or using a spinal or epidural anaesthetic. With general anaesthesia, you’ll be asleep throughout the operation. If you have a spinal anaesthetic or an epidural, you’ll be awake but you’ll feel no pain from the waist down.

Vaginal hysterectomy

Your doctor will use special instruments inside your vagina to carry out the operation. They make a cut in the top of your vagina and take out your cervix and womb through the cut. They close the cut in your vagina using stitches.

Your doctor may also use laparoscopic instruments through small cuts in your abdomen to help them during your operation. This is called a laparoscopic-assisted vaginal hysterectomy. 

Abdominal hysterectomy

Your doctor will make a cut across your lower abdomen (tummy). The cut is usually just below your bikini line and above your pubic hair. Sometimes the cut is made from your tummy button (navel) down to your bikini line instead. Your doctor then removes your womb and sometimes your cervix, ovaries and fallopian tubes, depending on the reasons for your operation. 

Your doctor may leave a thin tube called a drain inside your wound. It helps to drain away any blood or fluid that builds up. Your nurse will take this out while you’re still in hospital.

Laparoscopic hysterectomy

Laparoscopy is sometimes called ‘keyhole surgery’. Your doctor makes one or more small cuts in your lower abdomen. 

A tube is put into one of the cuts and through this your doctor will pass carbon dioxide (a gas). This gently inflates your abdomen, so that your doctor can see better. A tube with a camera is put in through one of the cuts and special surgical instruments used to remove your womb and cervix.

Aftercare for hysterectomy

You’ll need to rest until the effects of your anaesthetic have worn off. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. 

You’re likely to have some pain and discomfort in your lower abdomen for a few days after your operation. If you’ve had a laparoscopic hysterectomy you may have some pain in your shoulder too. Ask your nurse for painkillers if you need them.

You may have a catheter in for about 24 hours after your operation. This drains urine through a tube and into a bag. Once you’re able to get up and go to the toilet easily, your nurse will take it out. If you have problems peeing, it may stay in for a few days.

You’ll probably have some bleeding from your vagina for up to two weeks after your operation. Wear a sanitary pad, rather than using a tampon, until any bleeding stops.

You should be able to have a shower the day after your operation, but avoid having a bath for five days after your surgery. 

If you’ve had a vaginal hysterectomy, you won’t have any wounds on the outside of your body. Any stitches inside your vagina may come out on their own after a few days or weeks – this is normal.

If you’ve had an abdominal or laparoscopic hysterectomy, you may have stitches or staples which need to be removed.

Before you go home, your nurse will advise you about caring for your wounds and may arrange a date for a follow-up appointment. 

Recovering from a hysterectomy

Recovery after a hysterectomy is different for every woman. You should build up your activity slowly and gradually and it can take up to eight weeks before things are back to normal for you. Don’t lift anything heavy or do any strenuous housework (like vacuuming) for three to four weeks after having a hysterectomy.

You should be given some painkillers to take home with you. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your doctor may suggest that you do pelvic floor exercises as part of your recovery. Your pelvic floor muscles help to hold your abdominal organs in the right place and keep your bladder and bowel closed. You doctor or nurse will tell you what you need to do and how often.

For information about having sex after a hysterectomy, see our FAQ: When can I have sex after a hysterectomy?

Going back to work

If you’ve had a vaginal or laparoscopic hysterectomy, you should be able to go back to work between two and six weeks after your operation. If you’ve had an abdominal hysterectomy, this will probably take a little longer. When you go back to work will depend on your job and how well you feel.

Driving

If you’ve had a vaginal or laparoscopic hysterectomy, it can take two to four weeks before you feel comfortable enough, and are safe enough, to drive. If you’ve had an abdominal hysterectomy, this may take longer. You should check with your motor insurance provider in case they have specific conditions for driving after surgery.

When to seek medical help

Contact the hospital or your GP if you develop any of the following symptoms when you’re at home.

Side-effects of a hysterectomy

Side-effects are the unwanted, but mostly temporary effects you may get after having the operation.

Side-effects of a hysterectomy include:

• pain and discomfort in your lower tummy (for a few days)
• bleeding from your vagina (for one to two weeks) 
• feeling tired and emotional (many women find this takes a while to pass)

Complications of a hysterectomy

Complications are problems that can occur during or after the operation. Some of the possible complications after a hysterectomy are:

• heavy (excessive) bleeding
• a wound or urine infection
• damage to some of the blood vessels or organs in your abdomen – including your bowel, bladder and ureters (the tubes that carry urine from your kidneys to your bladder)
• developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT) or, rarely, in the lungs (pulmonary embolism)

For more information on when to seek help, see our section on recovery.