A hysterectomy is a surgical procedure to remove the womb (uterus). You'll no longer be able to get pregnant after the operation.
If you haven't already gone through the menopause, you'll no longer have periods, regardless of your age. The menopause is when a woman's monthly periods stop, which usually occurs from the ages of to 45 to 55.
Around 30,500 hysterectomies were carried out in England in 2012 and 2013. It's more common for women aged 40-50 to have a hysterectomy.
Why do I need a hysterectomy?
Hysterectomies are carried out to treat conditions that affect the female reproductive system, including:
- heavy periods
- long-term pelvic pain
- non-cancerous tumours (fibroids)
- ovarian cancer, uterine cancer, cervical cancer or cancer of the fallopian tubes
A hysterectomy is a major operation with a long recovery time and is only considered after alternative, less invasive, treatments have been tried.
Read more about why a hysterectomy is needed.
Things to consider
If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to also have your cervix or ovaries removed.
Your decision will usually be based on your personal feelings, medical history and any recommendations your doctor may have.
You should research the different types of hysterectomy and their implications.
Read about the things to consider before having a hysterectomy.
Types of hysterectomy
There are various types of hysterectomy. The type you have depends on why you need the operation and how much of your womb and surrounding reproductive system can safely be left in place.
The main types of hysterectomy are:
- total hysterectomy - the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
- subtotal hysterectomy - the main body of the womb is removed, leaving the cervix in place
- total hysterectomy with bilateral salpingo-oophorectomy - the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed
- radical hysterectomy - the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue
There are three ways to carry out a hysterectomy:
- vaginal hysterectomy - where the womb is removed through a cut in the top of the vagina
- abdominal hysterectomy - where the womb is removed through a cut in the lower abdomen
- laparoscopic hysterectomy (keyhole surgery) - where the womb is removed through several small cuts in the abdomen
Read more about how a hysterectomy is performed.
Complications of a hysterectomy
There's a small risk of complications, including:
- heavy bleeding
- damage to your bladder or bowel
- serious reaction to the general anaesthetic
Read more about the complications of a hysterectomy.
Recovering from a hysterectomy
A hysterectomy is a major operation. You can be in hospital for up to five days after surgery, and it takes about six to eight weeks to fully recover. Recovery times can also vary, depending on the type of hysterectomy.
Rest as much as possible during this time and don't lift anything heavy, such as bags of shopping. You need time for your abdominal muscles and tissues to heal.
Read more about recovering from a hysterectomy.
If your ovaries are removed during a hysterectomy, you'll go through the menopause immediately after the operation, regardless of your age. This is known as a surgical menopause.
If one or both of your ovaries are left intact, there's a chance you'll experience the menopause within five years of having your operation.
If you experience a surgical menopause after having a hysterectomy, you should be offered hormone replacement therapy (HRT).
Read more about surgical menopause.
Why a hysterectomy is necessary
Why a hysterectomy is necessary
A hysterectomy is a major operation for a woman that's only recommended if other treatment options have been unsuccessful.
The most common reasons for having a hysterectomy include:
- heavy periods - which can be caused by fibroids, for example
- pelvic pain - which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids
- prolapse of the uterus
- cancer of the womb, ovaries or cervix
Many women lose a large amount of blood during their monthly periods. They may also experience other symptoms, such as pain and stomach cramps.
For some women, the symptoms can have a significant impact on their quality of life. Sometimes heavy periods can be caused by fibroids, but in many cases there's no obvious cause.
In some cases, removing the womb may be the only way of stopping persistent heavy menstrual bleeding when:
- other treatments haven't worked
- the bleeding has a significant impact on quality of life and it's preferable for periods to stop
- the woman no longer wishes to have children
Read more about heavy periods.
Pelvic inflammatory disease (PID)
PID is a bacterial infection of the female reproductive system.
If detected early, the infection can be treated with antibiotics. However, if it spreads, it can damage the womb and fallopian tubes, resulting in long-term pain.
A hysterectomy to remove the womb and fallopian tubes may be recommended if a woman has severe pain from PID and no longer wants children.
Endometriosis is a condition where cells that line the womb are also found in other areas of the body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum.
If the cells that make up the lining of the womb become trapped in other areas of the body, it can cause the surrounding tissue to become inflamed and damaged. This can lead to pain, heavy and irregular periods, and infertility.
A hysterectomy may remove the areas of endometrial tissue causing the pain. However, it will usually only be considered if other less invasive treatments haven't worked and the woman decides not to have any more children.
Read more about endometriosis.
Fibroids are non-cancerous tumours that grow in or around the womb (uterus). The growths are made up of muscle and fibrous tissue, and vary in size.
The symptoms of fibroids can include:
- heavy or painful periods
- pelvic pain
- frequent urination or constipation
- pain or discomfort during sex
A hysterectomy may be recommended if you have large fibroids or severe bleeding and you don't want to have any more children.
Read more about fibroids.
Adenomyosis is a common condition where the tissue that normally lines the womb starts to grow within the muscular wall of the womb. This extra tissue can make your periods particularly painful and cause pelvic pain.
A hysterectomy can cure adenomyosis, but will only be considered if all other treatments have failed and you don't want to have any more children.
Prolapse of the uterus
A prolapsed uterus happens when the tissues and ligaments that support the womb become weak, causing it to drop down from its normal position.
Symptoms can include:
- back pain
- a feeling that something is coming down out of your vagina
- leaking urine (urinary incontinence)
- difficulty having sex
A prolapsed uterus can often occur as a result of childbirth.
A hysterectomy resolves the symptoms of a prolapse because it removes the entire womb. It may be recommended if the tissues and ligaments that support the womb are severely weakened and the woman doesn't want any more children.
Read more about prolapse of the uterus.
A hysterectomy may be recommended for the following cancers:
If the cancer has spread and reached an advanced stage, a hysterectomy may be the only possible treatment option.
Things to consider before having a hysterectomy
Things to consider before having a hysterectomy
If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to have your cervix or ovaries removed.
These decisions are usually made based on:
- your medical history
- your doctor's recommendations
- your personal feelings
It's important that you're aware of the different types of hysterectomy and their implications.
Removal of the cervix (total or radical hysterectomy)
Even if you don't have cancer, removing the cervix means there's no risk of developing cervical cancer in the future.
Many women are concerned that removing the cervix will lead to a loss in sexual function, but there's no evidence to support this.
Some women are reluctant to have their cervix removed because they want to retain as much of their reproductive system as possible. If you feel this way, ask your surgeon whether there are any risks associated with keeping your cervix.
If you have your cervix removed, you'll no longer need to have cervical screening tests. If you don't have your cervix removed, you'll need to continue having regular screening for cervical cancer (cervical smears).
Removal of the ovaries (salpingo-oophorectomy)
The National Institute for Health and Care Excellence (NICE) recommends that a woman's ovaries should only be removed if there's a significant risk of associated disease, such as ovarian cancer.
If you have a family history of ovarian or breast cancer, removing your ovaries (an oophorectomy) may be recommended to prevent cancer occurring in the future.
Your surgeon can discuss the pros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed.
If you've already gone through the menopause or you're close to it, removing your ovaries may be recommended regardless of the reason for having a hysterectomy. This is to protect against the possibility of ovarian cancer developing.
Some surgeons feel it's best to leave healthy ovaries in place if the risk of ovarian cancer is small - for example, if there's no family history of the condition.
This is because the ovaries produce several female hormones that can help protect against conditions such as osteoporosis (weak and brittle bones). They also play a part in feelings of sexual desire and pleasure.
If you would prefer to keep your ovaries, make sure you've made this clear to your surgeon before your operation. You may still be asked to give consent to treatment in regards to having your ovaries removed if an abnormality is found during the operation.
Think carefully about this and discuss any fears or concerns that you have with your surgeon.
If you have a total or radical hysterectomy that removes your ovaries, you'll experience the menopause immediately after your operation, regardless of your age. This is known as a surgical menopause.
If a hysterectomy leaves one or both of your ovaries intact, there's a chance that you'll experience the menopause within five years of having the operation.
Although your hormone levels decrease after the menopause, your ovaries continue producing testosterone for up to 20 years. Testosterone is a hormone that plays an important part in stimulating sexual desire and sexual pleasure.
Your ovaries also continue to produce small amounts of the hormone oestrogen after the menopause. It's a lack of oestrogen that causes menopausal symptoms such as:
Hormone replacement therapy (HRT) is usually used to help with menopausal symptoms that occur after a hysterectomy.
Hormone replacement therapy (HRT)
You may be offered HRT after having your ovaries removed. This replaces some of the hormones your ovaries used to produce and relieves any menopausal symptoms you may have.
It's unlikely that the HRT you're offered will exactly match the hormones your ovaries previously produced.
The amount of hormones a woman produces can vary greatly, and you may need to try different doses and brands of HRT before you find one that feels suitable.
Not everyone is suitable for HRT. For example, it's not recommended for women who have had a hormone-dependent type of breast cancer or liver disease. It's important to let your surgeon know about any such conditions that you've had.
If you're able to have HRT and both of your ovaries have been removed, it's important to continue with the treatment until you reach the normal age for the menopause (51 is the average age).
How a hysterectomy is performed
How a hysterectomy is performed
There are different types of hysterectomy. The operation you have will depend on the reason for surgery and how much of your womb and reproductive system can safely be left in place.
The main types of hysterectomy are described below.
During a total hysterectomy, your womb and cervix (neck of the womb) is removed.
A total hysterectomy is usually the preferred option over a subtotal hysterectomy, because removing the cervix means there's no risk of you developing cervical cancer at a later date.
A subtotal hysterectomy involves removing the main body of the womb and leaving the cervix in place.
This procedure isn't performed very often. If the cervix is left in place, there's still a risk of cervical cancer developing and regular cervical screening will still be needed.
Some women want to keep as much of their reproductive system as possible, including their cervix. If you feel this way, talk to your surgeon about any risks associated with keeping your cervix.
Total hysterectomy with bilateral salpingo-oophorectomy
A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also involves removing:
- the fallopian tubes (salpingectomy)
- the ovaries (oophorectomy)
The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there's a significant risk of further problems - for example, if there's a family history of ovarian cancer.
Your surgeon can discuss the pros and cons of removing your ovaries with you.
During the procedure, the body of your womb and cervix is removed, along with:
- your fallopian tubes
- part of your vagina
- lymph glands
- fatty tissue
Performing a hysterectomy
There are three ways a hysterectomy can be performed. These are:
- vaginal hysterectomy
- abdominal hysterectomy
- laparoscopic hysterectomy
During a vaginal hysterectomy, the womb and cervix are removed through an incision that's made in the top of the vagina.
Special surgical instruments are inserted into the vagina to detach the womb from the ligaments that hold it in place.
After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.
A vaginal hysterectomy can either be carried out using:
- general anaesthetic - where you'll be unconscious during the procedure
- local anaesthetic - where you'll be awake, but won't feel any pain
- spinal anaesthetic - where you'll be numb from the waist down
A vaginal hysterectomy is usually preferred over an abdominal hysterectomy, because it's less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.
During an abdominal hysterectomy, an incision will be made in your abdomen (tummy). It will either be made horizontally along your bikini line, or vertically from your belly button to your bikini line.
A vertical incision will usually be used if there are large fibroids (non-cancerous growths) in your womb, or for some types of cancer.
After your womb has been removed, the incision is stitched up. The operation takes about an hour to perform and a general anaesthetic is used.
An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it's not possible to remove it through your vagina.
It may also be recommended if your ovaries need to be removed.
Laparoscopic surgery is also known as keyhole surgery. Nowadays, a laparoscopic hysterectomy is the preferred treatment method for removing the organs and surrounding tissues of the reproductive system.
During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small incision in your abdomen.
This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.
Laparoscopic hysterectomies are usually carried out under general anaesthetic.
Recovering from a hysterectomy
Recovering from a hysterectomy
After having a hysterectomy, you may wake up feeling tired and in some pain. This is normal after this type of surgery.
You'll be given painkillers to help reduce any pain and discomfort. If you feel sick after the anaesthetic, your nurse can give you medicine to help relieve this.
You may have:
- dressings placed over your wounds
- a drip in your arm
- a catheter - a small tube that drains urine from your bladder into a collection bag
- a drainage tube in your abdomen (if you've had an abdominal hysterectomy) to take away any blood from beneath your wound - these tubes usually stay in place for one to two days
- a gauze pack inserted into your vagina (if you've had a vaginal hysterectomy) to minimise the risk of bleeding - this usually stays in place for 24 hours
You may also be slightly uncomfortable and feel like you need to empty your bowels (do a poo).
The day after your operation, you'll be encouraged to take a short walk. This helps your blood to flow normally, reducing the risk of complications developing, such as blood clots in your legs (deep vein thrombosis).
After the catheter has been removed, you should be able to pass urine normally. Any stitches that need to be removed will be taken out five to seven days after your operation.
Your recovery time
The length of time it will take before you're well enough to leave hospital depends on your age and your general level of health.
If you've had a vaginal or laparoscopic hysterectomy, you may be able to leave between one and four days later. If you've had an abdominal hysterectomy, it will usually be up to five days before you're discharged.
You may be asked to see your GP in four to six weeks, but follow-up appointments with the hospital aren't usually needed unless there are complications.
It takes about six to eight weeks to fully recover after having an abdominal hysterectomy. Recovery times are often shorter after a vaginal or laparoscopy hysterectomy.
During this time, you should rest as much as possible and not lift anything heavy, such as bags of shopping. Your abdominal muscles and the surrounding tissues need time to heal.
If you live by yourself, you may be able to get help from your local NHS authority while you're recovering from your operation. Hospital staff should be able to advise you further about this.
After having a hysterectomy, you may experience some temporary side effects, as outlined below.
Bowel and bladder disturbances
After your operation, there may be some changes in your bowel and bladder functions when going to the toilet.
Some women develop urinary tract infections or constipation. Both can easily be treated. It's recommended that you drink plenty of fluids and increase the fruit and fibre in your diet to help with your bowel and bladder movements.
For the first few bowel movements after a hysterectomy, you may need laxatives to help you avoid straining. Some people find it more comfortable to hold their abdomen to provide support while passing a stool.
After a hysterectomy, you'll experience some vaginal bleeding and discharge. This will be less discharge than during a period, but it may last up to six weeks.
Visit your GP if you experience heavy vaginal bleeding, start passing blood clots, or have a strong-smelling discharge.
If your ovaries are removed, you'll usually experience severe menopausal symptoms after your operation. These may include:
- hot flushes
You may have hormone replacement therapy (HRT) after your operation. This can be given in the form of an implant, injections or tablets. It usually takes around a week before having an effect.
You may feel a sense of loss and sadness after having a hysterectomy. These feelings are particularly common in women with advanced cancer, who have no other treatment option.
Some women who haven't yet experienced the menopause may feel a sense of loss because they're no longer able to have children. Others may feel less "womanly" than before.
In some cases, having a hysterectomy can be a trigger for depression. See your GP if you have feelings of depression that won't go away, as they can advise you about the available treatment options.
Talking to other women who have had a hysterectomy may help by providing emotional support and reassurance. Your GP or the hospital staff may be able to recommend a local support group.
The Hysterectomy Association also provides hysterectomy support services, including a one-to-one telephone support line, counselling, and "preparing for hysterectomy" workshops.
Getting back to normal
Returning to work
How long it will take for you to return to work depends on how you feel and what sort of work you do.
If your job doesn't involve manual work or heavy lifting, it may be possible to return after four to eight weeks.
Don't drive until you're comfortable wearing a seatbelt and can safely perform an emergency stop.
This can be anything from three to eight weeks after your operation. You may want to check with your GP that you are fit to drive before you start.
Some car insurance companies require a certificate from a GP stating that you're fit to drive. Check this with your car insurance company.
Exercise and lifting
After a hysterectomy, the hospital where you were treated should give you information and advice about suitable forms of exercise while you recover.
Don't lift any heavy objects during your recovery period. If you have to lift light objects, make sure your knees are bent and your back is straight.
After a hysterectomy, it's generally recommended that you don't have sex until your scars have healed and any vaginal discharge has stopped, which usually takes at least four to six weeks. As long as you're comfortable and relaxed, it's safe to have sex.
You may experience some vaginal dryness, particularly if you've had your ovaries removed and you're not taking HRT.
Many women also experience an initial loss of sexual desire (libido) after the operation, but this usually returns once they've fully recovered.
At this point, studies show that pain during sex is reduced and that strength of orgasm, libido and sexual activity all improve after a hysterectomy.
Complications of a hysterectomy
Complications of a hysterectomy
As with all types of surgery, a hysterectomy can sometimes lead to complications.
Some of the possible complications are described below.
It's very rare for serious complications to occur after having a general anaesthetic (1 in 10,000 anaesthetics given).
Serious complications can include nerve damage, allergic reaction and death. However, death is very rare - there's 1 in 100,000 to 1 in 200,000 chance of dying after having a general anaesthetic.
Being fit and healthy before you have an operation reduces your risk of developing complications.
As with all major operations, there's a small risk of heavy bleeding (haemorrhage) after having a hysterectomy.
If you have a haemorrhage, you may need a blood transfusion.
The ureter (the tube that urine is passed through) may be damaged during surgery, which happens in around 1% of cases. This is usually repaired during the hysterectomy.
Bladder or bowel damage
In rare cases, damage to abdominal organs such as the bladder or bowel can occur. This can cause problems such as:
- a frequent need to urinate
It may be possible to repair any damage during the hysterectomy. You may need a temporary catheter to drain your urine or a colostomy to collect your bowel movements.
A thrombosis is a blood clot that forms in a vein and interferes with blood circulation and the flow of oxygen around the body. The risk of developing blood clots increases after having operations and periods of immobility.
You'll be encouraged to start moving around as soon as possible after your operation. You may also be given an injection of a blood-thinning medication (anticoagulant) to reduce the risk of clots.
If you have a vaginal hysterectomy, there's a risk of problems at the top of your vagina where the cervix was removed. This could range from slow wound healing after the operation to prolapse in later years.
Even if one or both of your ovaries are left intact, they could fail within five years of having your hysterectomy. This is because your ovaries receive some of their blood supply through the womb, which is removed during the operation.
If you've had your ovaries removed, you'll usually have menopausal symptoms soon after the operation, such as:
- hot flushes
- vaginal dryness
- disturbed sleep
This is because the menopause is triggered once you stop producing eggs from your ovaries (ovulating).
This is an important consideration if you're under the age of 40, because early onset of the menopause can increase your risk of developing brittle bones (osteoporosis). This is because oestrogen levels decrease during the menopause.
Depending on your age and circumstances, you may need to take additional medication to prevent osteoporosis.
'There are pros and cons to everything'
'There are pros and cons to everything'
Susan Carlton, from Lincoln, Lincolnshire, had an abdominal hysterectomy in 2002 at the age of 33. She lives with her husband Richard and three children.
"Ever since my periods started, when I was around 14, I have had problems. They were very heavy and very painful right from the beginning. Over the years, my GP has referred me for several investigations to check inside my abdominal cavity and also inside my womb. Nothing was ever found to be physically wrong with me.
"In the meantime, my quality of life was severely affected. Each month, the bleeding was so heavy that I had to use two maternity pads at a time to soak up the flow. The pain was very bad - some days I was literally on my hands and knees, as that was the position I felt most comfortable in. I sometimes even slept in that position, which of course wasn't ideal for the comfort of my husband Richard, who was sharing my bed.
"After I'd had my children and was sure I didn't want any more, I decided to have a treatment called uterine ablation, where the lining of my womb was permanently taken away. It was successful in that it stopped my periods, but unfortunately I still had the same horrendous pain each month around the time I would have had my period. My doctor couldn't explain it, but thought that I might have a kind of endometriosis that grows in the muscle of the womb.
"My life continued to be badly affected. I had to cancel family gatherings and was miserable and in pain for almost two weeks every month. Still searching for a solution, I tried all sorts of painkillers, both prescription and over the counter, but nothing really worked.
"When I was 33, I finally came to the conclusion that the best solution was to have a hysterectomy. I didn't like the thought of having to wait almost 20 years for my menopause to arrive, so that I would be naturally free of the pain. I did a lot of reading about the procedure and was confident it was what I wanted. My surgeon decided that an abdominal hysterectomy under general anaesthetic was best for me.
"Unfortunately, during the operation, he found that I had numerous cysts on my ovaries, some of them quite large. As I had given my consent for him to remove my ovaries if he found a problem, he took my ovaries out.
"It was a shock when I woke up to hear my ovaries had been removed, but first I concentrated on my recovery. It took a few days before I was comfortable getting out of bed to go to the toilet, as I was very tender internally and around the scar. I was given painkillers and the nurses were very kind.
"Then, three days after the operation, although I had been put on HRT straight after the hysterectomy, I had full-blown menopausal symptoms. But thankfully around a week later, the HRT kicked in and I felt better.
"Five days after the operation, I was well enough to go home. To start with, I was only able to walk a little bit around the house every day and relied on my family to do most things for me. But gradually I got my strength back. Although I was told I would be almost back to normal within six weeks, for me it took around four months. This might be because I'm overweight.
"I don't regret having my hysterectomy, as it has improved my quality of life enormously. It's really wonderful that I'm no longer in pain.
"Sadly, my sex drive has taken a dive since the operation, and I have since learned that this may be down to the loss of the hormone testosterone, which my ovaries were producing. I am currently on oestrogen-only HRT, but will ask my doctor about having testosterone added to see if it improves my sex life. I also notice that I don't have as much energy as before the operation, which again may be due to a lack of testosterone.
"What I've discovered is that there are pros and cons to everything. Without the hysterectomy, I was in pain for around half of every month, but since the hysterectomy, I have less energy. I wish I'd had more information about the effects of having my ovaries removed before going ahead, but overall I'm satisfied and happy with the result."