What is a hysterectomy?
A hysterectomy is a surgical procedure to remove a woman’s uterus (womb). The uterus is located in the pelvis and is where a baby grows during pregnancy.
It is important for women to ensure that they make their own individual decision about whether to have a hysterectomy. As the procedure involves the removal of the uterus it is important that women realise they will no longer menstruate or be able to become pregnant.
For many women making this decision may be a difficult and an emotional process. As such, it is critical for women to be well informed about the procedure so they can confidently discuss all available options with their gynaecologist.
Reasons for having a hysterectomy
There are various conditions that can be treated by hysterectomy. You may need a hysterectomy if you have:
- menorrhagia – heavy or prolonged menstrual periods
- dysmenorrhoea – painful periods
- fibroids – non-cancerous tumours of the uterus
- cancer of the uterus, cervical cancer or ovarian cancer
- pelvic inflammatory disease (PID) – bacterial infection of a woman’s reproductive organs, which if not detected early can cause scarring of the uterus and fallopian tubes
- uterine prolapse – uterus drops toward or into the vagina due to weakened and damaged pelvic floor muscles or loose ligaments
- endometriosis – cells of the uterine lining (endometrial tissue) grow in other parts of the body
- adenomyosis – a form of endometriosis where the endometrial tissue extends into the muscles of the uterus.
Types of hysterectomies
There are different types of hysterectomies including:
- sub-total or partial hysterectomy – the body of the uterus is removed leaving the cervix (neck) in place.
- total hysterectomy – the entire uterus including the cervix is removed, but the ovaries are left in place. In some cases the fallopian tubes and ovaries are also removed.
- hysterectomy with bilateral salpingectomy – hysterectomy with the additional removal of the fallopian tubes.
- hysterectomy with oophorectomy – hysterectomy with the additional removal of one or both ovaries.
- radical or Wertheim’s hysterectomy – the uterus, cervix, ovaries, fallopian tubes, upper part of the vagina (vaginal vault) and lymph nodes are removed. This type of hysterectomy may be performed when a woman has cancer of the cervix, ovaries or uterus.
How is a hysterectomy performed?
A hysterectomy is a major surgical procedure performed under general anaesthesia. There are different ways a gynaecologist might perform the operation. This will be determined by the reason for performing the hysterectomy and other factors, such as the size of the uterus and the experience of the gynaecologist.
- Abdominal hysterectomy – performed through an approximate 6 inch horizontal cut made across the bikini line (lower abdomen).
- Vaginal hysterectomy – performed through the vagina and will leave no visible external signs that the woman has had an operation.
- Laparoscopic hysterectomy – performed by making 3 or 4 small cuts in the abdomen to allow insertion of instruments and a laparoscope. A laparoscope is a thin lighted tube with a camera that allows the gynaecologist to see the pelvic organs.
- Laparoscopically assisted vaginal hysterectomy (LAVH) – gynaecologist uses keyhole surgery in combination with surgery through the vagina in order to complete the operation.
What to discuss with your gynaecologist
There are a number of questions you may like to ask your gynaecologist when discussing the option of having a hysterectomy.
- what type of hysterectomy is being recommended and why?
- which the method of surgery will be performed?
- what experience has the surgeon had with this procedure?
- what are the possible complications and side effects including possible impacts on sexual function?
- what is the length of recovery time in hospital and recovery period at home?
- will hormone replacement therapy (HRT) be recommended?
You may wish to bring a partner or friend to your appointment to provide support and also take notes so you have a clear record of what was discussed in your consultation.
You can also ask your gynaecologist for written information about the procedure.
Risks of a hysterectomy
Most women do not experience health problems after their hysterectomy; however some health risks can arise during or after surgery.
Surgery risks include:
- injury to neighbouring organs such as the bladder, urinary tract or bowel
- bleeding during the surgery that makes a transfusion necessary i.e. excessive loss of blood (haemorrhage)
- allergic reaction to the anaesthetic
- if undergoing a vaginal or laparoscopic hysterectomy, a need to change to abdominal incision during the surgery.
Post-operative risks include:
- difficulty urinating after surgery
- hematoma (collection of blood) at the surgical site
- blood clots
Expected outcomes after a hysterectomy:
- Menopause occurring post-operatively (if the ovaries are removed).
- Sterility after surgery – you will no longer be able to have a baby.
It is important to closely follow the instructions you are given to fully prepare your hysterectomy.
Tell your doctor before the procedure if you:
- are sensitive or allergic to any drug or substance
- are taking any medication such as aspirin or any herbal supplements
- are taking blood thinning tablets such as Warfarin
- have any health issues such as diabetes, heart valve disease or have a pacemaker.
On the day of the procedure
- Report to the hospital as outlined in your referral letters.
After a hysterectomy
Following surgery, as a side effect of the general anaesthetic you may feel nauseous, and experience some abdominal discomfort and/or pain. Medication to relieve nausea and pain is available. There may also be some vaginal bleeding which should reduce after a few days.
You will be encouraged to get up and walk around on the first day following surgery to avoid constipation and gas, and to also decrease the risk of blood clots and lung infections. You can expect to be eating and drinking during this time. Following a routine hysterectomy, most women will stay in hospital between 3 to 5 days.
You will be advised to plan 4 to 6 weeks of recovery following your hysterectomy, although recovery times vary from one woman to the next and depend on the type of procedure performed. The recovery time is often shorter if a vaginal hysterectomy or LAVH has been performed, compared to an abdominal hysterectomy. The recovery time is longest following a radical hysterectomy.
Women will have different emotional responses after a hysterectomy due to the reason for their operation. For example:
- occasionally, women may feel relief that the monthly pain and inconvenience of periods are now gone and they can move forward with their life in a more positive manner
- women who have been diagnosed with cancer are frequently, and very understandably, anxious about whether the surgery will have been successful and may be concerned about the necessity of other forms of treatment aimed at preventing a recurrence.
Can you have sex after a hysterectomy?
Penetrative sex is not recommended until the top of the vagina has safely healed which is generally about 6 to 8 weeks after a hysterectomy.
During this time women and their partners may wish to focus on other activities such as the touching of outer genitals, hugs, kisses and massage.
Women that are experiencing problems with their sex life following a hysterectomy may find it helpful to speak to their gynaecologist, a psychologist, counsellor or sex therapist.
When will you get the results?
The amount of time it takes for you to get your results will differ depending on where you have the procedure done and the laboratory processing time. The specialist will write a report, which may include pictures. The pictures may be on films or on a CD.
Your doctor will need to discuss the report and results with you at your post-operative follow-up appointment, which is usually 4 to 6 weeks after the procedure.
Will you need to have cervical screening tests after a hysterectomy?
Women who did not have their cervix removed during their hysterectomy will need to continue having regular cervical screening tests (Pap smears).
Other women who have had a hysterectomy but still need to have regular vaginal vault smears include those who:
- have a history of a high-grade cervical abnormality
- had abnormal cells found at the time of surgery
- have been treated for invasive gynaecological cancer
- take medication which suppresses the immune system
- were exposed to the drug Diethylstilboestrol (DES)
- do not know the exact reason for their hysterectomy.
Women should consult their gynaecologist about their individual need for cervical screening tests or vaginal smears after they have had a hysterectomy.
Will you need to start hormone replacement therapy after a hysterectomy?
If a woman has not gone through menopause and her ovaries were removed during the hysterectomy, then hormone replacement therapy (HRT) may be recommended.
If the ovaries have not been removed, then they will continue to produce the female hormone oestrogen and hormone replacement therapy is not necessary.
Where to get help
- See your doctor
- Visit a GP after hours
- Ring healthdirect on 1800 022 222
- A hysterectomy is a surgical procedure to remove a woman’s uterus (womb).
- Hysterectomy is one of the most common types of elective surgeries for Australian women – 1 in 5 women will undergo a hysterectomy during their lifetime.
- Reasons for having a hysterectomy can include cervical cancer, ovarian cancer, heavy or painful menstrual periods, endometriosis and pelvic inflammatory disease.
Western Australia Cervical Cancer Prevention Program
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.