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Hysterectomy

A hysterectomy is an operation to remove the uterus or womb. It is only carried out as a last resort after all other treatments have failed. It is a serious, but common, operation which can affect you in several ways, both mentally and physically.

What is my uterus and where is it?

Your uterus, which is about the size of a pear, forms part of your female reproductive system. It is found inside your pelvis, protected by the pelvic bones. The reproductive system consists of your uterus (also known as your womb), ovaries, fallopian tubes and vagina.

What problems can I have with my uterus?

There are a number of problems that may result in your uterus being removed (hysterectomy): cancer, a prolapsed womb (fallen uterus), fibroids, chronic heavy periods and Endometriosis.

Cancer

If you develop cancer of any part of the reproductive system and radiation or chemotherapy subsequently fail, then a hysterectomy is recommended.

Prolapsed womb

After the menopause, the body decreases its hormone production of oestrogen. Oestrogen is a hormone that helps to keep muscles elastic and its reduction means that muscles (all over the body) can begin to sag. Your pelvic floor is one group of muscles that, when affected by reduced oestrogen, can sag enough to affect the organs it normally supports.

This may result in your uterus dropping so much that you may be able to feel a lump in your vagina. There may be problems with bowel movements and urinating because of it. If the vaginal walls are too thin to be fixed then a hysterectomy may have to be the answer.

Fibroids

These are abnormal but benign growths, sometimes big enough to press on the bladder, causing urinary problems. They are also responsible for causing heavy and painful periods and are often the reason for a hysterectomy.

Heavy Periods

They can make life difficult, inconvenient and sometimes painful. Chronic bleeding can lead to constant tiredness because of anaemia. A hysterectomy is recommended when other treatments have been tried and failed.

Endometriosis

This is where cell tissues, normally found on the inside of the uterus, begin to grow on its outer wall. They can grow on the fallopian tubes, on the ovaries and on other organs that may attach themselves to the uterus with the help of these cells. This condition can be extremely painful.

What does the surgery involve?

You may be recommended to have a total removal involving your uterus and cervix. A partial removal may be more suitable for your individual condition and this is where only the upper half of your uterus is removed. A radical hysterectomy is where the uterus, cervix and upper part of the vagina are removed, mainly due to malignant cancer.

Abdominal hysterectomy

Your uterus may be removed via your abdomen. Recovery is longer when incisions have to be made in your abdomen.

• Your hysterectomy can also be carried out using keyhole surgery instruments called Laparoscopes. They are equipped with lights, even cameras and tiny cutting instruments. The surgeon may use this instrument to make incisions and remove your womb this way. This procedure is known as a Laparoscopically Assisted Vaginal Hysterectomy.

• When your surgeon removes part of your womb via your abdominal incisions and the remainder of it via your vagina, this is called a Total Laparoscopic Hysterectomy.

In both cases, because of the abdominal incisions, your recovery is likely to take longer. However, not as long as if you had a complete abdominal hysterectomy.

Vaginal hysterectomy

If your uterus has prolapsed, it is likely to be removed via your vagina. Your recovery will be quicker if the operation is carried out through your vaginal canal.

The surgeon will discuss with you the most appropriate procedure.  If you have your womb extracted via your vagina, it will take less time, your recovery will be quicker and there will be less pain and blood. You’re likely to feel better mentally, too.

If your ovaries are recommended for removal you may be prescribed a course of HRT (Hormone Replacement Therapy).

Will there be complications?

More seriously, although less likely, you may encounter infection, heavy bleeding after surgery, lung or leg blood clotting or intestinal blockages from scar tissue. During the operation accidental damage to your bladder and bowels may have occurred. 

With keyhole surgery there is the possibility of damage to your bladder being sustained or the occurrence of heavy bleeding.

How long does the surgery take?

Surgery will take approximately 1 hour. Laparoscopic hysterectomies can take longer.

What will happen in the recovery period?

You take some time to recover. You may suffer from depression and/or fever after the operation, and also encounter a mild bladder infection.

You will experience some abdominal pain accompanied by some bleeding from the vagina. Bowel movements may be slow or forthcoming in which laxatives may be employed. Urination may prove difficult without a catheter.

What is the recovery time?

You may stay in hospital for any time up to 4 days for post-operative recovery.

If you have had an abdominal hysterectomy, it may take anywhere from 1 to 2 months to recover. A vaginal or laparoscopic hysterectomy means a faster recovery period of about 1 to 2 weeks. 

Assuming no major complications have occurred, it should take approximately 6 weeks but will vary from person to person. Sexual intercourse and normal activities can also resume after this period.

What can I expect from the surgery?

You can expect the reverse of whatever the problem was. For example, if heavy bleeding due to fibroids was the problem, this will no longer be the case.

Having a hysterectomy where either one or both ovaries have to be removed can result in decreased libido or a loss of, or little, interest in sex. Depression may also occur.