Hysterectomy is the surgical removal of the womb (uterus), with or without the removal of the ovaries. This procedure is used to treat a variety of conditions, including heavy or painful periods, fibroids and endometriosis. Hysterectomy should be a last resort when all other treatments have failed.
Hysterectomy is the surgical removal of the womb (uterus), with or without the removal of the ovaries.
The uterus is a muscular organ of the female body, shaped like an upside-down pear. The lining of the uterus, the endometrium, thickens during ovulation in preparation for receiving a fertilised ovum (egg). If the ovum is unfertilised, the lining comes away as bleeding. This is known as menstruation. If the ovum is fertilised, the developing baby is nurtured inside the uterus throughout the nine months of pregnancy.
Once a woman has had a hysterectomy, she will no longer have menstrual periods and cannot bear a child. She no longer needs to use contraception.
Hysterectomy is used to treat a number of conditions, such as excessive menstrual bleeding. Every year in Australia, around 30,000 women have a hysterectomy. Some people are concerned that more hysterectomies are performed than are necessary.
Reasons for hysterectomy
The conditions that may be treated by hysterectomy include:
- Fibroids – non-malignant (non-cancerous) growths inside the muscular walls of the uterus
- Heavy or irregular menstrual periods
- Severe period pain (dysmenorrhoea)
- Cancer of the cervix, uterus or ovaries
- Endometriosis – a condition in which cells move from the lining of the uterus to other areas of the body
- Adenomyosis (a form of endometriosis)
- Prolapse – the uterus falls into the vagina because of loose ligaments or damage to the pelvic floor muscles
- Pelvic inflammatory disease (PID), caused by bacterial infection.
Hysterectomy for women of childbearing age
Once a woman has had a hysterectomy of any kind, she cannot become pregnant. If the ovaries of a premenopausal woman are removed, she will also stop ovulating. This means she will have a drop in production of the sex hormones oestrogen and progesterone. This can cause vaginal dryness, hot flushes, sweating and other symptoms of natural menopause.
Women who undergo bilateral oophorectomy, (removal of both ovaries), usually take hormone replacement therapy (HRT) – also known as hormone therapy (HT) – to maintain their hormone levels.
Other roles of the uterus and ovaries
Once a woman’s childbearing years are finished, hysterectomy may seem a logical treatment choice. This is because pregnancy is often considered to be the only function of the uterus, which may explain Australia’s high hysterectomy rate.
However, the uterus has a number of other important functions, including:
- Sexuality – the uterus rhythmically contracts during orgasm, contributing to sensations of pleasure
- Hormone production by the uterus – some researchers believe the uterus contributes to the maintenance of the female hormonal system
- Hormone production by the ovaries – the ovaries definitely play a major role in maintaining the female hormonal system. Their removal results in instant menopausal symptoms and therefore, unless diseased, a woman’s ovaries should not be removed during hysterectomy
- Self-image – the uterus is of great psychological importance to many women, whether or not the woman is menstruating or able to bear a child.
Treatments other than hysterectomy
Except if a woman has cancer, doctors recommend that hysterectomy should be a procedure of last resort, when all other treatment options have failed.
Other treatments for the conditions that may prompt a hysterectomy include:
- Fibroids – options include surgery to remove them (myomectomy), medications to temporarily block the action of sex hormones and shrink the growths, freezing, cauterisation, laser removal (myolysis) or resection (cutting out) if they are located inside the uterine cavity (submucosal)
- Heavy bleeding – options include taking the contraceptive pill to regulate your periods, other hormonal drug therapies, surgical removal of the endometrium (the mucous membrane lining the uterus), or the insertion of an intrauterine device (IUD) that releases small amounts of synthetic progesterone into the uterus to thin the endometrium
- Uterine prolapse – options include pelvic floor exercises, the insertion of a pessary into the vagina to prop up the uterus, or surgical repair
- Endometriosis – options include hormonal drugs, surgical removal of areas of endometriosis, or the insertion of an IUD that releases small amounts of synthetic progesterone into the uterus.
Types of hysterectomy
The five types of hysterectomy are:
- Total hysterectomy – the entire uterus and cervix are removed, but the ovaries are left in place
- Subtotal (partial) hysterectomy – the uterus is removed, but the cervix may be left in place. While removal of the cervix is generally advised because it is a potential cancer site, some women feel that it serves a purpose during penetrative sex. If the cervix is kept, regular pap tests are necessary
- Hysterectomy and bilateral salpingo-oophorectomy – the uterus, fallopian tubes and ovaries are removed. This operation is performed if the woman has cancer of the ovaries or the uterus, or for severe infection or endometriosis
- Radical hysterectomy – the most extensive version of the operation. It involves the removal of the uterus, fallopian tubes, ovaries, upper part of the vagina, and associated pelvic ligaments and lymph nodes. This may be performed if the woman has cancer of the cervix, ovaries or uterus
- Hysterectomy with prophylactic bilateral salpingectomy – some doctors recommend removing the fallopian tubes at the time of hysterectomy due to research suggesting that early ‘ovarian’ cancers are found in the tubes.
Before choosing a hysterectomy
If, after talking about all the options with your doctor, you choose to have a hysterectomy, your doctor should discuss several things with you before the operation. These include:
- Your medical history – as some pre-existing conditions may influence decisions on surgery and anaesthetics
- The pros and cons of abdominal (open or laparoscopic) surgery versus vaginal surgery
- Your support options after surgery
- Your feelings about the surgery.
You will have a range of tests before your hysterectomy, including a complete blood-count test to check for problems such as anaemia (deficiency in red blood cells, haemoglobin, or in total blood volume).
The operation may be performed via an incision (cut) in your lower abdomen (abdominal hysterectomy), three to four small incisions in your abdomen (laparoscopic hysterectomy), or through your vagina (vaginal hysterectomy).
For an abdominal hysterectomy, the surgeon usually makes a horizontal cut along your pubic hairline (your pubic hair will have been shaved around the incision). For most women, this leaves a small scar. Some women may need a vertical incision in the lower abdomen.
In a laparoscopic hysterectomy, the surgeon inserts a keyhole telescope (laparoscope) to see your pelvic organs through a small incision in your navel, and makes another three or four small incisions through which other instruments are used. They use carbon dioxide gas to distend (inflate) your abdomen, like a balloon, so that they can see all of your organs clearly.
The surgeon then removes a woman’s uterus, with or without fallopian tubes and ovaries, through the vagina. If the top of her vagina is sutured (stitched) through keyhole incisions, the operation is called a total laparoscopic hysterectomy.
A vaginal hysterectomy is performed through an incision at the top of the vagina. Many women prefer a vaginal hysterectomy, as you do not need a long abdominal cut. However, an abdominal hysterectomy is generally recommended when a woman has large fibroids, or cancer.
If the gynaecologist stitches the top of the vagina through the vagina, it is called a laparoscopically assisted vaginal hysterectomy.
After a hysterectomy
Immediately after a hysterectomy operation, you can expect to:
- Wake up in the recovery room
- Feel some soreness around the operation site – you will be given pain-relieving medication to enable you to maintain some mobility
- Experience wind pain for a few days
- Have the intravenous (IV) tube removed from your arm sometime during the first few days, depending on the procedure and your condition
- Have the catheter (drainage tube) removed from your bladder within 24 hours of surgery, unless your bladder was traumatised during surgery
- Be encouraged to get out of bed and go for short walks around the hospital ward as soon as possible
- Stay in hospital for two to seven days, depending on the type of surgery
- Have a faster recovery after vaginal surgery than open abdominal surgery, although with good pain relief, recovery may be rapid for all forms of the surgery.
It is important to start pelvic floor and abdominal exercises within the first few weeks after surgery. These exercises strengthen the muscles in your pelvis and help maintain normal bladder function and vaginal muscle tone. Your doctor or physiotherapist will let you know how soon you can start these particular exercises.
Complications after a hysterectomy
The possible complications of a hysterectomy include:
- Nausea and vomiting
- Internal haemorrhage (copious discharge of blood)
- Build-up of blood beneath the stitches (haematoma)
- Internal scar tissue
- Allergic reaction to the anaesthetic
- Blood clots
- Difficulties with urination
- Decreased sexual desire
- Constant pelvic pain
- Feelings of grief and loss
- Injury to the bowel, bladder or ureters (tubes that carry urine from the kidneys to the bladder) – rare
- Fistula (abnormal hole between internal structures, such as the bowel and vagina) – rare
- Vaginal vault prolapse (when the upper vaginal wall loses its shape and sags or bulges).
Self-care after hysterectomy
Be guided by your doctor, but general suggestions for the six-week post-operative period are:
- Rest – try to rest as much as possible for at least two weeks. You should avoid driving during this time. Always rest lying down
- Exercise – continue with the exercises you were shown in hospital. You should aim to go for a walk each day, unless advised otherwise by your doctor
- Standing – avoid standing for more than a few minutes at a time in the early post-operative period. You can increase standing time as your recovery progresses
- Lifting – avoid heavy lifting and stretching
- Constipation – to avoid constipation, drink plenty of fluids and eat fresh fruits and vegetables. You may wish to take stool softeners for the first few days
- Medications – if you have been prescribed antibiotics, make sure you take the full course, even if you feel well
- Sex – it is advised that you avoid vaginal sex until after the post-operative check (about four to six weeks after the operation) to ensure the vagina is fully healed. If vaginal dryness is a problem, it may be helpful to use a water-based lubricant or sweet almond oil.
Long-term outlook after hysterectomy
After hysterectomy, you will no longer need contraception or have menstrual periods. If your ovaries were removed, you will experience menopause, with symptoms starting within a few days of your surgery.
If you were still having periods before your hysterectomy, you may want to discuss oestrogen replacement therapy (ERT) or other options with your doctor. How long you might need ERT will depend on your age.
Hysterectomy can be effective for gynaecological conditions like fibroids, endometriosis and adenomyosis, but some conditions may recur, such as cancer (depending on the stage of the cancer). You will need to have regular check-ups to make sure you are cancer free. You may need to have a regular vault test – similar to a pap test, but involving cells from the top of your vagina instead of the cervix.
Where to get help
- Your doctor
- Your local women’s health centre or community health centre
- Family planning clinic
Things to remember
- Hysterectomy is the surgical removal of the womb (uterus), with or without the removal of the ovaries.
- Hysterectomy is used to treat a number of conditions, including heavy or painful periods, fibroids and prolapse.
- The operation may be performed through the abdomen or the vagina.
- Apart from cancer, many of the gynaecological conditions cured by hysterectomy can often be successfully treated using other methods.
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Last reviewed: June 2013
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