Hysterectomy is often recommended in the following circumstances:
- Excessive bleeding or pain which cannot be controlled by other treatments
- Fibroids which are increasing in size, cause pain and/or excessive bleeding (fibroids are non-cancerous)
- Changes in the cervix or lining of the womb which may lead to cancer
- Cancer of the lining of the womb or ovaries
- Uterine prolapse (dropping of the womb)
A hysterectomy is an operation to remove the womb (uterus) which often includes removing the cervix (neck of womb).
- Total hysterectomy – Removal of the entire womb (uterus) and cervix.
- Salpingo-oophorectomy – Removal of an ovary and Fallopian tube, often bilateral (both sides) and performed at the same time as a total hysterectomy.
- Subtotal hysterectomy – Is occasionally performed. This is removal of the womb only. The neck of the womb or cervix is left therefore smear tests need to be continued.
If the ovaries are removed, These symptoms can be treated in a variety of forms ie: implants, patches, tablets and topical applications. Your doctor will discuss the most appropriate form of treatment. Please feel free to ask any member of staff for information.
Even if you have not had your ovaries removed, you can still have menopausal symptoms, these should resolve within a week.
- Hysterectomy ends periods – If one or both ovaries remain a hysterectomy does not cause hormone related problems or an early menopause. The ovary will still produce hormones. However, menopause may occur a little earlier for some women.
- Hysterectomy is a common operation – approximately 50,000 are performed annually in the UK. The benefits of this surgery far outweigh any minor problems that you may experience such as slight bleeding or temporary difficulty in passing water.
- Types of hysterectomy: Your uterus may be removed through an abdominal incision or through the vagina. The method used will depend on several factors including symptoms and findings on examination.
Before your operation
An appointment for pre assessment will be arranged prior to your procedure. These tests are to check that you are fit for surgery. You will have blood taken and may have an x-ray of your chest, monitoring to check your heart (ECG) or other investigations if the doctor thinks they are necessary.
You will be asked to have a shave or a clipping the evening before your operation, depending on which type of hysterectomy (abdominal or vaginal) you are having.
There will be a period of time just before your operation when you won’t be able to eat or drink – you will be informed of this at PAC (Pre Anesthetic-Checkup). You will also be assessed for your likelihood of developing
a blood clot and will be fitted with stocking during your stay, to help following surgery. You are also advised to refrain from smoking for a few days before and after your operation. If you are having an abdominal hysterectomy, you will be assessed for patient-controlled analgesia (PCA). A gynaecological doctor and an anaesthetist will also see you.
After your operation
You will wake up in the recovery area or in your bed on the ward. You may have a drip (a tube going into a vein to provide you with fluids), a catheter (a tube going into your bladder to drain urine), a drain near your incision to remove excess fluid and/or a pack in your vagina. All of these are usually removed within 24-72 hours, but you will be kept informed of this.
Your blood pressure, heart rate, pain level and vaginal loss will be checked regularly and you will be given pain relief as required or advised how to use your PCA, if you have one. Most people can tolerate oral pain relief within 12-24 hours post operatively.
The day after your operation, a doctor will see you to explain what has been done. You may find you have vaginal bleeding which is quite normal and you may feel ‘windy’. Walking is encouraged and will help in getting rid of the wind and t is also important in achieving a good recovery. The nurse will tell you when you can drink and eat.
Suppositories will be offered on the third day after your operation if you are having difficulty with your bowels. You are generally able to take shower 1 day after your surgery. Sutures in vagina are dissolvable. Sutures on your tummy are in most instances dissolvable but will be guided by your doctor if needed to be removed.
You stay in hospital is likely to be between 1 to 2 days and your discharge letter, follow-up appointment and any necessary medication will be dispensed and ready for you to take home on your day of discharge.
When you wake up, start the deep breathing and leg exercises (found in the leaflet you should have received in the post). Repeat these three times every hour until you are walking. When you need to cough, sit up straight, support your wound, take in a deep breath and cough. It might be easier if you hold a pillow over the incision site. The physiotherapist will teach you how to do other helpful exercises.
You may find that you have some vaginal discharge for a couple of weeks after going home. This is quite normal as long as it does not have a bad smell, is too excessive or too painful. This discharge can be in the form of light period, and you should use sanitary pads rather than tampons as they increase the risk of infection.
When you first go home, you should rest, gradually increasing the amount that you do. Do not lift anything heavy. Walking is good exercise. But, remember to rest when you feel tired. You should be back to full activity approximately four to eight weeks after your operation. Six weeks rest from work is the minimum recommendation. However, return to work will depend on your condition and type of work.
You are advised to refrain from sexual intercourse until after your post-operative check-up, about six weeks after the operation. Your doctor will advise you when you can drive again; this would usually be after four to six weeks depending on your comfort. Also check with your car insurance company.
Maintaining an active lifestyle with a healthy diet will help to ensure you feel fit and make a good recovery.
Talk to GAU on numbers provided in first week of operation if you develop any of the following complaints or you are worried, your GP after 1 week:
- Burning and stinging when you pass urine or pass urine frequently: This may be due to a urine infection. Treatment is with a course of antibiotics. Also, if you feel no control over passing urine, in that case you may need further investigations.
- Vaginal bleeding that becomes heavy or smelly: Some amount of discharge vaginally is common but if bleeding is heavy leading to frequent changing of pads, have a temperature (fever), this may be due to an infection or a small collection of blood at the top of the vagina called a vault hematoma. Treatment is usually with a course of antibiotics. Occasionally, you may need to be admitted to hospital for the antibiotics to be administered intravenously (into a vein). Rarely, this blood may need to be drained.
- Red and painful skin around your scars: This may be normal, but if there is pus coming out or you are worried please contact your GP. Treatment is with the course of antibiotics.
- Increasing abdominal pain: If you also have a temperature (fever), have lost your appetite and are vomiting, this may be due to complication of surgery, in which case you should contact your doctor earlier rather than later.
- A painful, red, swollen, hot leg: This may be due to a deep vein thrombosis (DVT). If you have shortness of breath or chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolism).
If you have these symptoms, you should seek medical help immediately