What is a Hysterectomy?

According to the National Library of Medicine, the UK has a hysterectomy rate of 42/100,000, much less than the rates in the USA (143/100,000) and Canada (108/100,000). The vast majority of hysterectomies are performed to improve a woman’s quality of life rather than save it.

Linda Parkinson-Hardman’s website, which includes the former Hysterectomy Association’s webpages, states that around 55,000 hysterectomies are carried out in the UK each year, with around 38,000 of those being in an NHS hospital. Her website also states that around 1 in 5 women will undergo the operation at some point in their life.

What is a hysterectomy?

The Royal College of Obstetricians and Gynaecologists describes a hysterectomy as the “surgical removal of the uterus (womb)”. It is one of the most common operations for women. As well as the uterus, a hysterectomy may involve the surgical removal of the cervix, ovaries and fallopian tubes.

For many women, a hysterectomy comes as a relief after having suffered from heavy and painful periods for years or even decades. For other women, the need for a hysterectomy can come as shock. A hysterectomy is often the last resort as a form of treatment after all other avenues have been exhausted.

Following a hysterectomy operation, a woman will no longer have periods and will no longer be able to get pregnant. The majority of hysterectomies are performed on women who are aged between 40 and 50 years old, though some women have the procedure outside of this age range.

What are the types of hysterectomy?

There are several types of hysterectomy operations:

• A total hysterectomy.
• A subtotal hysterectomy.
• A total hysterectomy with bilateral salpingo-oophorectomy.
• A radical hysterectomy.

Total Hysterectomy

A total hysterectomy is where both the womb and the cervix are removed. This is the most common type of hysterectomy operation.

Subtotal Hysterectomy

This type of hysterectomy is where only the uterus is removed and the cervix remains in place. A subtotal hysterectomy may be better for women who have not had problems with their cervix, such as cervical cell changes. This operation is also said to help to reduce any sex-related consequences. A woman will need to continue attending cervical screening appointments after a subtotal hysterectomy.

Total Hysterectomy with Bilateral Salpingo-Oophorectomy

With this type of hysterectomy, the female reproductive organs are all removed: the uterus, cervix, fallopian tubes and ovaries. If a woman has not already reached menopause, this type of hysterectomy will cause what’s known as induced or surgical menopause.

The National Institute for Care Excellence (NICE) only recommends that the ovaries are removed if there are risks involved in keeping them, i.e. if there’s a family history of ovarian cancer.

Radical Hysterectomy

This is where the uterus and the surrounding tissues are removed including part of the vagina, fallopian tubes, fatty tissue and lymph glands. A radical hysterectomy is usually performed if the woman has received a cancer diagnosis.

How long does a hysterectomy take?

How long a hysterectomy takes will depend on the type of hysterectomy and the type of surgery that the woman undergoes. There are three kinds of surgical procedures used when carrying out a hysterectomy: abdominal, laparoscopic and vagina.

Abdominal Hysterectomy

An abdominal hysterectomy allows the surgeon to have a full view of the inside of the pelvis during the procedure. The surgeon makes an incision into the abdomen, either horizontally or vertically, and this will leave a scar. Horizontal incisions are the norm, usually along the bikini line. Vertical incisions are used when there are larger fibroids or in cases of cancer.

Abdominal surgery is usually carried out when the woman has large or multiple adhesions within the pelvis. There are significant drawbacks to this procedure, however, as there is a greater risk of complications such as bleeding, clots, nerve and tissue damage, and infection.

The operation usually takes between one and three hours. After an abdominal hysterectomy, you will usually need to stay in hospital for around five days after the procedure. Recovery then takes about six to eight weeks.

Laparoscopic Hysterectomy

A laparoscopic hysterectomy is a procedure that’s minimally invasive in comparison to an abdominal hysterectomy. It is carried out using a laparoscope – a device where a camera is used to visualise what is going on inside the pelvis. It’s also known as keyhole surgery. Surgical instruments are inserted through small incisions in the abdomen and the uterus is removed in sections either through one of the incisions or through the vagina.

A laparoscopic hysterectomy has the advantage of having fewer risks with the procedure in comparison to an open hysterectomy. There is often much less pain, less time needed to stay in hospital, a quicker recovery and a reduced risk of infection. However, there are still risks, including a risk of injury to other organs or the urinary tract.

Laparoscopic hysterectomy operations usually take around an hour. After a laparoscopic hysterectomy, you should be able to leave hospital between one and four days after the surgery.

Vaginal Hysterectomy

This surgical procedure is carried out via the vagina, with no incisions made into the abdomen at all. For this reason, it is the best choice cosmetically, if a woman has such concerns.

In a vaginal hysterectomy, the uterus is removed via an incision in the top of the vagina. This procedure is often the first choice for surgeons and women unless there are specific reasons why abdominal surgery or a laparoscopic procedure are preferred such as in the case of a larger than average uterus or adhesions.

A vaginal hysterectomy can be performed with either a general anaesthetic, local anaesthetic or spinal anaesthetic. The type of anaesthesia used will also contribute to the length of the surgery and recovery times. The operation usually takes around an hour.

A vaginal hysterectomy usually has the shortest recovery time of all hysterectomy operations. Often, women who have had vaginal hysterectomies can leave hospital between one and four days after the procedure.

Why do people have a hysterectomy?

There are many reasons why women may need to undergo a hysterectomy.

These reasons include:

• Heavy, painful and/or frequent periods which have not improved despite other medical treatments.
• A prolapsed uterus, where the womb drops and can lower into the vagina.
• Fibroids, which are abnormal muscle growths within the uterus. Fibroids can cause pressure on other organs in the pelvis as well as heavy, painful periods.
• Endometriosis – A condition where tissue from the uterus grows outside of the womb and causes pain within the pelvis.
• Adenomyosis – Similar to endometriosis but affecting the uterine muscle.
• Recurrent or severe pelvic infection.
• Pre-cancerous or cancerous changes in the uterus, cervix, vagina, ovaries or fallopian tubes.

Rarely, but worth mentioning, a hysterectomy can be performed as an emergency life-saving procedure during or after childbirth if bleeding cannot be controlled. Usually, however, a hysterectomy is considered an elective procedure with the woman opting to have the operation rather than it being an emergency.

Does having a hysterectomy cause menopause?

Whether a hysterectomy will cause menopause depends on the type of hysterectomy procedure the woman has undergone as well as her age. A hysterectomy that removes both ovaries (a total hysterectomy with bilateral salpingo-oophorectomy) means that the woman will enter immediate surgical menopause.

However, even if a woman’s ovaries are not removed during her hysterectomy operation, the woman has a 50% chance of going through menopause within five years of the operation, regardless of her age.

A surgically induced menopause caused by a total hysterectomy with bilateral salpingo-oophorectomy will not be like experiencing natural menopause as it is much more abrupt. With natural menopause, hormone levels drop over time and cause a gradual onset of menopausal symptoms. However, surgical menopause will mean that menopausal symptoms will begin abruptly after surgery. As a result, the symptoms will likely be more severe than if the woman had experienced natural menopause.

Many doctors treat surgical menopause with hormone replacement therapy to help alleviate the symptoms.

Recovering from a hysterectomy

Immediately after the procedure, the woman will likely wake up feeling fatigued and experiencing some pain. The medical staff will give painkillers to reduce this discomfort and pain. Some women also feel nauseous after general anaesthesia and medication can also be prescribed to reduce this.

After surgery, the woman may have dressings in place, a drip, a catheter, a drainage tube and, if a vaginal hysterectomy, a gauze pack inserted inside the vagina. Over the first few hours to a day or so after surgery, these will gradually be removed. Drainage tubes are usually only used for abdominal hysterectomies, and these remain in place for around 24-48 hours after surgery.

As explained above, recovering from a hysterectomy will depend on the procedure involved as well as the surgical method used. For laparoscopic and vaginal hysterectomies, women can usually leave hospital between one and four days after the procedure. For an abdominal hysterectomy, the time is usually up to five days.

Follow up hospital appointments are usually not necessary, but the patient is normally requested to visit their GP four to six weeks after the surgery. It usually takes between six and eight weeks to recover fully from the surgery.

Aside from the physical effects in the recovery period, a woman may go on to experience severe menopausal symptoms (depending on the procedure) as well as some emotional effects.

The menopausal symptoms may include:

• Hot flushes.
• Weepiness.
• Sweating.
• Insomnia.
• Brain fog.
• Anxiety.

To reduce the impact of these symptoms, many GPs prescribe hormone replacement therapy (HRT). This can be as tablets, patches, injections or an implant.

When it comes to the emotional effects of a hysterectomy, a woman may feel sadness as well as a sense of loss following a hysterectomy. Such feelings are common for women who have cancer, especially if they are young and have not had children or have not completed their family.

Women who have surgically induced menopause may also feel a sense of loss as it puts an end to their childbearing years at an earlier than normal age. Some women also report feeling less “womanly” after their hysterectomy. For most, these feelings are temporary. But, if they aren’t, the woman must seek support from her GP as they will be able to advise about suitable treatments to help.

What not to do after having a hysterectomy

Recovering from any surgical procedure takes time. However, for a hysterectomy, it’s important that you avoid certain activities to recover properly.

These include:

• Lifting heavy objects such as shopping bags or carrying children.
• Doing too much physical activity too soon. Walking is recommended, as is swimming once wounds are healed. However, you should not run or do vigorous exercise until you have recovered fully, which can be up to eight weeks.
• Driving – Driving requires the ability to perform an emergency stop and wear a seatbelt. Most women are normally able to drive comfortably and safely between three and eight weeks after their operation. However, many car insurance providers need a GP to certify that a woman can drive after such surgery.
• Sex – Medical professionals usually advise that after a hysterectomy, you do not have sex until any vaginal discharge has stopped and until scars are healed. This usually takes a minimum of four to six weeks.

Final thought on ‘What is a Hysterectomy?’

Given the incidence rates of hysterectomy, the chances are that most people have either experienced it themselves or have someone close to them that has had one. Despite being a common procedure, women undergoing such surgery will no doubt be apprehensive about what is involved. For this reason, women must be supported throughout the process and during the recovery period.