Hysterectomy

A hysterectomy is an operation to remove your womb (uterus). After the operation you will no longer be able to have children. If you have not yet gone through the menopause, you will no longer have periods.

A hysterectomy is used to treat conditions that affect the female reproductive system, such as:

You may have a hysterectomy if your uterus is causing health problems that cannot be treated by other means. 

Possible reasons include the following: 

• Heavy or very painful periods. In some women, day-to-day life is made difficult because of heavy periods. Sometimes the heavy bleeding can cause anaemia. There are various other treatment options for heavy periods, including tablets and an intrauterine system (Mirena® coil). If they do not help to improve the problem, hysterectomy is an option for treatment. See separate leaflet called ‘Heavy Periods (Menorrhagia)’ for further information.
• Fibroids. These are swellings of abnormal muscle that grow in the womb. Fibroids are common and often do not cause any symptoms. However, in some women they can cause heavy or painful periods. Some fibroids are quite large and can press on the bladder to cause urinary symptoms.
• Prolapse. This is where the uterus or parts of the vaginal wall drop down. This may happen after the menopause when the tissues which support the uterus tend to become thinner and weaker.
• Endometriosis. This is a condition where the cells which line the uterus are found outside the uterus in the pelvis. This can cause scarring around the uterus, and may cause the bladder or rectum to stick to the uterus or Fallopian tubes. Endometriosis may cause only mild symptoms, but some women develop painful periods, abdominal pain or have pain during sex.
• Cancer. Hysterectomy may be advised if you develop cancer of the cervix, uterus, Fallopian tubes or ovaries. 

A hysterectomy is a major operation with a long recovery time. It is usually only considered after alternative, less invasive treatments have been tried.

There are three types of hysterectomy, depending on which structures or organs are removed:

• Total Hysterectomy: the most commonly performed operation. This is the removal of the entire uterus, including the cervix.  The cervix is the lower narrow portion of the uterus.
• Supracervical Hysterectomy: involves the removal of the upper part of the uterus. In this case, the cervix is left in place. There is controversy over whether it’s better to remove or keep the cervix in place. You will discuss these issues with your doctor well ahead of your trip to Spain for surgery.
• Total hysterectomy with bilateral salpingo-oophorectomy: the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed.
• Radical hysterectomy:  a total hysterectomy that also involves removing tissues around the uterus called the parametrium.

There are three ways to perform a hysterectomy:

• Vaginal hysterectomy: the womb is removed through a cut in the top of the vagina.
• Abdominal hysterectomy: the womb is removed through a cut in the lower abdomen.
• Laparoscopic hysterectomy (keyhole surgery): the womb is removed through a number of small cuts in the abdomen.

We will arrange a consultation with a gynaecologist. This is the opportunity for you to seek advice about which surgery will be most suitable for you.

What is the Role of the Ovaries?

Sometimes both ovaries are removed when a woman hasn’t already reached menopause. She will abruptly experience premature menopause along with the menopausal symptoms like hot flashes, vaginal dryness or decreased sex drive.

Women may opt to keep their ovaries if they have not gone through the menopause, so as to preserve their natural source of hormones. These hormones, including oestrogen, progesterone, and testosterone  are important in reducing the risk of heart disease. Additionally, they help prevent osteoporosis and play a role in maintaining sexual interest.

Some women who are at low risk of ovarian cancer may prefer the option to keep the ovaries and removing the fallopian tubes. This is because of the evidence that ovarian cancer often originates in the fallopian tube, rather than the ovary.

Postmenopausal women who are at a higher risk of breast and ovarian cancer are often advised to have their ovaries removed.

The pros and cons of removing or keeping ovaries is something you should discuss with your doctor. We will arrange the consultation.

Recovering from an abdominal hysterectomy