What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus (womb) and is one of the more common major operations in gynaecology. The uterus may be removed together with the cervix or with the cervix left in place, and depending on the situation the fallopian tubes and ovaries may also be removed during the same operation. After a hysterectomy there are no periods and pregnancy is not possible.
A hysterectomy is a permanent decision. For benign conditions there are often other options that preserve the uterus, so the decision takes into account how much the symptoms affect your life, treatments already tried, your wishes about pregnancy and your personal preferences.
When is it done?
- Fibroids: fibroids causing heavy bleeding, anaemia, pelvic pain or pressure on the bladder and bowel, when uterus-preserving treatments are unsuitable or have not helped enough.
- Heavy menstrual bleeding that does not respond to treatment: bleeding that cannot be controlled with medication and other methods and affects quality of life.
- Adenomyosis: tissue similar to the lining of the uterus growing into the muscular wall of the uterus, which can cause painful, heavy periods. It is one of the options for women who do not wish to become pregnant and have not benefited from other treatments.
- Endometriosis: it may be considered for severe pain that persists despite other treatments in women who do not wish to become pregnant. Endometriosis deposits also need to be removed, and the possibility that pain may not resolve completely is discussed beforehand.
- Uterine prolapse: the uterus descending into the vagina. The uterus may be removed as part of prolapse repair, although repairs that preserve the uterus are also available.
- Precancerous changes: conditions such as atypical hyperplasia of the endometrium, or recurrent high-grade cervical cell changes.
- Gynaecological cancers: in the treatment of cancers of the endometrium, cervix and ovary; surgery is planned according to the type and stage of the cancer.
- Obstetric emergencies: rarely, an emergency hysterectomy is needed for life-threatening situations such as severe bleeding after birth (postpartum haemorrhage) that cannot be controlled by other means, or abnormal attachment of the placenta to the uterine wall.
Options that preserve the uterus
For benign conditions, suitable alternatives should be discussed before deciding on a hysterectomy. These depend on the symptoms and their cause:
- Medication: non-hormonal medicines that reduce bleeding (such as tranexamic acid), combined contraceptive pills, progestogen medicines and hormonal treatments that can temporarily shrink fibroids.
- Hormone-releasing intrauterine system (hormonal coil): can markedly reduce bleeding and pain in heavy menstrual bleeding and adenomyosis.
- Endometrial ablation: destruction of the lining of the uterus with hysteroscopic techniques or special devices. It is an option for suitable women with heavy bleeding who do not wish to become pregnant; pregnancy is not advised afterwards and effective contraception is needed.
- Myomectomy: removal of the fibroids only, leaving the uterus in place. It can be done laparoscopically, hysteroscopically or as open surgery and is the preferred option for women who wish to become pregnant.
- Uterine artery embolisation: blocking the blood vessels that supply the fibroids using interventional radiology; a non-surgical option for suitable women.
- Pessary: a device, usually a silicone ring, placed in the vagina to support the uterus in prolapse.
Which path to take is a personal decision. Your wishes about pregnancy, your age, how severe the symptoms are, the results of previous treatments and your own priorities all matter. It is natural to take your time, have all your questions answered and seek a second opinion if you wish.
Types of hysterectomy
- Total hysterectomy: the uterus and cervix are removed together. This is the most common type.
- Subtotal (supracervical) hysterectomy: the body of the uterus is removed and the cervix is left in place. Because the cervix remains, regular cervical screening continues; some women have light, period-like spotting afterwards.
- Radical hysterectomy: the uterus and cervix are removed together with the upper part of the vagina and the supporting tissues around the uterus. It is used only for some cancers, particularly cervical cancer.
Are the tubes and ovaries removed too?
Fallopian tubes (salpingectomy)
Many cancers known as ovarian cancer are now thought to start at the far end of the fallopian tubes. For this reason, the American College of Obstetricians and Gynecologists (ACOG) recommends discussing removal of the tubes (opportunistic salpingectomy) with women having a hysterectomy for a benign condition. Removing the tubes does not noticeably increase surgical risk, and current evidence suggests it does not harm ovarian function. Once the uterus has been removed, the tubes no longer have a role in pregnancy.
Ovaries (oophorectomy)
Before menopause, the ovaries are usually conserved unless there is a specific reason to remove them. The ovaries continue to produce hormones until menopause. Removing them before menopause may increase the long-term risk of problems such as osteoporosis and cardiovascular disease.
Removal of the ovaries may be recommended if there is separate ovarian disease, extensive endometriosis, or a high inherited risk of ovarian cancer, for example due to a BRCA gene variant. After menopause, the decision is made after discussing your individual risks and preferences.
If both ovaries are removed before menopause, menopause begins immediately after the operation (surgical menopause). Symptoms such as hot flushes, sleep problems and vaginal dryness can be more sudden and pronounced than in natural menopause. Unless there is a reason not to, hormone replacement therapy is usually recommended until the age of natural menopause. Because the uterus has been removed, oestrogen-only therapy is usually sufficient; in some situations, such as a history of endometriosis, treatment may be planned differently.
Surgical routes
The uterus can be removed in different ways. The route is chosen according to the size and shape of the uterus, the reason for the hysterectomy, previous surgery, general health and your preference. ACOG recommends that, for benign conditions, the vaginal or laparoscopic route is preferred whenever feasible; these routes usually mean a shorter hospital stay and faster recovery than open surgery.
Vaginal hysterectomy
The uterus is removed through the vagina, with no abdominal incision. It is particularly suitable for women with prolapse and a uterus that is not very large. A Cochrane review supports the vaginal route in preference to other routes for benign conditions whenever possible.
Laparoscopic hysterectomy
This is performed with a camera and fine instruments through several small incisions in the abdomen. When the entire operation is done laparoscopically and the uterus is removed through the vagina, it is called a total laparoscopic hysterectomy; when part of the operation is done laparoscopically and the rest is completed vaginally, it is called a laparoscopically assisted vaginal hysterectomy. Laparoscopy also gives a direct view of the tubes, ovaries and pelvis (for example, endometriosis or adhesions).
Robotic hysterectomy
This is a form of laparoscopy in which the surgeon controls instruments attached to robotic arms from a console. It may help in some complex situations; for benign conditions, a clear advantage over standard laparoscopy has not been shown.
Abdominal (open) hysterectomy
The uterus is removed through an incision in the lower abdomen, usually horizontal. It is chosen if the uterus is very large, there are extensive adhesions, cancer is suspected or other routes are not suitable. Recovery takes longer.
During keyhole surgery it may occasionally be necessary to convert to an open operation for safety; this possibility is discussed beforehand.
Removing a large uterus through small incisions (morcellation)
In laparoscopic surgery, a large uterus may need to be cut into smaller pieces so that it can be removed through small incisions. Rarely, an unsuspected malignant tissue (such as a sarcoma) may be present, and cutting it up could spread it within the abdomen. For this reason, morcellation is used only after careful assessment before surgery and, whenever possible, inside a special containment bag; it is not used when cancer is suspected.
Preparing for surgery
- Assessment: a detailed history, pelvic examination and ultrasound assess the uterus, fibroids and ovaries; further imaging such as MRI is arranged if needed.
- Cervical screening: your smear and/or HPV test should be up to date.
- Endometrial sampling (endometrial biopsy): taken before surgery in women with abnormal bleeding and risk factors, to exclude precancerous change or cancer.
- Correcting anaemia: if heavy bleeding has caused anaemia, correcting it with iron before surgery reduces the need for blood transfusion.
- Stopping smoking: supports wound healing and lowers the risk of lung and clotting problems.
- Preventing blood clots (thrombosis): your individual risk is assessed; early mobilisation, compression stockings and, if needed, blood-thinning injections are planned. Tell your doctor before surgery about all your medicines, especially blood thinners and oestrogen-containing hormones.
- Anaesthetic assessment and consent: blood tests and an anaesthetic review are carried out. The type of operation, the decision about the tubes and ovaries and the possible risks are discussed, and your consent is obtained.
Possible risks
Hysterectomy is generally a safe operation but, like any major surgery, it carries some risks. The level of risk depends on the reason for surgery, the route and your general health:
- Bleeding during or after surgery; sometimes a blood transfusion is needed
- Infection (wound, urinary tract, vaginal vault or within the pelvis)
- Injury to nearby organs: the bladder, ureter (the tube carrying urine from the kidney to the bladder) or bowel
- Blood clots in the leg veins (deep vein thrombosis) and a clot travelling to the lungs (pulmonary embolism)
- Problems related to anaesthesia
- Temporary difficulty passing urine
- Rarely, particularly after laparoscopic or robotic total hysterectomy, opening of the stitched top of the vagina (vaginal cuff dehiscence)
Your individual risks and the steps taken to reduce them are discussed in detail before surgery.
Recovery after surgery
The length of hospital stay depends on the route: it is usually shorter after vaginal and laparoscopic hysterectomy, and may be a few days after open surgery. Getting up and walking early after the operation speeds recovery and lowers the risk of blood clots.
- Pain: controlled with pain relief in the first days and gradually eases. After laparoscopy, shoulder pain from the gas used to inflate the abdomen may last a few days.
- Vaginal bleeding and discharge: light bleeding or brownish discharge for a few weeks is normal.
- Returning to normal activities: this takes roughly 2-6 weeks depending on the route; usually less after vaginal and laparoscopic surgery and longer after open surgery. Return to work is planned according to how physically demanding your job is.
- Heavy lifting: avoid heavy lifting and strenuous exercise for several weeks; short, frequent walks are encouraged.
- Sexual intercourse: usually wait about 6 weeks for the top of the vagina to heal; your doctor will confirm at the follow-up visit. Avoid tampons during this time.
- Driving: you can drive once you can wear a seat belt comfortably and feel able to perform an emergency stop without pain.
- Showering and bathing: showering is usually fine from the first days; wait for your doctor's advice before baths and swimming.
Tiredness can last several weeks, especially after open surgery. A balanced diet, enough fluids and avoiding constipation support recovery.
Life after a hysterectomy
Periods and pregnancy
After a hysterectomy there are no periods and pregnancy is not possible, so contraception is no longer needed. If you may want children in the future, this must be discussed when making the decision.
Menopause
If the ovaries are conserved, the operation does not cause menopause; the ovaries continue to produce hormones. However, in some women menopause may begin somewhat earlier than expected. Because there are no periods, the onset of menopause is recognised by symptoms such as hot flushes. If the ovaries were removed, surgical menopause and hormone therapy options are considered as described above.
Sexual life
For most women, sexual desire and satisfaction are unchanged after a hysterectomy, and some find their sex life improves once symptoms such as pain or heavy bleeding have gone. If the ovaries were removed, vaginal dryness and reduced desire may occur; lubricants and hormone therapy can help. If you have any concerns, do not hesitate to discuss them with your doctor.
Emotional aspects
Losing the uterus can be emotionally difficult for some women, bringing feelings of loss, sadness or anxiety. These feelings may be stronger if you still wished to have children or if the hysterectomy was done in an emergency. Sharing these feelings with your partner, family and doctor, and seeking psychological support if needed, is part of recovery.
Cervical screening
If a total hysterectomy was done for a benign reason and you have no history of high-grade cervical cell changes (CIN2 or higher) or cervical cancer, smear and HPV screening can usually stop. After a subtotal hysterectomy the cervix remains, so screening continues as before. Women with a history of high-grade cell changes continue screening of the vaginal vault after total hysterectomy for a period determined by their doctor.
Follow-up
A check-up is arranged in the first weeks after surgery to review wound healing and the pathology result. After that, regular gynaecological check-ups and age-appropriate screening such as breast screening continue. Because prolapse of the vaginal vault can develop over the years, a feeling of fullness or of something coming down in the vagina should be assessed; pelvic floor exercises may help.
When should you see a doctor?
After surgery, contact your doctor without delay if you notice any of the following:
- Fever of 38 °C or above, or chills
- Abdominal or pelvic pain that keeps increasing despite pain relief
- Vaginal bleeding heavier than a period, with clots, or increasing
- Foul-smelling vaginal discharge
- A sudden gush of fluid from the vagina or a feeling that something is coming out
- Swelling, pain or redness in one leg
- Burning when passing urine, inability to pass urine, blood in the urine or continuous leakage of urine from the vagina
- Redness, swelling, discharge or opening of the wound
- Persistent nausea and vomiting, or being unable to pass wind or stools
- Chest pain or sudden shortness of breath: this is an emergency; call emergency services (112 in Türkiye) or go to the nearest emergency department.
Births and surgeries are performed at Anlaşmalı Hastane. Examination, planning and follow-up take place at the clinic.
Frequently Asked Questions
Will I go into menopause after a hysterectomy?
Will I gain weight after a hysterectomy?
Will it affect my sex life?
When can I return to work?
Do I still need cervical screening after a hysterectomy?
Are the ovaries removed too?
Can fibroids be treated without removing the uterus?
How long will I stay in hospital?
Sources
- American College of Obstetricians and Gynecologists. Hysterectomy. Patient FAQ.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol, 2017.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention. Obstet Gynecol, 2019.
- NHS. Hysterectomy.
- Aarts JWM, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews, 2015.
The information on this website is for general information only and does not replace a medical consultation.
