Abdominal hysterectomy

About abdominal hysterectomy

A hysterectomy is an operation to remove your uterus (womb). We usually remove your cervix (neck of your womb). It is also possible to remove your ovaries, but usually we leave them alone. We will discuss this with you before the operation.

If you decide against a hysterectomy or it is delayed

You may prefer to put up with your symptoms, rather than have the operation. Your gynaecologist will talk to you about the risks of not having the operation.

We will monitor your condition and try to control your symptoms.

Benefits

We will discuss with you why we suggest you consider having a hysterectomy.

A hysterectomy may cure or remove the following conditions:

• Heavy or painful periods not controlled by other treatments.
• Fibroids, where part of the muscle of your womb becomes overgrown.

The following are less common reasons for having a hysterectomy:

• Endometriosis, where the lining of your uterus grows outside your uterus.
• Adenomyosis, where the lining of your uterus grows into the muscle of your uterus.
• Chronic pelvic inflammatory disease, where inflammation of your pelvis leads to chronic pain and often heavy periods.
• As part of treatment following abnormal cervical smear tests.

A hysterectomy may cure or improve your symptoms. However, pain may continue, depending on what causes it.

You will no longer have periods after a hysterectomy.

If we do not remove your ovaries, you may continue to have your usual premenstrual symptoms.

Alternative treatment

A hysterectomy is a major operation, usually recommended to women after simpler treatments have failed to control their symptoms.

For some women there may be no suitable alternatives and a hysterectomy may be recommended immediately, but this is unusual.

Your gynaecologist will discuss the following alternative treatments with you.

Heavy periods

• We can treat heavy periods using the following methods:
  • A variety of non-hormonal and hormonal oral (by mouth) medicines.
  • An IUS (intra-uterine system). This is an implant containing a synthetic form of the hormone progesterone that fits in your uterus.
  • ‘Conservative surgery’ which removes only the lining of your womb (this is called endometrial resection).
  • 'Conservative surgery' which prevents the lining of your womb from growing each month (this is called endometrial ablation).

Fibroids

Depending on the size and position of the fibroids, we can give you medicine to try to shrink them and control the symptoms.

We can also use surgery to remove the fibroids (myomectomy), or shrink the fibroids by reducing their blood supply (uterine artery embolisation).

Endometriosis and adenomyosis

We can treat heavy periods using the following methods:

• A variety of non-hormonal and hormonal oral (by mouth) medicines.
• An IUS (intra-uterine system). This is an implant containing a synthetic form of the hormone progesterone that fits in your uterus.

Chronic pelvic inflammatory disease

We can treat this with painkillers and antibiotics.

About the operation

We usually perform the operation while you are under a general anaesthetic (asleep). We can also use other anaesthetic techniques.

We may give you injections of local anaesthetic to help with pain, and antibiotics to help reduce the risk of infection.

During the operation [slightly edited]

During the operation we do the following.

• We may examine your vagina.
• We make a cut on your abdomen, usually on your 'bikini' line or downwards from your belly button (in some cases from above your belly button).
• We remove your womb and fallopian tubes, usually along with your cervix, through the cut. To remove your cervix we also need to make a cut at the top of your vagina.
• We may be able to remove only your womb (this is called a subtotal hysterectomy).
• We may need to remove your ovaries, even if this was not originally planned. We will discuss this with you before the operation.
• We may place a catheter in your bladder to help you to pass urine (wee). 
• We may insert a drain (tube) in your abdomen to drain away fluid that can sometimes collect.

Complications and risks

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After-effects of the operation

You can expect the following after-effects.

• Pain. We will give you medicine to control this. Take it as instructed so that you can move about and cough freely. 
• Scarring of your skin.
• Sometimes the wound opens after the operation. In this situation,  we give you another procedure to fix it.
• You will no longer have periods.
• You will not be able to get pregnant.

Recovery afterwards

After the operation we will transfer you to the recovery area and then to the ward. We may give you fluid for 12 to 24 hours through a drip (small tube) in a vein in your arm.

You will probably feel some pain or discomfort when you wake and we may give you strong painkillers. Pain relief is an important part of your recovery. Tell your healthcare team if you are in pain.

If you have a catheter or drain, we usually remove them after 4 to 6 hours.

We usually remove the drip after 12 to 24 hours.

We will allow you to start drinking and eating light meals. 

You may get a slight discharge or bleeding from your vagina for the first 2 weeks. Tell your healthcare team if this becomes heavy. Use sanitary pads, not tampons.

You may get wind pains on day 2 or 3. We can give you medicine to relieve this.

You will be able to go home when your gynaecologist decides you are medically ready, which is usually after 3 to 5 days.

Nutrition and exercise

We advise you to drink plenty of fluid and increase the amount of fibre in your diet to avoid constipation.

We may recommend exercises to help you recover. Getting out of bed and walking is an important part of your recovery. We may also give you breathing, pelvic floor or other exercises to do. Try to do these, even if you do not feel like it.

Returning to everyday activities

To reduce the risk of a blood clot, follow our instructions if we give you medicine or ask you to wear special stockings.

Rest for 2 weeks and continue to do the gentle exercises we give you. Try to take a short walk every day.

Regular exercise will help you to return to normal activities as soon as possible. Before you start exercising, ask your healthcare team or GP for advice.

Eat healthily, drink plenty of fluid and rest when you need to.

You can return to work once your doctor has said you are well enough to do so. For most people this is after 6 to 8 weeks, depending on the type of work they do.

Most people feel more or less back to normal after 3 months.

While you recover, do not:

• Do not drive or ride a bike until you are confident about controlling your vehicle, including in an emergency. Check your insurance policy first and speak to your doctor if you have concerns.
• Do not have sex for at least 6 weeks and before any bleeding or discharge has stopped. When you have sex again, it can be uncomfortable at first and you may need to use a lubricant.
• Do not stand for too long or lift anything heavy.

Menopause and HRT

If your hysterectomy is performed while you are still having periods and your ovaries are removed during the operation, it is likely you will have menopausal symptoms.

These may include hot flushes, night sweats, passing urine more often, a dry vagina, dry skin and hair, mood swings and lack of sex drive. You can usually treat these symptoms with HRT.

Your GP is likely to recommend you take HRT until the time when you would have gone through menopause naturally (at about age 50 to 52). You can carry it on for longer if you want to. Discuss this with your GP.

Most women take HRT in tablet form but it is also available as patches, gels, nasal sprays, vaginal rings and implants. Your GP can discuss these options with you.

If we do not remove your ovaries

Your ovaries should continue to produce the hormones you need until you have reached the normal age of menopause. However, there is some evidence to suggest that some women who have had a hysterectomy may start menopause 2 to 3 years earlier.

After a hysterectomy, it can be more difficult to know when you are in menopause, as your periods will have stopped. You may need blood tests.

If you develop flushes or sweats or other menopausal symptoms, talk to your GP about HRT.