Vaginal hysterectomy

About vaginal hysterectomy

A vaginal hysterectomy is an operation to remove your uterus (womb) and cervix (neck of your womb) through your vagina.

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 a hysterectomy. 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

An abdominal hysterectomy may cure or remove the following conditions:

• heavy or painful periods
• fibroids, where part of the muscle of your womb becomes overgrown.

You will no longer have periods after an abdominal hysterectomy.

Alternatives to hysterectomy

There are alternative methods to treat some common conditions.

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 womb.
  • ‘Conservative surgery’ which removes the lining of your womb.

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, or shrink the fibroids by reducing their blood supply.

Endometriosis and adenomyosis

Endometriosis is a condition where the lining of your uterus grows outside your uterus.

Adenomyosis is a condition where the lining of your uterus grows into the muscle of your uterus. 

We can treat these conditions using a variety of non-hormonal and hormonal oral medicines.

We can also use an IUS (intra-uterine system). This is an implant containing a synthetic form of the hormone progesterone that fits in your womb.

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 make a cut on your abdomen. This is usually on your ‘bikini’ line or downwards from your belly button (sometimes 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 make a cut at the top of your vagina.

The operation usually takes an hour.

After the operation

After the operation, most people go home after 3 to 5 days, when they are medically fit for discharge.

We recommend you rest for 2 weeks. We will also give you a set of gentle exercises to do during these 2 weeks.

Most people return to work after 6 to 8 weeks (depending on the type of work they do).

Speak to your healthcare team or your GP for advice on regular exercise. This will help with your recovery.

Patients usually feel they are back to normal after 3 months.

After-effects and risks

After-effects of this operation

• pain
• unsightly scarring of your skin
• you will no longer have periods
• you will not be able to get pregnant.

General risks of any operation

• feeling or being sick
• bleeding
• developing a hernia in the scar (a hernia means an internal part of your body pushes through a weakness in the muscle or tissue wall).
• infection of the surgical site 
• allergic reaction to the equipment, materials or medicine
• acute kidney injury
• venous thromboembolism (a clot travelling through the bloodstream)
• chest infection.

Risks of this operation

• pelvic infection or abscess (collection of pus)
• vaginal cuff dehiscence, where the cut at the top of your vagina opens. You will need another procedure.
• developing an abnormal connection (fistula) between your bowel, bladder or ureters and your vagina
• damage to structures close to your womb
• developing a collection of blood (haematoma) inside your abdomen

Long-term problems

• developing a prolapse (when an organ slips from its normal position)
• continued bleeding from your cervix, if you have a subtotal hysterectomy
• difficulty or pain having sex
• tissues can join together in an abnormal way
• passing urine more often, having uncontrolled urges to pass urine or urine leaking from your bladder when you exercise, laugh, cough or sneeze
• feelings of loss because a hysterectomy will make you infertile
• going through menopause.