What a hysterectomy is
A hysterectomy is an operation to remove the uterus. After it you will not have periods and cannot become pregnant. It is done under general or spinal anaesthesia and needs a hospital stay. It is a major and permanent step, so it is usually considered when medicines or smaller procedures have not worked or are not suitable. The main exception is cancer, where it may be the first treatment advised.
Why it may be advised
- Fibroids that cause heavy bleeding, pain or pressure
- Heavy or prolonged periods that do not respond to other treatment
- Prolapse, where the uterus slips down into the vagina
- Adenomyosis or severe endometriosis
- Cancer or pre-cancer of the uterus, cervix or ovaries
- Rarely, life-threatening bleeding after childbirth
Ask about alternatives first
For non-cancer problems there are often other choices. These include tablets, a hormone-releasing intrauterine device, procedures that treat only the lining, or uterus-sparing fibroid treatment. Ordinary white discharge, mild period pain or a small fibroid with no symptoms is not by itself a reason to remove the uterus. If surgery is suggested at a young age, or you feel unsure, it is reasonable to take a second opinion.
Types of hysterectomy
| Type | What is removed | Periods afterwards |
|---|---|---|
| Total | Uterus and cervix | None |
| Subtotal | Uterus only, cervix stays | None or light spotting |
| Total with tubes and ovaries | Uterus, cervix, tubes, ovaries | None, and menopause begins |
| Radical | Uterus, cervix and nearby tissue, for cancer | None |
Whether the ovaries are removed is a separate decision. Ovaries keep making hormones until natural menopause, so in younger women they are usually left in place unless there is a medical reason. Discuss this clearly before signing the consent form.
How the operation is done
Vaginal route
The uterus is removed through the vagina, with no cut on the abdomen. It is often preferred for prolapse and when the uterus is not very large.
Laparoscopic route
The surgeon works through small cuts using a camera. Recovery tends to be quicker than with an open operation. You can read more under laparoscopic surgery.
Abdominal route
A cut is made on the lower abdomen, similar to a caesarean scar. It may be needed for a very large uterus, dense scarring or cancer.
The route depends on the reason for surgery, the size of the uterus, past operations and the surgeon's training. Your doctor decides what is safest for you.
Possible risks
Like any major operation, a hysterectomy carries risks. These include bleeding that may need a transfusion, infection, blood clots, anaesthesia reactions and, uncommonly, injury to the bladder, ureter or bowel. Your surgeon should explain how likely these are in your case, as it depends on your health and the reason for surgery.
Steps before the operation
- Tests are done, usually blood tests, a scan, ECG and a cervical screening test if not done recently.
- Anaemia from heavy bleeding is corrected where possible with iron or other treatment.
- You meet the anaesthetist, who reviews conditions such as diabetes, blood pressure, asthma or thyroid disease.
- You are told which medicines to stop and when to begin fasting.
- You sign consent after the type of hysterectomy, the route and the plan for the ovaries are explained.
Arrange help at home for the first few weeks. Costs vary by city, hospital and case, so ask for an estimate in writing.
Recovery and life afterwards
Hospital stay is commonly one to three days for vaginal or laparoscopic surgery and a little longer for an open operation. Light bleeding or brownish discharge for some weeks is expected. Full recovery often takes around four to six weeks, sometimes more after open surgery. Walk a little every day, avoid heavy lifting and wait for your doctor's clearance before resuming sex, which is commonly after about six weeks. Constipation is common in the first week, so drink enough water and eat fibre-rich food. Stitches in the vagina dissolve by themselves. Do not use tampons or douche until you are told the top of the vagina has healed.
Hormones and menopause
If your ovaries are kept, you will not go into menopause at once, though it may come slightly earlier than otherwise. If both ovaries are removed before natural menopause, hot flushes, poor sleep and vaginal dryness can start within days. Your doctor may discuss menopause management, including hormone therapy where suitable, and bone health.
Body and emotions
The operation by itself does not cause weight gain or end your sex life. Many women feel relief from pain and bleeding. Some feel a sense of loss, and that is normal too. Talk to your doctor if low mood continues. If your cervix was left in place, or surgery was for cancer or pre-cancer, ask whether you still need screening tests.
When to see a gynecologist
Before surgery, see a doctor for bleeding that soaks pads every hour, bleeding after menopause, a feeling of something coming down in the vagina, or constant pelvic pressure. After a hysterectomy, seek prompt care for:
- Fever or chills
- Heavy fresh bleeding or foul-smelling discharge
- Severe or rising abdominal pain
- Trouble passing urine, burning, or leaking urine
- Redness or pus from the wound
- Swelling or pain in one leg, or sudden breathlessness
Pain or swelling in the leg with breathlessness can mean a blood clot, which is an emergency. For anything that worries you in the first weeks, call the hospital where you had the operation instead of waiting for the planned review.
This page is general information for readers in India. It is not medical advice. Speak to a qualified gynecologist about your own health.