A hysterectomy is a surgical procedure that may be required when there is no other alternative and/or previous treatments have failed e.g. for endometriosis, tumours, abnormal cells in the uterus, fibroids and pelvic floor problems. The surgery is carried out under general anaesthetic or epidural. It requires a hospital admission and it takes 4-8 weeks to recover.
Usually, the cervix (neck of the womb) and the womb are removed. If the cervix is left intact, there is a 10 per cent chance of some bleeding at the times you would normally have your periods as the endometrium (womb lining) will remain in the cervix. If your cervix is removed, you will no longer be at risk of cervical cancer, so won’t need cervical smears.
The risks of the procedure are comparable to those of any other complex abdominal surgery, for example, infections, bleeding, blood clots, damage to intestines and/or other internal organs.
Sometimes the ovaries are also removed in a hysterectomy. This greatly reduces the risk of cancer, but will affect your hormone levels. You will begin the menopause immediately and its associated symptoms such as hot flushes, vaginal dryness, dizziness and night sweats. You may require hormonal treatment.
Types of hysterectomy
There are various surgical techniques for performing a hysterectomy. These are:
1. Vaginal hysterectomy
With this method, the uterus (womb) and the cervix (neck of the womb) are removed via the vagina. This technique is preferred because there are no visible scars and the recovery period is shorter than for the other methods, however it does not always work and is only possible if the uterus is not too big.
2. Key hole surgery
During keyhole surgery (a laparoscopic operation) a number of incisions are made in the stomach. These are used to insert a laparoscope, which allows the surgeon to monitor the operation on a screen. The uterus (womb) is removed in sections via the laparoscope or the vagina. The risk of infection is lower than with the standard method of surgery and the recovery time is shorter in comparison. The likelihood of permanent scars is also reduced.
3. Abdominal hysterectomy
With this method, the uterus (womb) is removed via an incision in the abdomen, just above the pubic bone. That horizontal incision is about 15cm long and can cause an unsightly scar. Sometimes a vertical scar is also necessary, for example, if the uterus is large or if cervical cancer has been diagnosed. The risk of complications is highest with this method, and the recovery period is the longest.
Is a hysterectomy right for you?
In the case of benign conditions, it is important to consider the pros and cons of a hysterectomy carefully and explore other treatment options before making a decision. Thanks to innovative new treatment techniques e.g. endometrial ablation, a hysterectomy is not always necessary for heavy periods.