Hysterectomy

What is a hysterectomy?

A total hysterectomy is the most common operation and this means removal of the uterus and cervix (neck of the womb). A sub-total hysterectomy means the removal of the body of the uterus, leaving the cervix behind. A radical hysterectomy involves the removal of the uterus, cervix, a small portion of the upper part of the vagina and some soft tissue from within the pelvis.

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Why is a hysterectomy carried out?

A hysterectomy can help to ease many gynaecological complaints. These include:

• Heavy or very painful periods
• Fibroids: Swellings of abnormal muscle that grow in the uterus, and can cause heavy or painful periods, or problems with urination.
• Prolapse: Where the uterus, or parts of the vaginal wall, drops down.
• Endometriosis: A condition where the cells which line the uterus are found outside the uterus in the pelvis. This can cause scarring around the uterus, and may cause the bladder or rectum to 'stick' to the uterus or fallopian tubes.
• Various forms of cancer, including cancer of the cervix, uterus, fallopian tubes, or ovaries.

In most cases - except for cancer - the procedure is usually only used as a last resort. The most common method is to cut through the lower abdomen, usually leaving a six-inch, or smaller, scar. However, gynaecological surgeons are increasingly offering a vaginal hysterectomy, which removes the uterus through the vagina without any significant abdominal wounds, or combining vaginal hysterectomy with laparoscopy (‘key hole surgery’).

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Hysterectomy - what are the risks?

No operation is risk-free, especially surgery as major as a hysterectomy. However, the vast majority of women undergo the procedure without any complications. Obesity can make surgery more difficult and increases the risk of post-operative complications, such as heavy bleeding or wound infection. There is also a small risk of damage to the bladder, or the tubes that carry urine from the kidneys to the bladder (‘ureters’).
An uncommon - but serious - complication is the development of a blood clot in the veins of the leg (deep vein thrombosis, or DVT).

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Is a hysterectomy a common procedure?

Up to one in five women will undergo a hysterectomy during their lifetime so it is a relatively common operation. Around 60 000 women a year undergo hysterectomy per year in the UK. The NHS drug and treatment watchdog, the National Institute for Health and Clinical Excellence (NICE), warned in January 2007 that too many women were 'suffering in silence' from heavy periods because they feared having to have a hysterectomy.
NICE stressed that drugs and minor surgery could often be effective alternative treatments and many gynaecological units now offer these to women in order to offset or delay hysterectomy.

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Is there a long-term impact?

A woman who has had a hysterectomy should be able to enjoy a satisfying sex life - in fact many women report that their level of sexual pleasure improves following the surgery. Provided the surgery goes well, it should be possible to resume a normal sex life about six weeks after the operation.
If a woman undergoes hysterectomy with removal of her ovaries before she has gone through the menopause, she should be offered hormone replacement therapy (HRT) by her doctor if she develops physical symptoms of the menopause such as hot flushes or night sweats. This is a common development in 80% of women undergoing a so called ‘surgical’ menopause, which is the same proportion as women experiencing a natural ‘change of life’.