What is a Hysterectomy?

A hysterectomy is major surgery to remove your uterus (womb). In a total hysterectomy, the cervix is also removed.

Your doctor may recommend a hysterectomy if symptoms, such as heavy bleeding, haven’t improved with other treatments.


There are many different type of Hysterectomy surgery:

•  Abdominal – your uterus is removed through a cut in your lower abdomen

•  Vaginal – your uterus is removed through your vagina

•  Laparoscopic – This is when instruments are placed through small 5-10mm sized incisions in 2-4 locations around the abdomen. A camera on a telescope is used to provide vision while the operation is performed using those instruments.

You should discuss with your doctor the best type for you.



Why should I have a hysterectomy?

Your doctor may recommend a hysterectomy if you have:

•  Menorrhagia or heavy periods

Menorrhagia is the most common reason for hysterectomy

•  Fibroids

Fibroids, a benign growth of the muscle cells of the uterus are very common. It can result in heavy periods or problems related to a very large uterus.

•  Adenomyosis

Adenomyosis is a condition associated with both heavy and painful periods, and often will not be diagnosed until the hysterectomy is performed.

•  Prolapse

A hysterectomy will commonly be performed as a part of an operation to address prolapse.

•  Chronic Pelvic Pain/ Endometriosis

Hysterectomy may be indicated after other possible causes have been ruled out and fertility is no longer an issue.

•  Cancer

Cancer surgery is a sub-specialty area of care. If cancer is proven or strongly suspected, I would refer you to a gynae-oncologist


Unless you have cancer, your doctor will probably recommend other treatments, such as medicines or other surgical procedures, first.

Depending on your medical problem, your doctor may recommend you also have your cervix, ovaries or fallopian tubes removed.


How is a hysterectomy performed?

Whether laparoscopic, vaginal or abdominal, the procedure aims to separate the uterus from its connection points without damaging the surrounding organs, and remove it from the body.

The uterus has little in the way of support above the pelvis. Its main support ligaments and blood supply are at the level of the cervix, at the top of the vagina. Above this, there are some thin and flexible attachments to the tube and ovaries. 

The hardest part of the operation is separating the uterus from its attachments at the level of the vagina, and doing it in a way that the blood supply can be safely controlled.  The ureters overlie the main blood vessels to the uterus (uterine artery), just before they enter the bladder, and are especially vulnerable.



Recovering from a hysterectomy

A hysterectomy has risks such as heavy bleeding and infection that you should discuss with your doctor. You may experience effects from the anaesthetic.

You’ll be in hospital for a day or two, and perhaps up to seven days.

There’ll be vaginal bleeding and discharge for up to a few weeks after surgery.

Some women find a hysterectomy very difficult emotionally, worrying that they have lost something important about being a woman.

You won’t be able to lift heavy objects or do anything strenuous for at least a few weeks. Standing for long periods can also be tiring.

You should contact your doctor if pain worsens or if you develop nausea or vomiting, or bleeding that’s heavier than a menstrual period.


Bleeding after a hysterectomy

There is usually very little bleeding after hysterectomy. There will always be a wound at the top of the vagina where the cervix was, and this may bleed a little, but more than a couple of days is unusual. An infection at the top of the vagina can occur and will commonly present with bleeding.

Special care is required after hysterectomy – no heavy lifting and no sex for six weeks. Heavy lifting could disrupt the wound at the top of the vagina. Likewise, the wound at the top of the vagina can be disrupted by intercourse. 


Exercise and weight gain after a hysterectomy

Exercise is important and I encourage it as soon as it can be easily managed, but avoid heavy lifting!

Hysterectomy will not cause weight gain. A hysterectomy is usually performed on women in their 40s and weight gain at this stage of life is common.