Hysterectomy

A hysterectomy is a surgical operation to remove the uterus (womb), the organ in a woman's lower abdomen where a baby grows during pregnancy.

Once the uterus is removed, menstrual periods stop permanently and pregnancy is no longer possible. Depending on the reason for the operation, the surgeon may also remove the cervix (the lower opening of the womb), the ovaries (the glands that produce eggs and hormones), or the fallopian tubes (the channels that carry eggs from the ovaries to the womb). The extent of the removal is decided before surgery based on the underlying condition and the patient's overall health.

A hysterectomy is used when other, less invasive treatments have not worked or are not suitable. It is most often recommended for conditions that cause serious pain, heavy bleeding, or risk of cancer.

• Uterine fibroids — non-cancerous (benign) growths in the wall of the womb that cause heavy periods or pressure on nearby organs.
• Endometriosis — a condition where tissue similar to the womb lining grows outside the uterus, causing chronic pain and sometimes infertility.
• Adenomyosis — a condition where the womb lining grows into the muscular wall of the uterus, causing heavy, painful periods.
• Uterine prolapse — when the uterus drops into or out of the vaginal canal because its supporting muscles and ligaments have weakened.
• Abnormal or uncontrollable uterine bleeding that has not responded to other treatments.
• Cancer or precancerous changes of the uterus, cervix, or ovaries.
• Persistent pelvic pain linked to the uterus when all other treatments have been tried.

A hysterectomy is generally not suitable for patients who still wish to become pregnant, as the procedure permanently ends fertility. It is also usually avoided in people whose condition can be successfully managed with medication, physiotherapy (physical treatment for muscles and tissues), or a less invasive procedure such as endometrial ablation (a technique that destroys the womb lining without removing the whole uterus). Your doctor will carefully weigh these options with you.

• Patients who want to preserve fertility.
• Conditions that respond well to hormonal medication or minimally invasive procedures.
• Patients whose overall health makes major surgery too risky, unless the surgery is considered life-saving.

Like all major surgery, a hysterectomy carries risks; most people recover without serious complications, but it is important to understand what can occur.

• Pain and discomfort in the lower abdomen during the recovery period.
• Bleeding during or after the operation, which occasionally requires a blood transfusion.
• Infection of the wound, urinary tract, or internal tissues, usually treated with antibiotics.
• Urinary problems, such as difficulty passing urine or an overactive bladder (a sudden, urgent need to urinate), which may be temporary.
• Damage to nearby structures — including the bladder, ureters (the tubes that carry urine from the kidneys to the bladder), or bowel — which is uncommon but may need further surgical repair.
• Blood clots (deep vein thrombosis) in the legs or lungs, which are more likely in patients who are less mobile after surgery.
• Early menopause (the end of the hormonal cycle) if the ovaries are removed, bringing symptoms such as hot flushes and mood changes.
• Vaginal vault prolapse — over time, the top of the vagina may weaken and descend.
• Scar tissue (adhesions) forming inside the abdomen, which can occasionally cause pain or bowel obstruction.
• Reactions to general anaesthesia (the medication that puts the patient to sleep for the operation), which are rare but possible.

Good preparation helps the surgery go safely and recovery go smoothly. The surgical team will give specific instructions in the days before the operation, and it is important to follow them closely.

Before the procedure, patients are typically asked to:

• Fast (avoid eating and drinking) for several hours before the operation — the exact period is set by the anaesthetist (the doctor who manages sleep and pain during surgery).
• Stop taking blood thinners, anti-inflammatory pain relief, or certain supplements as directed by the medical team, because these can increase bleeding risk.
• Stop smoking and avoid alcohol for as long as possible before surgery, as both slow wound healing and increase anaesthetic risk.
• Arrange for a family member or companion to accompany them on the day of surgery and to help at home afterwards.
• Prepare comfortable, loose clothing and personal items for a hospital stay of usually a few days.

Before confirming the surgery, the team usually arranges several tests to check the patient is fit for the operation. These may include:

• Blood tests to check for anaemia (low red blood cell count), infection, and kidney and liver function.
• A pelvic ultrasound (USG) or MRI scan to give the surgeon a clear picture of the uterus and surrounding structures.
• A cervical smear or biopsy (a small tissue sample) if cancer or precancer is suspected.
• An ECG (electrocardiogram — a recording of the heart's electrical activity) to check heart health before anaesthesia.
• A urine test to rule out a urinary tract infection before the operation.

On the day of surgery, the typical steps are:

• 1. The patient is admitted to the ward and their identity, consent forms, and fasting status are confirmed.
• 2. An intravenous (IV) line is placed in the arm so fluids and medications can be given directly into the bloodstream.
• 3. The anaesthetist meets the patient to review health history and explain how anaesthesia will be given.
• 4. General anaesthesia is administered and the patient falls into a deep, painless sleep.
• 5. The surgical team cleans and drapes the abdomen and, if needed, the vaginal area.
• 6. The surgeon performs the hysterectomy. This may be done through an open incision (cut) in the lower abdomen, through several small incisions using a laparoscope (a thin camera-guided instrument — keyhole surgery), or through the vagina. The approach depends on the patient's condition and the surgeon's assessment.
• 7. The uterus — and any other planned structures — is carefully detached from surrounding blood vessels and tissues and removed.
• 8. The surgical site is checked for bleeding, then closed with stitches or surgical clips.
• 9. The patient is moved to a recovery area where nurses monitor them as the anaesthesia wears off.

Recovery after a hysterectomy takes time and varies depending on the surgical approach used — open abdominal surgery generally requires a longer recovery than keyhole or vaginal approaches. Most patients stay in hospital for a few days and are monitored for pain, bleeding, and the return of normal bladder and bowel function before going home.

• Rest and restricted activity: For the first several weeks at home, heavy lifting, strenuous exercise, and sexual intercourse are usually not permitted. Your doctor will advise when it is safe to gradually return to normal activity.
• Wound care: If an abdominal incision was made, the wound should be kept clean and dry. Any dressings are changed as instructed. Signs of infection — increasing redness, swelling, discharge, or fever — should be reported to a doctor promptly.
• Vaginal discharge: A light, blood-tinged discharge from the vagina is normal for several weeks after surgery. Heavy bleeding or an unpleasant smell should be reported immediately.
• Pain management: Mild to moderate discomfort is expected. The medical team will recommend safe pain relief options during recovery.
• Preventing blood clots: Walking short distances as soon as the medical team allows it helps keep blood flowing. In some cases, blood-thinning medication is prescribed for a period after surgery.
• Bladder and bowel care: A urinary catheter (a thin tube to drain urine) is usually in place for the first day or two after surgery. Staying well hydrated and gradually increasing dietary fibre helps the bowel return to normal.
• If the ovaries were removed: Hormone changes happen quickly. Doctors may discuss hormone replacement therapy (HRT — medication to replace the hormones the ovaries no longer produce) to manage symptoms such as hot flushes, sleep disturbance, and mood changes.
• Emotional wellbeing: Feelings of grief, loss, or low mood after a hysterectomy are common and normal. Support from family, friends, or a counsellor can be very helpful.
• Follow-up appointments: The surgical team will schedule check-ups to assess healing and address any concerns. Attending all follow-up visits is important.
• Long-term: Once fully recovered, most women are able to return to their usual activities. If the cervix was kept, routine cervical screening (regular smear tests) should continue as recommended by the doctor.