Hysterectomy

Overview

A hysterectomy is an operation to remove the womb (the uterus). The womb is where a baby grows during pregnancy. Depending on the reason for surgery, the surgeon may also remove the cervix (the neck of the womb), the fallopian tubes, or the ovaries. After this operation, you can no longer get pregnant.

Yes. Hysterectomy is one of the most common gynaecological operations performed in the UK and around the world.

It is most often done in women between the ages of 40 and 55. However, it can be done in younger or older people if they have certain medical conditions.

Symptoms

Common symptoms

• The operation itself does not have symptoms. The symptoms below are common reasons a hysterectomy might be suggested:
• Very heavy or painful periods that affect your daily life
• Long-term pelvic pain or pressure
• Bleeding between periods or after sex
• A feeling of fullness or a lump in your pelvis

Symptoms in children

• Hysterectomy is not performed in children. If a child has womb-related problems, they need specialist care from a paediatric gynaecology team.

Symptoms in older adults

• Recovery after hysterectomy may take longer in older adults. They may also have other health conditions, such as heart or lung problems, that need careful planning before surgery.

Causes

Main causes

• Uterine fibroids – non-cancerous growths in the womb wall that can cause pain and heavy bleeding
• Endometriosis – a condition where tissue similar to the womb lining grows outside the womb
• Adenomyosis – endometriosis inside the womb muscle, causing pain and heavy periods
• Uterine or cervical cancer – cancer that requires removing the womb to remove the tumour
• Uterine prolapse – when the womb drops down into the vagina
• Chronic pelvic pain that has not improved with other treatments
• Very heavy bleeding (also called heavy menstrual bleeding) that affects your health and quality of life

Risk factors

• Being over 40
• A family history of uterine, ovarian, or cervical cancer
• Having given birth multiple times (for prolapse)
• Obesity (being overweight)
• Certain conditions like endometriosis or polycystic ovary syndrome
• Previous pelvic surgery

When to see a doctor

See a doctor urgently if:

• You have sudden, heavy bleeding from the vagina and feel dizzy or faint
• You have severe pelvic pain that does not go away or gets worse
• You notice a new lump or bulge in your vagina

Book a routine appointment if:

• You have period pain or bleeding that is interfering with your normal life
• You have pelvic pressure, pain during sex, or a feeling of fullness that lasts for weeks
• You have been told you have fibroids or endometriosis and want to discuss your options

Diagnosis

A hysterectomy is a treatment, not a disease. Before you are offered one, your doctor will work out what is causing your symptoms. This usually starts with a conversation about your health, an internal examination, and some tests.

Tests that may be done

• Pelvic ultrasound – a scan that uses sound waves to look at your womb and ovaries
• Blood tests – to check for anaemia or other health conditions
• MRI scan – a detailed scan that can give a clearer picture of the womb and surrounding tissues
• Endometrial biopsy – a small sample of the womb lining is taken to check for abnormal cells
• Hysteroscopy – a thin telescope is passed through the vagina to look inside the womb
• Smear test (also called a cervical screening) – checks the cervix for early changes

What to expect at your appointment

Your doctor will explain the results and what they mean. If a hysterectomy seems to be an option, your specialist will talk through the different types of surgery, the risks and benefits, and what recovery will look like. It is okay to ask questions and take time to decide.

Treatment

Hysterectomy is a major operation, but it is only one of several possible treatments for many conditions. Your doctor will usually suggest trying other options first, unless the situation is urgent or cancer is involved.

Self-care at home

• After surgery, follow the exact advice your surgical team gives you about resting and moving around
• Take short walks to help your blood circulation, but do not push yourself
• Avoid lifting anything heavy, including shopping bags or children, for at least 6 weeks
• Drink plenty of fluids and eat high-fibre foods to avoid constipation during recovery
• Gently wash the wound as instructed and keep it dry
• Take over-the-counter pain relief only if your healthcare team says it is safe for you

Medical treatments

Alternative treatments depend on what is causing your symptoms. For heavy bleeding, options include simple pain relief, hormonal treatments (such as a hormonal coil or tablets) and medicines to reduce bleeding. For fibroids, procedures like uterine artery embolisation or myomectomy (removing only the fibroids) may be possible. For prolapse, a ring pessary or pelvic floor exercises may help. These options do not remove the womb, so pregnancy may still be possible. Your doctor will explain which ones are suitable for your situation.

When is surgery considered?

Surgery is considered when other treatments have not worked, when your symptoms are very severe, or when cancer is found or suspected. It may also be recommended for womb prolapse that causes significant discomfort.

Living with this condition

For the first few weeks after surgery, you will need plenty of rest. Most people can go home within a few days, but full recovery takes time. You may have some vaginal bleeding or discharge for the first 4 to 6 weeks. You can gradually return to normal activities, but check with your surgeon before heavy lifting or intense exercise. If your ovaries were removed, you may have hot flushes and other menopause symptoms, which you can discuss with your doctor.

Lifestyle tips

• Build a gentle routine with short, frequent rests
• Avoid swimming or taking baths until your wound has healed and your team says it is safe
• Wear loose, comfortable clothing
• Ask for help with household chores and children during recovery
• Plan ahead for your return to work, especially if your job is physically demanding

Diet and exercise

Eating well helps your body heal. Include plenty of fruit, vegetables, whole grains, and lean protein. Drink enough water. Gentle walking from the first day or two after surgery is encouraged. Avoid heavy exercise, such as running or lifting weights, for at least 6 weeks. Your doctor or a physiotherapist can give you specific advice.

Mental health and emotional wellbeing

Having a hysterectomy can affect how you feel about your body, your identity, and your sense of womanhood. Some people feel sadness, grief, or loss, especially if they could not have children or wanted more children. These feelings are normal and important. It can help to talk with your partner, family, or a counsellor. If you feel very low, anxious, or hopeless, tell your GP or a member of your healthcare team.

Prevention

You cannot always prevent the conditions that lead to a hysterectomy, such as cancer or some types of fibroids. However, a healthy lifestyle and early medical attention for pelvic symptoms may give you more treatment options and help you avoid emergency surgery.

Screening programmes

Regular gynaecological check-ups and cervical screening (smear tests) can detect early changes that may lead to serious problems. Screening does not prevent hysterectomy itself, but catching problems early can sometimes lead to less invasive treatments.

Complications

If left untreated

• If a condition like heavy bleeding, fibroids, or endometriosis is left untreated, symptoms may become worse over time and affect your quality of life
• In the case of cancer, delaying treatment can allow the cancer to spread, which reduces the chance of effective treatment
• Uterine prolapse can lead to difficulty emptying your bladder or bowels if not addressed

Long-term outlook

For most people, a hysterectomy brings relief from painful symptoms and allows them to regain their quality of life. The operation can be the right choice for many, and thousands of people recover well every year. Your healthcare team will support you throughout the process, and it is important to be honest about any worries you have. With time, rest, and support, most people return to a full and active life.

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