Having a hysterectomy
A hysterectomy is an operation to remove the womb, and it's used as a treatment for many different conditions.
Why women may have a hysterectomy
Back to top
A hysterectomy is one of the main treatments for cancers of the ovary, womb, cervix and fallopian tubes. Women with vaginal cancer may sometimes need a hysterectomy if their cancer has spread further. Cancers of these organs are sometimes called gynaecological cancers.
Surgery is usually carried out in specialist cancer centres or units by surgeons who are experts in this type of surgery. You'll be referred to a specialist cancer nurse (gynae-oncology nurse specialist) who will give you information and emotional support.
A hysterectomy is occasionally used to treat changes in the cells of the cervix that aren't cancerous but may develop into cancer. These cell changes are called cervical intra-epithelial neoplasia (CIN). CIN is often treated by removing the affected cells during a large loop excision of the transformation zone (LLETZ) or, less commonly, a cone biopsy. A hysterectomy is only done when CIN keeps coming back and if a woman has completed her family or been through the menopause.
We have information about CIN and its treatment in our section on cervical screening.
The female reproductive system
Back to top
A woman's reproductive system is made up of the parts of the body involved in having sexual intercourse, producing and fertilising eggs, carrying a baby and giving birth. A hysterectomy can be carried out for cancers that start in any of these organs.
The female reproductive system includes:
There are two ovaries, one on either side of the womb. In women who haven't reached menopause, one of the ovaries produces an egg each month, which travels down the fallopian tube to the womb.
This is about the size and shape of a small pear and is where a baby grows during pregnancy. In between periods, an egg travels down one of the fallopian tubes and into the womb.
The lining of the womb gets thicker and ready to receive the fertilised egg. If the egg is not fertilised by sperm, the thickened lining of the womb is shed as a period. The whole cycle then begins again.
This is the opening from the womb to the vagina. It’s a ring of muscle that can relax and open to allow a baby to pass through during childbirth.
This is also called the birth canal. The vagina is a muscular tube that runs from the cervix to the outside of a woman's body.
There are different types of hysterectomy. The operation you have will depend on the type of cancer you have, and its stage and grade.
The stage of a cancer describes its size and whether it has spread. The grade refers to how the cells look when examined under a microscope. This gives an idea of how the cancer may behave.
Once your specialists know the stage and grade of your cancer, they can decide on the most appropriate treatment for you. The different types of hysterectomy are:
a total hysterectomy, which is the removal of the womb and cervix
a radical (or Wertheim's) hysterectomy, which is the removal of the womb, cervix, tissue around the cervix (parametrium), fallopian tubes, pelvic lymph nodes, the upper part of the vagina and sometimes the ovaries
a sub-total hysterectomy, which is the removal of the womb but not the cervix. This operation is rarely done to treat cancer.
Other surgery you may have
At the same time as having your womb removed, you may have some other surgery as well. This will depend on the type and stage of the cancer you have. Other surgery may include:
Removal of both ovaries and fallopian tubes. You may have both your ovaries and fallopian tubes removed. This is called bilateral salpingo-oopherectomy, or BSO for short. It’s usually carried out during a hysterectomy for womb, ovarian and fallopian tube cancers.
Omentectomy (removal of the omentum). The omentum is an apron of fatty tissue that lies in the upper abdomen near the stomach. It helps support the organs nearby, but it's not essential to us. The omentum is a common place for gynaecological cancer to spread to, particularly ovarian cancer.
Removal of the lymph nodes. Lymph nodes (or glands) are small, bean-like structures that are part of the body's lymphatic system. The lymphatic system is one of the body's natural defences against infection. One of the ways a cancer may spread is through the nearby lymph nodes. The lymph nodes in the pelvis are often removed during a hysterectomy to find out if a cancer has spread. They may all be removed (called lymphadenectomy), or just some of them may be removed (lymph node sampling).
Which type of hysterectomy will I have?
The kind of hysterectomy you have, and any other surgery, usually depends on the type of cancer.
You’ll probably have a total hysterectomy, which means that the womb and cervix are removed. This is usually done in combination with removing both your ovaries and fallopian tubes (bilateral salpingo-oopherectomy). You’ll usually have an omentectomy, and the lymph nodes in the pelvis may also be removed. Sometimes the appendix is removed. If the cancer has spread to the bowel or the lining of the abdomen (peritoneum), the affected parts may also be removed.
Sometimes, if part of the bowel has to be removed, the upper end of the bowel will need to be brought out onto the skin of the abdomen. This is known as a colostomy, and the opening of the bowel is known as a stoma. Usually the colostomy is temporary, but in some situations it may be permanent.
Womb (endometrial) cancer
You’ll probably have a total hysterectomy, which means that the womb and cervix are removed. This is done in combination with removing both ovaries and fallopian tubes (bilateral salpingo-oopherectomy).
You may have an omentectomy, and the lymph nodes in the pelvis may be removed.
In younger women, some surgeons may leave one ovary behind to prevent early menopause. However, an ovary can only be left behind if the cancer is still in the early stages and there are no signs that it has spread.
Cervical cancer and vaginal cancer
You’ll probably have a radical (Wertheim's) hysterectomy. This involves removing the womb, the cervix and its surrounding tissue, fallopian tubes, pelvic lymph nodes, the upper part of the vagina and sometimes the ovaries.
In younger women with early cancers (cancer that is still in the first stages and hasn't spread), the ovaries are usually left behind to prevent early menopause, but they are usually removed in older women.
Fallopian tube cancer
The operation is similar to the surgery for ovarian cancer. You may have a total hysterectomy, which involves removing the womb and cervix. The ovaries and fallopian tubes will also be removed (bilateral salpingo-oopherectomy). You may also have an omentectomy (removal of the omentum), and the lymph nodes in the pelvis may also be removed.
About the operation for a hysterectomy
Back to top
A hysterectomy can be done in different ways. The most common way of carrying out a hysterectomy for cancer is through the abdomen (tummy).
The operation is carried out under general anaesthetic. The surgeon makes a 10cm (4in) cut across your abdomen, just above the pubic hair. Alternatively, they may need to cut downwards from the belly button to the pubic hair.
The surgeon removes the womb, and other organs where necessary, and lifts them out through the cut in your abdomen. The muscles and tissues are repaired, and the wound is closed with staples or a continuous stitch. Sometimes a special skin glue is used. The wound is then covered with a dressing. You can expect to be in hospital for 3-7 days after a total hysterectomy, and 5-8 days after a radical hysterectomy.
When a hysterectomy is carried out through the vagina, there is no scar. It’s done under general anaesthetic. The surgeon makes the necessary cuts internally and then gently removes the womb, and other organs where necessary, through the vagina. The surgeon then sews up the top of the vagina. You are usually in hospital for 2-4 days after this operation.
Keyhole surgery (also called laparoscopic surgery) is sometimes used to carry out a hysterectomy for cancers of the womb and cervix. The advantages are that you usually only need to stay in hospital for 2-3 days and your recovery is much faster. However, this operation is not appropriate for everyone.
Instead of having a large wound in your abdomen, you’ll have several smaller wounds, which eventually won't be noticeable. The doctor makes small cuts (incisions) in your abdomen. Small surgical instruments and a laparascope (a telescope with a camera on the end) can be inserted through these. The womb and ovaries are then removed through the vagina.
Before and after your operation for a hysterectomy
Back to top
Before your operation
You’ll have some tests to prepare you for surgery and to make sure that it can be done as safely as possible. You’ll usually have blood and urine tests and your blood pressure checked. Some women may also have a chest x-ray, an electrocardiogram or ECG (heart tracing), or a heart scan (echocardiograph). These tests are usually done a few days or weeks beforehand at a pre-assessment clinic.
You will usually be admitted to hospital on the day of your operation. If you have other medical conditions, such as diabetes that is controlled with insulin, you may be admitted the day before your operation. A doctor will explain more about your operation and ask you to sign a consent form.
You will see an anaesthetist before your operation. A nurse may shave some of your pubic hair to make sure the area is as clean as possible to prevent infection. You will be asked not to eat or drink anything for several hours before your operation.
If you smoke, try not to smoke for a few days before your operation. It's best to have your lungs free from cigarette smoke when you are having a general anaesthetic.
After your operation
You’ll be encouraged to start moving about as soon as possible. You’ll have been given support stockings to wear before your operation. These help prevent blood clots developing in the legs, and you may be asked to wear them for up to six weeks after you go home. While you're in hospital you'll be given small injections under the skin (subcutaneous) to prevent blood clots.
If you have to stay in bed, it's important to keep up regular leg movements and deep breathing exercises. A physiotherapist or specialist nurse will show you how to do these.
Drips and drains
You’ll usually have a drip (intravenous infusion) to give you fluids until you’re able to eat and drink normally, which is usually after a few days.
You may have a drainage tube in your wound or tummy (abdomen) to drain excess fluid into a small bottle. This is usually removed after a few days.
Normally, a small tube (catheter) is put into your bladder and urine is drained into a collection bag. The catheter will be removed when you become more mobile.
It's quite normal to have some pain or discomfort for a few days, but this can be controlled effectively with painkillers. It's important to let your doctor know as soon as possible if the pain is not controlled, so that your painkillers can be changed.
You may be given painkillers through an epidural for the first day after surgery. This is a small, thin tube that is inserted in the space just outside the membranes surrounding your spinal cord in your back. This gives you continuous pain relief.
Some women may be given painkillers through a small pump attached to the arm or hand. This is called Patient Controlled Analgesia (PCA). It allows you to release painkillers directly into the bloodstream by pressing a button. The machine is set so that you always get a safe dose and can't have too much.
Care of your wound
After a hysterectomy, the wound is closed using clips, stitches or sometimes, skin glue. Clips or stitches are usually removed after you go home by a practice nurse at your GP surgery. Some surgeons use dissolving stitches, which don't need to be removed. These will dissolve completely when the area is healed. Dissolving stitches are also used for a vaginal hysterectomy.
At first your scar will look like a red line, but this will gradually fade until it looks like a thin white line. It may also feel itchy and a bit lumpy. It's important to let your doctor know straight away if your wound becomes hot, painful or begins to bleed or leak any fluid.
It’s important to have a bath or shower every day while you are in hospital and when you go home.
It's common to have a vaginal discharge for up to six weeks after your hysterectomy. This is usually reddish brown in colour. If the discharge becomes bright red, heavy, or contains clots, or if the discharge is smelly, contact your doctor straight away. Use sanitary pads rather than tampons, which can increase the risk of an infection at this time.
Possible risks of surgery
Complications from having a hysterectomy are rare. However, as with any major surgery, there are risks. These include a reaction to the anaesthetic, bleeding, a blood clot - usually in a vein in the leg - or an infection, such as a wound or urine infection.
Following a radical hysterectomy, some women may have difficulty passing urine once their catheter has been removed. This is a temporary effect and the catheter usually needs to stay in for 2-3 weeks until normal bladder function returns.
Rarer complications can include injury to nearby nerves, organs and tissues in the abdomen. Some women develop lymphoedema in their legs. This is a swelling of the limbs caused by a build-up of lymph fluid in the tissues. It can happen as a result of the lymph nodes being removed during a hysterectomy.
We have more information in our section about lymphoedema.
If you think you may have problems when you go home - for example, if you live alone or have lots of stairs to climb - let the nurse or hospital social worker know when you’re admitted. Social workers are often available to give practical advice and many are also trained counsellors. If you would like to talk to a social worker, you can ask your nurse to arrange it for you.
Before you leave hospital you’ll be given an appointment to return to a clinic for a check-up. This is a good time to discuss any problems you may have. If you have any problems or worries before this time, you can phone your ward nurses, hospital doctor, gynae-oncology nurse or GP.
Going home - recovering after a hysterectomy
Back to top
It's important to get plenty of rest when you go home after a hysterectomy.
You may find you feel tired for several weeks or longer, so try to take things easy and have regular rest periods. Getting back to normal is a gradual process and can take some time.
It will also take a while for your abdominal (tummy) muscles and skin to heal. You will need to avoid strenuous physical activity or heavy lifting for at least three months. Some women also find it uncomfortable to drive for a few weeks after their operation, so it may be a good idea to wait a while before you start driving again. Your insurance company may have guidelines about this. You can also contact the DVLA (Drivers and Vehicles Licencing Association) for advice.
Looking after or supporting a family can be hard even when you are well. Women with young children or elderly relatives to care for won't be able to do all the things that they usually manage for several weeks after a hysterectomy. This can be difficult to adjust to and cope with. It's important to be realistic about what you can manage and to accept help from your partner, family and friends. You can also speak to a social worker about getting help for a while after your operation. We have more information on childcare for parents with cancer.
It's usually safe to start gentle exercise as soon as you feel able to after your hysterectomy. Walking is good exercise. Begin with 10 minutes a day, gradually increasing it as you feel able. You can do gentle swimming once your wound has healed and any vaginal discharge has stopped. Avoid strenuous exercise for at least 12 weeks.
It also helps to get into the habit of doing regular pelvic floor exercises. These help to keep the bladder muscles strong and prevent stress incontinence. A physiotherapist or community continence adviser can give you more information about these exercises.
The amount of time before you return to work will depend on the type of work you do, how much surgery you’ve had and how you are recovering. Depending on your individual circumstances, it may be anything from six weeks to three months after your operation.
You may need more time off if you’re having further treatment (chemotherapy and radiotherapy). Your doctor can give you advice on when to return to work.
Some women may want to work part-time at first. There may be certain things that your employer can do to make things easier for you. If you usually stand for long periods, you can ask to do work that allows you to sit more. If you sit for long periods, it’s important to get up and move around every now and then.
We have more information in our section on work and cancer..
One of the common questions women ask after a hysterectomy is whether the operation will affect their sex life. Getting back to a normal sex life after a hysterectomy is perfectly safe and healthy. You won't have any more periods or be able to become pregnant.
To allow the wound to heal properly, most women are advised to wait at least six weeks after their operation before having sexual intercourse. After this time many women find that they have no difficulties in their sexual relationships. However, some women do have problems.
Once the womb is removed, the surgeon stitches up the top end of the vagina. This makes it slightly shorter than before, which is not usually a problem. To begin with, while healing is taking place, you may want your partner to be gentle, or you may not want to have penetrative sex.
A hysterectomy may affect a woman's experience of orgasm. Most women find that they are still able to have an orgasm, but the sensation may be different from before the operation.
Some women may be frightened that sex will be painful after a hysterectomy. They may feel less feminine or worry that their partners will feel differently about them. Your partner may be concerned about causing any discomfort and may also need some reassurance.
Another fear may be that cancer can be passed on to your partner during intercourse. This is not true and it's perfectly safe for you to continue to have a sexual relationship.
Knowing that the operation was needed because of a cancer can also cause anxiety and tension. For some women, this may result in a decreased sex drive or a loss of sexual pleasure for a while.
Any sexual problems usually settle with time, as life begins to get back to normal after the surgery. If they don't improve, your doctor or specialist nurse will be able to give you advice. They may be able to arrange for you to have counselling, which is often helpful.
We have more detailed information in our section on sexuality and cancer.
Early menopause after a hysterectomy
Back to top
In younger women who are still having periods, removing the ovaries will bring on an early menopause. This can be difficult to cope with, particularly when you are already coping with cancer.
For some women it may be a difficult reminder that they can no longer have children. An organisation called The Daisy Network supports women who have had an early menopause.
Some of the main physical effects of the menopause are:
vaginal dryness, which can make sexual intercourse uncomfortable
lowered sex drive (libido).
Some women may be prescribed hormone replacement therapy (HRT), depending on the type of cancer they have. This can help reduce some of the changes caused by the menopause. Taking HRT under the age of 50 to help with some of the symptoms of an early menopause doesn't increase your risk of getting breast cancer.
Lubricants such as KY Jelly, Aquaglide®, Senselle®, Replens MD® or Sylk® vaginal moisturiser (a natural product made from kiwi fruit) can be bought from most chemists and can ease any discomfort during intercourse. We have more information on how menopausal symptoms can be managed.
Fertility after a hysterectomy
Back to top
Being told that you have cancer and that treatment will make you permanently infertile can be very difficult. You may be single or already have children, or may not have thought about becoming a mother before. Whatever your situation, the loss of fertility can be overwhelming.
Women can ask to be referred to a fertility specialist before their hysterectomy. Women who have a partner and are interested in surrogacy (another woman carrying a child in her womb for you) may want to share embryos (fertilised eggs).
Due to the immediate need for surgery and the wait to see an infertility specialist on the NHS, some women may have their eggs collected privately before their operation. Some women may also want to consider adoption.
We have more information on cancer and fertility.
It takes time to come to terms with a cancer diagnosis. You’re likely to experience a number of emotions, from shock and disbelief to fear and anger. Major surgery can often leave you feeling vulnerable.
Younger women in particular often find it difficult to come to terms with the fact that they can no longer have children after a hysterectomy. You may feel as if you have lost some of your identity as a woman. These are all natural, understandable emotions to have at this time.
Everyone has their own way of coping with difficult situations. Some women find it helpful to talk to friends and family, while others prefer to get help from people outside their situation. Some women prefer to keep their feelings to themselves.
There is no right or wrong way to cope and help is there if you need it. Counselling can usually be arranged by the hospital or your GP. We can give you information about counselling in your area.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment. You may also find some of the following organisations useful.
The Daisy Network Premature Menopause Support Group
The Daisy Network has a confidential service for women who have had an early menopause. You can shares experiences and it has a list helpful books.
Fertility Friends is a web-based information and support community. Message boards allow you to ask a nurse questions and you can chat with other people affected by infertility.
National Osteoporosis Society
The National Osteoporosis Society has a national helpline answered by experienced nurses, publications and a network of support groups.
The Hysterectomy Association
The Hysterectomy Association provides information to women who are facing a hysterectomy.
This information has been compiled using information from a number of reliable sources, including:
Almadrones-Cassidy L. Site-Specific Cancer series: Gynecologic Cancers. Oncology Nursing Society. 2010.
Falcone T, Overview of hysterectomy, Up-to-Date website http://www.uptodate.com (accessed October 2012).
National Institute for Health and Clinical Excellence (NICE). Laparoscopic techniques for hysterectomy. November 2007.
Tobias, Hochhauser. Cancer and its management. 6th edition. 2010. Wiley-Blackwell.
With thanks to June Allen, Lead Cancer Nurse, and the people affected by cancer who have reviewed this information. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.