What is a hysterectomy?

A hysterectomy is an operation to remove the womb (uterus) and sometimes other parts of a woman’s reproductive system. It can be used to treat cancers of the ovary, womb, cervix and fallopian tubes and sometimes cancer of the vagina that has spread. A hysterectomy is also occasionally used to treat changes in the cells of the cervix that aren’t cancerous but may develop into cancer.

There are two types of hysterectomy:

  • A total hysterectomy – This is when the womb and cervix are removed.
  • A radical (or Wertheim's) hysterectomy – This is when the womb, cervix, tissue around the cervix, fallopian tubes, pelvic lymph nodes, part of the vagina and sometimes ovaries are removed.

The type of surgery you have will depend on your type of cancer, its size and how far it has grown. The operation is done by a surgeon who is an expert in this type of surgery.

The female reproductive system

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
The female reproductive system

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The female reproductive system includes:

Ovaries

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.

Womb (uterus)

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.

Cervix

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.

Vagina

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.


Why women may have a hysterectomy

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). A hysterectomy is only done when CIN keeps coming back and if a woman has completed her family or been through the menopause.


Types of hysterectomy

There are different types of hysterectomy. The operation you have will depend on your type of cancer, its size and if it has spread (stage), and how the cancer cells look (grade).

  • Total hysterectomy removes the womb and the cervix.
  • Radical hysterectomy (or Wertheim’s hysterectomy) removes the womb, cervix, fallopian tubes. It sometimes removes the ovaries, upper part of the vagina, supporting tissue and pelvic lymph nodes.

A hysterectomy may also involve:

Removing both ovaries and fallopian tubes called bilateral salpingo-oopherectomy (BSO for short). It’s usually carried out during a hysterectomy for womb, ovarian and fallopian tube cancers.

Removing pelvic lymph nodes. Lymph nodes (or glands) are small, bean-shaped structures. They are part of the body's lymphatic system, which protects against infection and drains fluid from body tissues. Your surgeon may remove some or all the lymph nodes in the pelvis to check if the cancer has spread.

Removing the omentum (called an omentectomy). The omentum is the fatty layer that covers the bowel. It helps support the organs nearby, but it's not essential. It’s a common place for gynaecological cancer to spread to, particularly ovarian cancer.


Hysterectomy for different cancers

The kind of hysterectomy you have, and any other surgery, usually depends on the type and stage of the cancer.

Ovarian cancer

Women usually have a total hysterectomy. The surgeon also removes the ovaries and the fallopian tubes and usually the omentum. They may also remove some lymph nodes from your tummy (abdomen) and pelvis.

If the cancer has started to grow on the outside of the bowel, part of the bowel may also be removed. If possible, the surgeon removes the affected piece of bowel and rejoins the two remaining pieces of bowel together.

Womb (endometrial) cancer

Women usually have a total hysterectomy. The surgeon also removes both ovaries and fallopian tubes. In younger women with very early cancer, some surgeons may leave one ovary behind to prevent early menopause. You may have some or all the lymph nodes in the pelvis and tummy removed.

Cervical cancer and vaginal cancer

Women usually have a radical hysterectomy. In younger women with early cancer, the surgeon usually leaves the ovaries behind to prevent early menopause.

Fallopian tube cancer

You may have a total hysterectomy and the ovaries and fallopian tubes will also be removed. The surgeon may also remove the omentum (omentectomy) and the lymph nodes in the pelvis.


How a hysterectomy is done

A hysterectomy can be done in different ways. The most common way is through the abdomen (tummy).

Abdominal hysterectomy

The operation is carried out under general anaesthetic. The surgeon makes a 10cm (4in) cut (incision) across your tummy just above the pubic hair, or downwards from the belly button to the pubic hair. The womb and any other organs are removed through the incision. The surgeon repairs the muscles and tissues and closes the wound with staples or a continuous stitch. Sometimes a skin glue is used. They cover the wound 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.

Vaginal hysterectomy

When a hysterectomy is carried out through the vagina, there is no scar. It’s done under general anaesthetic. The surgeon removes the womb and cervix through a cut at the top of 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 hysterectomy

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 suitable for everyone.

Instead of a large wound in your lower tummy, you have several small cuts. The surgeon inserts small surgical instruments and a laparoscope (a telescope with a camera on the end) through these cuts. The womb and ovaries are then removed through the vagina.

A small number of hospitals carry out keyhole surgery using robotic equipment. The surgeon has very precise control of the movement of the robotic equipment. The camera on the end of the laparoscope produces a 3D magnified view of inside of the body to help guide the surgeon.

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Your feelings

It’s natural to feel strong emotions before and after a hysterectomy. Every woman will feel differently.