Hysterectomy: An expert guide

A hysterectomy procedure may be performed for a variety of reasons, from unresolved pelvic pain to prolapse of the uterus. In this informative guide, revered consultant obstetrician and gynaecologist Mrs Sajitha Parveen shares her expert insight on when a hysterectomy may be indicated as well as what to expect from the recovery period following surgery.

What is a hysterectomy, and how exactly is it performed?

Hysterectomy is the removal of the womb. It can be performed in several ways and with different approaches. It can be done through the tummy (abdomen) which is called abdominal hysterectomy or can be performed using the vaginal approach, known as vaginal hysterectomy.

The approach used for each patient is chosen depending on the clinical condition. For patients with prolapse, the vaginal approach is preferred. Abdominal hysterectomy is performed as an open procedure or as a keyhole (laparoscopic) procedure. Depending on whether the neck of the womb is retained or removed, we refer to the procedure as either a total or subtotal hysterectomy.

Are all women suitable for a hysterectomy?

There are several factors which are taken into consideration when assessing a patient's suitability for hysterectomy. This depends on the cause and indication for hysterectomy, the size of the womb, any previous abdominal surgeries or prior treatment to the neck of the womb, other medical conditions and the BMI of the patient, all of which can affect the decision making.

When is a hysterectomy indicated?

Depending on the clinical pathology, a hysterectomy will be considered if other simple treatment has failed. For example, if a patient is suffering from heavy periods and all other treatment has failed, hysterectomy may be considered. Additionally, in cases of cancer of the lining of the womb or ovarian cancer, hysterectomy can be considered.

What can patients expect in terms of results?

As with any operation, it is important to be aware of possible complications, although they are unlikely. Hysterectomy is a major surgery with a small risk of infection, injury to the nearby structures and clots in the legs or lungs. However, continued advances in surgical techniques mean that nowadays, hysterectomy procedures are very safe.

When performed for patients suffering from prolapse, they will see an immediate improvement following surgery. For patients who have been suffering from heavy periods, menstrual bleeding and periods will stop. Some patients may experience menopausal symptoms after undergoing a hysterectomy.

Contraception is not needed after hysterectomy to prevent pregnancy, but it is still advised to use condoms to protect against sexually transmitted infections.

How should patients prepare for a hysterectomy?

Patients should not eat or drink for 6 hours before undergoing surgery. Shaving any hair is not necessary and, if needed, clipping can be done. It's important to remove nail varnish before your operation.

If you are experiencing diarrhoea or vomiting, you should reschedule the procedure. It is also advised that you take precautions to avoid exposure to COVID-19. If you feel unwell or have a temperature or flu like symptoms, you should perform a lateral flow test.

What should patients expect from the recovery period following surgery?

After the procedure, it's important to get plenty of rest. You should not lift any heavy weights for at least six weeks following surgery. It's important to stay active after undergoing a hysterectomy, but cautiously so, and strenuous physical activity should be avoided for at least six weeks.

You should also wait six weeks before resuming sexual activity or swimming. It's also advised to wear TEDS stockings for six weeks after surgery to help prevent clots.

Most people wait between 2 and 6 weeks before resuming driving. You should not drive until you can safely perform an emergency stop and are comfortable wearing a seat belt. Some people visit their GP to check that they are fit to drive after surgery and your car insurance company may require this type of certification.

If you require a hysterectomy and wish to schedule a consultation with Mrs Parveen, you can do so by visiting her Top Doctors profile.