What Is a Hysterectomy?

In a hysterectomy, the surgeon removes the womb, the organ where a baby grows and the source of monthly periods. Depending on the reason for surgery, the cervix (the neck of the womb), the fallopian tubes and the ovaries may be removed too. The operation is done under anaesthesia, through the abdomen, through the vagina, or with keyhole instruments.

There are four main types, depending on what is removed:

• Subtotal (supracervical) hysterectomy — the body of the womb is removed and the cervix is left in place.
• Total hysterectomy — the whole womb and the cervix are removed. This is the most common type.
• Total hysterectomy with bilateral salpingo-oophorectomy (BSO) — the womb, cervix, both tubes and both ovaries are removed. Removing both ovaries before the natural menopause causes surgical menopause.
• Radical hysterectomy — the womb, cervix, upper vagina and surrounding tissue are removed, usually for cancer and by a gynaecological oncology team.

Hysterectomy is one of the most common gynaecological operations. Because it is permanent, guidelines advise that it should be offered for clear medical reasons and after other suitable options have been discussed.

When Is Hysterectomy Really Needed?

The table shows common reasons for hysterectomy, and what else may be considered:

Hysterectomy, Fertility and Hormones

Many women are told only that the womb will be removed. It helps to understand exactly what that means for pregnancy and for hormones, because the answers depend on whether the ovaries stay or go.

• Pregnancy — after hysterectomy you cannot carry a pregnancy, and periods stop. This cannot be reversed.
• If your ovaries are kept — they continue to release hormones, so you do not go into menopause because of the operation. Some women reach menopause a little earlier than they otherwise would.
• If both ovaries are removed — menopause begins straight away, with hot flushes, sleep disturbance, vaginal dryness and effects on bone health. This is especially important before the age of natural menopause. Hormone replacement therapy (HRT) is often discussed, and the decision depends on your health and the reason for surgery.
• Having a biological child later — if the ovaries are kept, eggs may still be collected, and a gestational carrier is one option in places where the law allows it. Laws on surrogacy differ widely between countries, so seek advice before relying on this option.
• Before surgery for cancer — in younger women, fertility preservation such as egg or embryo freezing should be discussed before treatment starts, where it is safe and time allows.
• The cervix — if it is left in place (subtotal hysterectomy), you still need routine cervical screening. After a total hysterectomy for a non-cancer reason, screening is often no longer needed, but your doctor will confirm this for you.
• Sex and pelvic floor — many women find sexual function is unchanged or improved once pain and bleeding stop. Some notice changes, and it can help to talk about this openly before surgery.

Abdominal, Vaginal, Laparoscopic and Robotic: How Do the Routes Differ?

The same operation can be done in different ways. Figures below are typical and vary with the person and the hospital:

For non-cancer conditions, guidelines generally favour a vaginal or laparoscopic route where it is safe and possible, because recovery is usually faster. The best route for you depends on the size of your womb, previous surgery, your condition and your surgeon's training.

Options to Consider Before Hysterectomy

For many non-cancer conditions, one or more of these may be tried first. Whether they suit you depends on your diagnosis, age and plans for pregnancy:

• Medicines — tranexamic acid, anti-inflammatory tablets, hormonal pills, or hormone treatments that reduce bleeding or shrink fibroids for a time.
• Hormonal coil (levonorgestrel IUS) — often very effective for heavy periods and some adenomyosis symptoms.
• Endometrial ablation — treats the womb lining to reduce or stop bleeding. It is not suitable if you may want a pregnancy.
• Myomectomy — removes fibroids and keeps the womb, which matters if you want to conceive.
• Uterine artery embolisation — blocks the blood supply to fibroids, done by an interventional radiologist.
• Hysteroscopic treatment — removes polyps or fibroids inside the womb cavity through the vagina.
• Pessary or pelvic floor therapy — for prolapse, without surgery or with a repair that keeps the womb.

What Happens Before, During and After?

• Before — you will have a consultation, blood tests, and often an ultrasound or MRI. You are usually asked to fast for several hours beforehand. Tell your doctor about all medicines, allergies and any blood-thinning treatment. Decisions about the cervix and ovaries should be agreed, and written down, before the day.
• During — under general or spinal anaesthesia, the womb is detached and removed by the planned route. The operation often takes one to three hours, depending on the type and route. A catheter may be placed in the bladder for a short time.
• Straight after — you are encouraged to sit up and walk early, which lowers the risk of blood clots. You may be given stockings or blood-thinning injections, and regular pain relief.
• Following days — bleeding or brown discharge for a few weeks is common. Tiredness, bloating, constipation and wound soreness are normal. Mood changes and tearfulness are also common and not a sign of weakness.
• Return to routine — commonly about two to four weeks after laparoscopic surgery and six to eight weeks after open surgery. Avoid heavy lifting until your surgeon allows it.
• Intimacy and the vaginal wound — the top of the vagina is stitched and needs time to heal. You are usually advised to avoid sex and anything inserted into the vagina for around six weeks, until your doctor confirms healing.
• Findings — the removed tissue is usually sent for laboratory examination. Ask when the report will be ready and for a clear explanation of the result.

Seek medical help promptly if you have fever, severe or worsening abdominal pain, heavy bleeding (soaking a pad in an hour), foul-smelling discharge, a red or leaking wound, difficulty passing urine, leakage of urine from the vagina, or a painful, swollen calf. Chest pain or sudden breathlessness is an emergency and needs immediate care.

Risks to Know About

Hysterectomy is generally safe in experienced hands, but it is major surgery:

• Anaesthetic risks — nausea, sore throat and, rarely, more serious reactions.
• Bleeding — occasionally a blood transfusion or further surgery is needed.
• Infection — of the wound, the urine, or the top of the vagina. Usually treatable with antibiotics.
• Injury to nearby organs — the bladder, ureters (the tubes from the kidneys) or bowel can be damaged. This is uncommon, but may need repair.
• Blood clots — in the leg veins or lungs. Early walking and preventive treatment lower this risk.
• Bladder and bowel changes — urinary problems or constipation can occur, usually temporary.
• Early menopause — if the ovaries are removed, and sometimes earlier menopause even if they are kept.
• Vaginal cuff problems — slow healing, bleeding, or rarely the cuff opening.
• Adhesions, hernia and long-term pelvic floor changes — scar tissue can form after any abdominal surgery, and prolapse of the vaginal vault can develop years later.
• Emotional effects — some women feel grief or loss, even when surgery was the right choice. Counselling and support can help.
• Symptoms may not fully go — especially for pelvic pain without a clear cause.

Questions to Ask Before Agreeing to Hysterectomy

• Why do I need it? — and what exactly is my diagnosis?
• What else could we try first? — and what happens if I wait or choose not to operate?
• Which type, and why? — will my cervix, tubes and ovaries stay or go, and why?
• Which route do you recommend? — and what would change it on the day?
• What does it mean for my hormones? — and will I need HRT?
• Could I need pregnancy or my own eggs in the future? — if so, what can be done first?
• What are the risks in my case? — including organ injury and conversion to open surgery.
• Who will operate, and how often do they do this procedure?
• Can I get a second opinion? — it is reasonable to ask for one for a permanent operation.
• Will I get everything in writing? — including the consent form, the full cost and the pathology report.

Red Flags to Watch For

• Hysterectomy advised as the first or only option for a condition where medicines or other procedures could be tried.
• No scan, examination or clear diagnosis before surgery is recommended.
• Ovaries removed without discussion — especially before menopause, when the effect on hormones and bone health matters.
• No discussion of fertility — in a woman who may still want children.
• Promise that surgery will cure all pain — no honest doctor can guarantee this, particularly for pelvic pain.
• No second opinion allowed, or no written explanation of the plan and consent.
• “Advanced” or “laser” branding used to justify a higher price — the surgeon's skill and the reason for surgery matter more than the label.
• Pressure to decide or pay quickly when the condition is not an emergency.

Frequently Asked Questions

Is hysterectomy major surgery?

Yes. It is a major operation under anaesthesia, although keyhole and vaginal routes usually mean a shorter hospital stay and faster recovery than open surgery.

Will I go through menopause after a hysterectomy?

Not necessarily. If your ovaries are left in place, you do not go through menopause because of the operation, although you will stop having periods. If both ovaries are removed before natural menopause, menopause starts straight away.

Can I still have a baby after a hysterectomy?

You cannot carry a pregnancy without a womb. If your ovaries are kept, it may be possible to have a biological child with a gestational carrier, where the law in your country allows it. This should be discussed before surgery.

How long will I be off work?

This depends on the route and your job. Many women return after about two to four weeks following keyhole surgery, and after six to eight weeks following open surgery. Heavy physical work may take longer.

Will a hysterectomy affect my sex life?

Many women find it unchanged or improved because pain and bleeding settle. Some notice changes in sensation or desire, especially if the ovaries are removed. You will be advised to wait about six weeks for the vaginal wound to heal before having sex.

Will I gain weight or age faster?

Hysterectomy itself does not directly cause weight gain. Changes in activity during recovery, and menopause if the ovaries are removed, can affect weight and energy. Regular activity and a balanced diet help.

Will I need HRT?

Not everyone does. If both ovaries are removed before the usual age of menopause, HRT is commonly discussed to manage symptoms and protect bone health. Whether it is right for you depends on your health and the reason for surgery.

Do I still need cervical screening?

If your cervix was left in place, yes. After a total hysterectomy for a non-cancer reason, screening is often no longer needed, but follow your doctor's advice based on your previous results.

Is hysterectomy safe?

Serious complications are uncommon, and the operation is widely performed. It is still major surgery, so it should be done for good reasons, by a trained surgeon, in a well-equipped hospital.

Why does StemRx publish this information?

Because many women are advised to have a permanent operation without a clear explanation of the reasons, options or risks. We believe informed patients make safer decisions, whether or not they choose to be treated with us.