Hysterectomy

This surgery involves the complete removal of the uterus (womb) and the cervix, which is the neck of the womb. This is the most commonly performed type of hysterectomy. By removing the cervix as part of this procedure, this means that there is no risk of cervical cancer developing in the future.

In this procedure, the main body of the uterus is removed, but the cervix is left in place. This means that there is still a risk of cervical cancer and cervical screening tests (smear tests) will still need to be carried out.

Some women prefer a subtotal hysterectomy over a total hysterectomy as they want to be able to maintain their reproductive system as much as possible. Subtotal hysterectomy is a procedure that is not performed very often as surgeons tend to favour a total hysterectomy.

Bilateral salpingo-oophorectomy refers to the removal of both (bilateral) fallopian tubes (salpingo) and ovaries (oophorectomy). The uterus and cervix are also removed. Because the ovaries are removed, this will trigger menopause.

The National Institute for Health and Care Excellence (NICE) only recommends this particular type of hysterectomy if the ovaries are likely to cause problems if left in situ. A surgeon may recommend this type of hysterectomy if you have a family history of ovarian cancer, for example.

This involves the removal of the uterus and all surrounding tissues, including the ovaries, fallopian tubes, part of the vagina, lymph glands and fatty tissue. Because the ovaries are removed as part of this procedure, this will trigger a surgical menopause.

This is a much more extensive type of hysterectomy and is usually carried out to remove and treat cancer. A radical hysterectomy is recommended if other cancer treatments, such as chemotherapy or radiotherapy, have not worked.

Fibroids are benign (noncancerous) growths made up of muscle and fibrous tissue that develop in or around the uterus. They range from the size of a pea up to the size of a melon. Some women may not even be aware that they have fibroids, but around one in three will experience fibroids symptoms such as heavy or painful periods, abdominal or lower back pain and pain during sex.

In endometriosis, tissue similar to that found in the uterus starts growing where it shouldn’t be, for example on the ovaries or fallopian tubes. This can be incredibly painful and lead to heavy and irregular periods. A hysterectomy will usually only be considered as a treatment if other less-invasive treatments have not worked.

After childbirth, the tissues and ligaments supporting the uterus may become weak, causing it to drop down from its normal position and bulge into the vagina. Women with a prolapsed uterus, who are post-menopausal or who do not plan on having any more children, may be suitable for a hysterectomy. This can help to relieve the pressure on the vaginal walls, cutting the chance of a prolapse recurring. 

A hysterectomy is carried as a cancer treatment only when all other treatments, such as chemotherapy and radiotherapy, have not worked. A hysterectomy may be carried out to treat cervical cancer, ovarian cancer, cancer of the uterus or cancer of the fallopian tubes.

Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. It can be successfully treated with antibiotics if caught early, but as it progresses it can damage the uterus and fallopian tubes, resulting in long-term pain.

Sometimes heavy periods are caused by fibroids, but in many cases it isn’t clear why a woman suffers from heavy periods. As well as losing lots of blood, a woman experiencing regular heavy periods may suffer from stomach cramps and pain, affecting her quality of life.

In this condition, tissue that normally lines the uterus starts to grow within the muscular wall of the uterus, causing a great deal of pelvic pain and period pain.

Laparoscopic (keyhole) surgery is by far the preferred method to carry out a hysterectomy. Laparoscopy is a minimally-invasive surgical procedure which allows the surgeon to see inside the abdomen and pelvis without having to make large cuts through the skin. Instead only a small incision is needed, just big enough to allow a small tube with a light and camera (a laparoscope) into the body. Surgical instruments will be inserted through other small incisions made in the abdomen or vagina to remove your uterus, cervix and any other parts of the reproductive system. A laparoscopy is usually carried out under a general anaesthetic. It is the least invasive of the three hysterectomy procedures.

A vaginal hysterectomy, where the uterus and cervix are removed through a cut made at the top of the vagina, can be carried out under a general, local or spinal anaesthetic.

Once the incision has been made special surgical instruments are put into the vagina to gently detach the uterus from the ligaments that hold it in place. After the uterus and cervix have been removed, dissolvable stitches are used to close the incision.

A vaginal hysterectomy is a less invasive procedure than an abdominal hysterectomy and the recovery time is usually quicker.

An abdominal hysterectomy is usually recommended if your uterus has been enlarged by fibroids of pelvic tumours, making it physically impossible to remove the uterus through the vagina.

The surgeon will make a horizontal incision along the bikini line to remove the uterus. If there are particularly large fibroids present, then a vertical incision, stretching from the belly button to the bikini line, may be used instead.

An abdominal hysterectomy takes around one hour to perform under a general anaesthetic. It is the most invasive surgical option.