Hysterectomy
What is a hysterectomy?
A hysterectomy is an operation to remove the uterus. In most cases, the cervix is also removed. Depending on the reason for surgery, the fallopian tubes and ovaries may also be removed.
Removing the uterus means you will no longer have menstrual periods or be able to become pregnant.
A hysterectomy is considered major surgery and is recommended only after careful discussion of the benefits, risks and alternative treatment options.
Why is this done?
A hysterectomy may be recommended to treat a range of gynaecological conditions when other treatments have been unsuccessful or are not appropriate.
Common reasons include:
- adenomyosis
- endometriosis
- gynaecological cancers or precancerous conditions.
Your specialist will explain why a hysterectomy has been recommended and discuss the treatment options available for your individual circumstances.
What are the alternatives to this treatment?
For many conditions, less invasive treatments may be appropriate before considering hysterectomy.
Depending on your diagnosis, these may include:
- medication
- hormone therapy
- Mirena insertion
- endometrial ablation
- removal of fibroids or polyps
- laparoscopic surgery.
Your specialist will discuss whether these options are suitable for you before recommending hysterectomy.
How is a Hysterectomy done?
The operation is performed under a general anaesthetic.
Several surgical approaches are available, and the most appropriate method depends on your condition, previous surgery, anatomy and the reason for the procedure.
Laparoscopic or robotic hysterectomy
Small incisions are made in the abdomen, and a camera (laparoscope) is inserted to perform the operation using specialised instruments. A robotic hysterectomy is in effect a laparoscopic hysterectomy but uses a robot to drive the instruments under the control of the gynaecologist.
This approach is associated with:
- smaller incisions
- less postoperative pain
- a shorter hospital stay
- a quicker recovery for many women.
Vaginal hysterectomy
The uterus is removed through the vagina without any abdominal incisions.
This approach may be suitable for selected women depending on the size of the uterus and the reason for surgery.
Abdominal hysterectomy
A larger incision is made across the lower abdomen (bikini line) or vertically through the abdomen.
This approach may be recommended when the uterus is significantly enlarged, cancer is suspected or more complex surgery is required.
The operation itself generally takes between one and two hours, although your total time in theatre and recovery may be longer.
What should I do before the procedure?
Before your operation:
- complete any investigations arranged during your pre-operative consultation
- continue your usual medications unless advised otherwise
- stop smoking if possible to reduce the risk of complications
- notify your specialist if you become unwell before surgery.
If bowel preparation has been recommended, follow the instructions provided by your healthcare team.
What should I do on the day of the procedure?
Eating and drinking
Unless advised otherwise, you should stop eating and drinking:
- from midnight before a morning procedure, or
- from 6.00 am before an afternoon procedure.
Your hospital will provide specific fasting instructions before surgery.
What should I bring?
Please bring:
- your usual medications
- recent imaging or scans
- toiletries
- comfortable nightwear
- underwear
- sanitary pads.
What should I expect after the procedure?
Following surgery, you will spend time in the recovery area before returning to the ward.
A urinary catheter is usually left in place until the following day, and intravenous fluids may continue for one or two days.
Most women remain in hospital for between two and five days, depending on the type of hysterectomy performed and their recovery.
It is normal to experience:
- abdominal discomfort
- tiredness
- light vaginal bleeding or discharge
- reduced energy levels during the first few weeks.
Pain relief will be provided, and your healthcare team will encourage you to begin walking as soon as it is safe to do so.
Recovering at home
You should:
- eat and drink normally
- remain gently active
- shower as normal
- use sanitary pads rather than tampons if required.
For approximately six weeks, you should avoid:
- heavy lifting
- strenuous exercise
- activities involving significant abdominal strain
- sexual intercourse until your specialist confirms it is safe.
Many women require between four and six weeks away from work, although recovery varies depending on the type of surgery and the physical demands of your occupation.
While many women feel well within several weeks, complete recovery may take up to three months.
How will a hysterectomy affect me?
Following a hysterectomy:
- you will no longer have menstrual periods
- you will no longer be able to become pregnant.
If your ovaries are removed during surgery, menopause begins immediately because the ovaries are no longer producing hormones.
Even if your ovaries are retained, menopause may occur slightly earlier than expected.
Some women notice temporary changes in bladder or bowel function during recovery. There is also a small increased risk of pelvic organ prolapse in the future, particularly following vaginal hysterectomy.
Studies have shown that hysterectomy does not generally reduce sexual function overall, although some women notice changes in sexual sensation or comfort. These experiences vary between individuals.
It is also common to experience numbness around the surgical scar, which may improve over time but can occasionally be permanent.
What are the complications of this procedure?
Every major operation carries some risk.
Although serious complications are uncommon, they can occur.
Anaesthetic risks
As with any procedure performed under general anaesthesia, there is a small risk of complications related to the anaesthetic.
Surgical risks
Potential complications include:
- injury to the bladder
- injury to the ureters (the tubes connecting the kidneys to the bladder)
- bowel injury
- bleeding requiring blood transfusion
- injury to major blood vessels
- conversion to a larger abdominal incision if required.
Recovery-related risks
Potential complications during recovery include:
- wound infection
- infection involving the bladder, lungs or abdomen
- blood clots affecting the legs or lungs
- delayed wound healing
- variable postoperative pain
- a longer-than-expected recovery.
Your specialist will discuss any risks that are particularly relevant to your individual circumstances before surgery.
What if I have any problems?
Contact your healthcare provider promptly if you experience:
- fever or feel generally unwell
- heavy vaginal bleeding
- offensive-smelling vaginal discharge
- increasing redness, swelling or discharge from your wound
- severe abdominal pain
- persistent nausea or vomiting
- difficulty passing urine or opening your bowels.
What can I expect?
For many women, a hysterectomy provides permanent relief from symptoms that have significantly affected their quality of life.
Recovery takes time, and it is important to allow your body to heal gradually. Your specialist will review you after surgery and discuss the findings, pathology results (if relevant) and any ongoing care that may be required.
What to remember
A hysterectomy is a major operation and should be considered only after discussing all appropriate treatment options with your specialist.
For women whose symptoms cannot be managed with more conservative treatments, hysterectomy can provide effective, long-term relief and significantly improve quality of life. Understanding the procedure, recovery and potential risks will help you feel prepared and informed before your surgery.
Further information
Additional information about hysterectomy is available through the Australasian Gynaecological Endoscopy & Surgery Society (AGES).
This article is intended for educational purposes only and should not replace personalised medical advice, diagnosis or treatment. Every article is written by a qualified specialist clinician and independently reviewed by a second specialist clinician to help ensure clinical accuracy and reflect current evidence-based practice.
