What You Need to Know About Hysterectomy Surgery

10 Aug What You Need to Know About Hysterectomy Surgery

A hysterectomy is an operation to remove the uterus and may be recommended for conditions such as fibroids, adenomyosis, persistent heavy bleeding, endometriosis or gynaecological cancer. Different surgical approaches are available, including abdominal, vaginal, laparoscopic and robotic-assisted techniques. The appropriate procedure depends on the condition being treated, the planned extent of surgery and your individual clinical circumstances. Learn more about hysterectomy surgery.

Key takeaways

• A hysterectomy removes the uterus, meaning periods stop and pregnancy is no longer possible.
• It may be considered when symptoms are severe or have not improved with other treatments.
• The ovaries are separate from the uterus and are not automatically removed during a hysterectomy.
• Hysterectomy may be performed through an abdominal, vaginal, laparoscopic or robotic-assisted approach.
• Recovery depends on the surgical approach, the complexity of the procedure and your general health.

What is a hysterectomy?

A hysterectomy is a major gynaecological operation involving the removal of the uterus, also called the womb.

Once the uterus has been removed, menstrual periods stop and it is no longer possible to carry a pregnancy. However, a hysterectomy does not automatically involve removing the ovaries. Whether the fallopian tubes or ovaries are removed is a separate decision discussed before surgery.

When may a hysterectomy be recommended?

A hysterectomy may be discussed when a gynaecological condition is causing significant symptoms or affecting quality of life, particularly when previous treatments have not provided adequate relief.

Reasons may include:

• Persistent heavy or painful periods
• Adenomyosis
• Symptomatic uterine fibroids
• Endometriosis associated with ongoing pelvic pain
• Uterine prolapse
• Certain gynaecological cancers
• Uncontrolled uterine bleeding in uncommon emergency situations

Fibroids

Uterine fibroids are non-cancerous growths arising from the muscle of the uterus. They may cause heavy bleeding, pelvic pressure, urinary symptoms or abdominal enlargement.

Treatment depends on the size, number and location of the fibroids, as well as the symptoms they cause. Hysterectomy may be considered when symptoms are significant, other treatments have not helped or preserving the uterus is no longer a treatment priority.

Adenomyosis

Adenomyosis occurs when tissue similar to the lining of the uterus grows within its muscular wall. It may cause painful periods, heavy bleeding, chronic pelvic pain and an enlarged uterus.

Medical and hormonal treatments are often considered first. Hysterectomy may be discussed when symptoms remain severe or persistent despite other management options.

Endometriosis and pelvic pain

Hysterectomy may sometimes form part of the treatment plan for endometriosis or chronic pelvic pain. However, pelvic pain can have more than one cause, and removing the uterus may not address endometriosis located elsewhere in the pelvis.

A detailed assessment is therefore important before deciding whether hysterectomy is appropriate.

What are the different types of hysterectomy?

The type of hysterectomy refers to which reproductive structures are removed.

Total hysterectomy

A total hysterectomy removes the uterus and cervix. This is the most commonly discussed form of hysterectomy.

Subtotal hysterectomy

A subtotal or partial hysterectomy removes the main body of the uterus while leaving the cervix in place.

If the cervix remains, ongoing cervical screening may still be required.

Radical hysterectomy

A radical hysterectomy removes the uterus, cervix and additional surrounding tissues. It is generally performed as part of treatment for certain gynaecological cancers rather than benign conditions.

Salpingectomy and oophorectomy

A salpingectomy is the removal of one or both fallopian tubes. An oophorectomy is the removal of one or both ovaries.

These are separate procedures that may be performed at the same time as a hysterectomy where clinically appropriate. Your surgeon should explain exactly which structures are planned for removal before you provide consent.

Will the ovaries be removed during a hysterectomy?

The ovaries are not automatically removed during hysterectomy.

For benign conditions, the ovaries are typically preserved because they continue producing hormones even beyond menopause. The decision depends on factors such as age, ovarian health, cancer risk, symptoms and the reason for surgery.

If both ovaries are removed before natural menopause, menopause begins immediately. Menopausal hormone therapy may then be discussed depending on your circumstances.

How is hysterectomy surgery performed?

Hysterectomy can be performed through several surgical approaches.

Abdominal hysterectomy

An abdominal hysterectomy is performed through an incision in the lower abdomen. It may be used where open access is required because of the condition being treated or the complexity of the operation.

Vaginal hysterectomy

During a vaginal hysterectomy, the uterus is removed through the vagina without an abdominal incision. This approach may be used for selected conditions, including some cases of uterine prolapse.

Laparoscopic hysterectomy

Laparoscopic hysterectomy is performed through several small abdominal incisions using a camera and specialised instruments.

It is a minimally invasive approach and is associated with smaller incisions, a shorter hospital stay and earlier recovery than traditional abdominal surgery.

Robotic-assisted hysterectomy

Robotic-assisted hysterectomy is a form of minimally invasive surgery in which the surgeon controls specialised robotic instruments and a high-definition three-dimensional camera.

The system does not perform the operation independently. Every movement is directed by the surgeon.

Robotic technology can provide enhanced visualisation, precision and instrument movement during complex gynaecological procedures. Learn more about robotic gynaecological surgery.

How do you prepare for a hysterectomy?

Preparation varies according to the procedure, your health and the hospital where surgery will be performed.

Before surgery, your gynaecologist should discuss:

• Why hysterectomy is being recommended
• The type and surgical approach planned
• Which organs will be removed
• Potential benefits and risks
• Available alternatives
• Expected hospital stay and recovery
• The effect on periods, fertility and menopause
• When you may return to work, exercise and sexual activity

Pre-operative assessment may include blood tests, imaging, medication review, an anaesthetic assessment and other tests based on your medical history.

You may also need to arrange:

• Time away from work
• Transport home from hospital
• Help with household responsibilities
• Support during the early recovery period
• Comfortable clothing and sanitary pads for light post-operative bleeding

Follow the specific instructions provided by your surgeon, anaesthetist and hospital.

What happens after hysterectomy surgery?

After surgery, you will be monitored while the anaesthetic wears off. Pain relief, fluids and medication to reduce complications may be provided.

You will usually be encouraged to begin gentle movement as soon as it is safe. Walking supports circulation, bowel function and general recovery.

During the early recovery period, you may experience:

• Abdominal or pelvic discomfort
• Fatigue
• Light vaginal bleeding or discharge
• Temporary constipation
• Bloating
• Changes in bladder function
• Reduced energy and stamina

Your hospital stay and recovery time will depend on the surgical approach and your individual progress. Minimally invasive hysterectomy often involves a shorter hospital stay and recovery than open abdominal surgery.

How long does hysterectomy recovery take?

Recovery is gradual and varies from person to person.

Many patients undergoing vaginal, laparoscopic or robotic-assisted hysterectomy recover more quickly than those undergoing abdominal hysterectomy. However, even when external incisions are small, internal healing still takes time.

The first one to two weeks

Rest is important, although regular gentle walking is usually encouraged. Pain, tiredness and light bleeding may still be present.

Activities should be increased gradually according to your surgeon’s instructions.

Weeks three to four

Energy and comfort may begin to improve. Some patients can return to light work and everyday activities during this period, depending on the procedure and the physical demands of their job.

Heavy lifting and strenuous exercise should still be avoided until medically cleared.

Weeks five to six and beyond

Many patients continue moving towards their normal routine. The timing of exercise, driving, lifting, penetrative sex and returning to physically demanding work should be discussed with your healthcare team.

Read more about recovery after a minimally invasive hysterectomy.

What are the possible risks of hysterectomy?

All surgery carries potential risks. Your individual risk depends on your health, the condition being treated and the surgical approach.

Possible complications include:

• Bleeding
• Infection
• Blood clots
• Urinary tract infection
• Reaction to the anaesthetic
• Injury to the bladder, bowel, ureters or surrounding structures
• Difficulty passing urine or opening the bowels
• Wound complications
• The need for additional treatment or surgery

Your surgeon should explain the risks most relevant to your procedure before surgery.

Seek medical advice after surgery if you experience symptoms such as increasing pain, fever, heavy bleeding, offensive discharge, difficulty passing urine, worsening wound redness or feeling significantly unwell.

What changes can occur after hysterectomy?

After hysterectomy:

• Menstrual periods stop
• Pregnancy is no longer possible
• Contraception is no longer required to prevent pregnancy
• Hormonal function may continue if the ovaries remain
• Menopause begins immediately if both ovaries are removed before natural menopause

Some patients experience temporary emotional changes while adjusting to surgery, recovery and the loss of fertility. Concerns about body image, sexuality or menopause can also occur.

Discuss these concerns with your gynaecologist, GP or another appropriate healthcare professional.

What is sex like after a hysterectomy?

Sexual activity is generally avoided during the early healing period. Your surgeon will advise when it is appropriate to resume penetrative sex.

Some patients notice temporary discomfort, reduced confidence or changes in desire during recovery. Many othersexperience an improvement in sexual wellbeing after symptoms such as heavy bleeding or pelvic pain have resolved.

If discomfort or concerns continue after recovery, speak with your doctor rather than assuming they are an unavoidable consequence of surgery.

Are there alternatives to hysterectomy?

The alternatives depend on the condition being treated and your personal goals.

They may include:

• Medication for pain or heavy bleeding
• Hormonal treatment
• A hormonal intrauterine device
• Endometrial ablation
• Uterine artery embolisation
• Myomectomy for fibroids
• Other minimally invasive procedures
• Continued monitoring where treatment is not immediately required

Hysterectomy is usually considered after reviewing the expected benefits, possible risks and available alternatives.

Making an informed decision about hysterectomy

Deciding whether to proceed with hysterectomy requires a clear understanding of your diagnosis, treatment options and personal priorities.

A specialist assessment can help determine:

• Why your symptoms are occurring
• Whether other treatments remain appropriate
• Which type of hysterectomy may be considered
• Whether a minimally invasive or robotic approach may be used
• Whether the ovaries or fallopian tubes should be removed
• What recovery may involve

Dr Kent Kuswanto is a Melbourne specialist gynaecologist with experience in robotic and minimally invasive hysterectomy procedures. To discuss your treatment options or seek a second opinion, contact Dr Kent Kuswanto’s team with your referral.