A hysterectomy is where you undergo surgery to remove your womb. In most cases this is carried out as elective surgery to improve health conditions in women approaching menopause (40-50 years old). Only 5% of hysterectomies1 are carried out due to cancer or because of bleeding after childbirth. This is a major surgical procedure, so is only under taken for women who no-longer want to get pregnant and have exhausted other avenues of treatment, which have been unsuccessful. Approximately 30,500 hysterectomies were carried out in England in 2012 and 2013.
Why do you need a hysterectomy?
There could me a number of reasons why you might be considered for a hysterectomy, and although your doctor will advise you, it is a personal decision at the end of the day. It could be used to help with the following conditions:
- Heavy or irregular periods. A third of the women in the UK say they suffer from heavy periods, and this can impact on your everyday life and wellbeing.
- Endrometriosis. This is a condition where menstrual tissue grows outside the womb, and as well as being painful can lead to tissue in other parts of the body fusing and forming scar tissue.
- Fibroids. These are benign growths of muscle and fibrous tissue that grow in the womb, which can be painful or cause heavy periods.
- An ovarian cyst. An ovarian cyst is a fluid-filled sack, which is usually harmless and will disappear on its own, however, sometimes they become too large, and can cause pelvic pain if they become twisted or burst.
- Uterine prolapse. This is where the womb has collapsed, or partially collapsed, and drops towards the vagina.
- Cancer is found. A hysterectomy is usually recommended if you’re diagnosed with cancer of the womb, ovarian cancer, or some cancers of the cervix.
- Premenstrual syndrome (PMS) (or PMT) is the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman’s period. One woman in 20 with PMS has severe symptoms. It’s rare for this to be a reason for a hysterectomy, but may be a contributing factor.
- Pelvic inflammatory disease (PID), occurs when microbes get into the womb – through sexually transmitted diseases or as a result of abdominal surgery – and spread to the fallopian tubes, ovaries and surrounding tissues. Again this is usually one of a number of reasons that might result in a hysterectomy if severe enough.
Who do I talk to about a hysterectomy?
If you think you may need a hysterectomy, in the first instance you should go and talk to your GP. They will assess your condition in full, and then discuss the pros and cons of this type of treatment with you. If you feel you want to go ahead, they will then refer you to a gynaecologist so they can help you to decide which procedure might be best for you.
Are there different sorts of hysterectomies?
The type of hysterectomy you have depends on your individual health needs. For instance, some women have their fallopian tubes removed too, if they’re considered at risk of having ovarian cancer in the future. Here are the main types of hysterectomy:
Total hysterectomy – this is the most common type, where the womb and cervix (the neck of your womb) is removed
Subtotal hysterectomy (also known as a partial hysterectomy or supracervical hysterectomy). The main part of the womb is removed leaving the cervix in place.
Total hysterectomy with salpingo-oophorectomy – is where your fallopian tubes and ovaries are removed in addition to your womb and cervix.
Radical hysterectomy – the womb, cervix and surrounding tissues are removed, including the ovaries, fallopian tubes, part of the vagina, lymph nodes and fatty tissue.
What’s involved in a hysterectomy?
There are three different types of surgery to carry out a hysterectomy, and which one you have will depend on your individual situation. Most hysterectomies are carried out under general anaesthetic. Occasionally it’s possible to have the procedure with an epidural, were you have an injection in your back to numb your abdomen and legs. The 3 main types of surgical hysterectomy are:
Vaginal hysterectomy – where a cut is made in the top of the vagina, and the womb is removed through it.
Abdominal hysterectomy – where a single, large cut, is made in the lower abdomen, and the womb is removed through it.
Llaparoscopic hysterectomy (keyhole surgery) – where your surgeon makes several small cuts are made in the abdomen for a tiny camera and instruments. The womb is then removed through a cut in the top of the vagina.
How much recovery time will I need after a hysterectomy?
Your body will need time to recover from having a general anaesthetic and surgery. Depending on the type of surgery you have, you could stay in hospital for up to five days, less if you have keyhole surgery. It will take 6-8 weeks for the muscles and tissues of your tummy to heal. During this time you should avoid any heavy lifting or strenuous exercise.
What happens to my body after a hysterectomy?
Following a hysterectomy, your periods will stop, and you’ll no-longer be able to get pregnant.
Women who have their ovaries removed as part of the procedure, will go through the menopause (known as a surgical menopause).
If you have a partial hysterectomy, which leaves your cervix in place, you should continue having regular smear tests. This cervical screening won’t be necessary if you have the other types of hysterectomy.
Are there any alternatives to a hysterectomy?
If you are considering having a hysterectomy to treat heavy bleeding, then it may be suitable for you to have a less invasive procedure, called an endometrial ablation. An ablation treats just the womb lining, rather than removing the whole womb. There are many different ways of performing this, including using laser energy, microwave energy, hot water and a heated cutting wire. However, at women’s clinic Twenty-five Harley Street, we use leading ablation method, the NovaSure Endometrial Ablation.
This is a safe procedure which is combined with a diagnostic hysteroscopy to assess the cavity of the womb, using a telescope with a small camera.
Then using NovaSure, our skilled gynaecologists use a controlled radio frequency energy for a safe and reliable ablation which takes between 90 and 120 seconds.
Patients recover for up to 2 hours, with most leaving the clinic within 30 minutes of the procedure with simple oral painkillers.
What do patients think of NovaSure ablation?
Consultant gynaecologist Mr Francis Gardner has adapted and developed a technique of pain relief for the NovaSure endometrial ablation which is based on the published work of Mr Henrik Skensved (Copenhagen). Mr Gardner’s team presented their data at the World Congress of Royal College of Obstetricians and Gynaecologist in 2016. Their study demonstrated the current technique provided the most consistent and best pain relief published to date any where in the world. The average pain score was just 1.1 on a visual analogue scale of 0 to 10 where 10 is the worst possible pain and 0 was nothing.
A study of the technique revealed that after three months of receiving the ablation, 70% of women reported that periods had ceased. The patients also reported a 95% reduction in menstrual dysfunction after having the NovaSure.
SOURCES: The Hysterectomy Association, NHS
1 Only 5% of hysterectomies are carried out due to cancer or because of extensive bleeding after childbirth, https://www.hysterectomy-association.org.uk/information/is-a-hysterectomy-right-for-me/.