How it's performed

There are different types of hysterectomy. The operation you have will depend on the reason for surgery and how much of your womb and reproductive system can safely be left in place.

The main types of hysterectomy are described below.

Total hysterectomy

During a total hysterectomy, your womb and cervix (neck of the womb) is removed.

A total hysterectomy is usually the preferred option over a subtotal hysterectomy, as removing the cervix means there's no risk of you developing cervical cancer at a later date.

Subtotal hysterectomy

A subtotal hysterectomy involves removing the main body of the womb and leaving the cervix in place.

As the cervix is left in place, there's still a risk of cervical cancer developing and regular cervical screening will still be needed.

Some women want to keep as much of their reproductive system as possible, including their cervix.

If you feel this way, talk to your surgeon about any risks associated with keeping your cervix.

Total hysterectomy with bilateral salpingo-oophorectomy

A total hysterectomy with bilateral salpingo-oophorectomy is a hysterectomy that also involves removing:

• the fallopian tubes (salpingectomy)
• the ovaries (oophorectomy)

The National Institute for Health and Care Excellence (NICE) recommends that the ovaries should only be removed if there's a significant risk of further problems – for example, if there's a family history of ovarian cancer.

Your surgeon can discuss the pros and cons of removing your ovaries with you.

Radical hysterectomy

A radical hysterectomy is usually carried out to remove and treat cancer when other treatments, such as chemotherapy and radiotherapy, are not suitable or have not worked.

During the procedure, the body of your womb and cervix is removed, along with:

• your fallopian tubes
• part of your vagina
• ovaries
• lymph glands
• fatty tissue

Performing a hysterectomy

There are 3 ways a hysterectomy can be performed.

These are:

• laparoscopic hysterectomy
• vaginal hysterectomy
• abdominal hysterectomy

Laparoscopic hysterectomy

Laparoscopic surgery is also known as keyhole surgery.

During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small cut (incision) in your tummy.

This allows the surgeon to see your internal organs. Instruments are then inserted through other small incisions in your abdomen or vagina to remove your womb, cervix and any other parts of your reproductive system.

Laparoscopic hysterectomies are usually carried out under general anaesthetic.

Vaginal hysterectomy

During a vaginal hysterectomy, the womb and cervix are removed through an incision that's made in the top of the vagina.

After the womb and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.

A vaginal hysterectomy can either be carried out using:

• general anaesthetic – where you'll be unconscious during the procedure
• local anaesthetic – where you'll be awake, but the area will be numb so you will not feel any pain
• spinal anaesthetic – where you'll be numb from the waist down

A vaginal hysterectomy is usually preferred over an abdominal hysterectomy as it's less invasive and involves a shorter stay in hospital. The recovery time also tends to be quicker.

Abdominal hysterectomy

During an abdominal hysterectomy, an incision will be made in your tummy (abdomen). It'll either be made horizontally along your bikini line, or vertically from your belly button to your bikini line.

After your womb has been removed, the incision is stitched up. The operation takes about an hour to perform and a general anaesthetic is used.

An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it's not possible to remove it through your vagina.

It may also be recommended if your ovaries need to be removed.

Getting ready

If you need to have a hysterectomy, it's important to be as fit and healthy as possible.

Good health before your operation will reduce your risk of developing complications and speed up your recovery.

As soon as you know you're going to have a hysterectomy:

• stop smoking
• eat a healthy, balanced diet
• exercise regularly
• lose weight (if you're overweight)

You may need to have a pre-assessment appointment a few days before your operation.

This may involve having some blood tests and a general health check to ensure you're fit for surgery.

It's also a good opportunity to discuss any concerns and to ask questions.

Find out more about how to prepare for surgery