What is it?
You are having trouble with the periods. They may be heavy, painful, or not regular, or all three. The doctors have not been able to find any serious cause. At the same time, they have not been able to find anything to help. If your womb is taken out (hysterectomy), the problem is solved. This is done through a cut in the vagina (a vaginal hysterectomy). At the same time, if the ovaries (the small glands that produce the eggs) are diseased, they can be taken out as well, with the Fallopian tubes (which connect the ovaries with the womb). This is called a salpingo-oophorectomy. Rarely, the operation cannot be safely finished through the vagina. This may be because the womb is too large, or fixed to other organs. It is then necessary to make a cut in the tummy to free the womb and take it out from above.
You will have a general anaesthetic and will be completely asleep. A cut is made in the upper part of the vagina. This will not leave any visible scar. The womb is taken out. If the ovaries are diseased, they will need to be taken out as well. This will usually require an abdominal incision (see Abdominal hysterectomy). The space fills in naturally. The wound in the top of the vagina is then closed up. All tissue is sent to the laboratory to be examined under the microscope. You will be in hospital for about three days. If both ovaries are taken out, you may have menopausal problems such as hot flushes and dizzy spells. You can stop them by taking hormone replacement therapy (HRT). This can be started at the time of the hysterectomy. A small pellet of HRT may be implanted under the skin. It may even help you get over your operation quicker.
A new way of hysterectomy is using keyhole surgery to free off the body of the womb. This is followed by bringing the womb out through the vagina. This can lead to a 2-3 day hospital stay if it goes well. If not, the tummy has to be opened as for an abdominal hysterectomy. Your gynaecologist will be able to advise you.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you.
On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
You will probably have a small/thin plastic tube (a drip) in an arm vein. This gives you salt and sugar and water, and sometimes blood, for a day or so from a plastic bag on a stand. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. There may be a gauze pack in the vagina to absorb any ooze of blood. This is usually taken out the next day. You may have some backache. You may be given injections or tablets by the nurses for the pain.
By the end of two days you should have little pain. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that time. The nurses will help you with everything you need until you can do things for yourself. You will have some blood and urine tests in the first few days after your operation. These will check you are not anaemic and have no infection in the urine. If you have had the ovaries taken out, the HRT pellet will stop hot flushes for about six months. You can decide about more HRT then. You may have a fine tube (catheter) in the bladder to drain it for a day or so after the operation. The wound in the top of the vagina is out of sight. There may be some discharge from the vagina after the gauze is taken out. There will be slight bleeding like the end of a period. It should be almost nil by the time you leave hospital. Use pads. Do not use tampons for six weeks. There are stitches in the top of the vagina. Sometimes the surface knots of the stitches will appear on the pads with some bleeding after about two weeks. This is quite normal. If the bleeding is heavy, contact the ward.
You will be able to take a bath or shower as often as you wish. You do not need salt water. Do not soak in the bath for more than 10 minutes. Try to keep the wound area dry for a week.. You will be given an appointment for an Out Patient check up about six weeks after you leave hospital. They will have the results of the tests on the womb then. Some hospitals leave check -ups to the General Practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
At home, you are likely to feel tired and need rest two or three times a day for three to four weeks. You will gradually improve. After three months, you should be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort, generally after six weeks. You will be able to start sexual relations before your six-week check, if you are comfortable and have no bleeding or discharge. You may be able to return to a light job after about eight weeks, but you will not be able to cope with a busy job until at least 12 weeks.
As with any operation under general anaesthetic there is a very small risk of complications related to your heart or you lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Most hysterectomies are without complication. Minor complications happen in up to 2% of cases. Chest infections may arise, particularly in smokers. Do not smoke. Occasionally the bladder is slow to start working again. This requires patience. You may need the catheter back in the bladder for a few days. Wound infection is sometimes seen. This settles down with antibiotics in a week or two. Aches and twinges may be felt in the wound for up to six months. Sometimes there are numb patches in the skin around the wound which get better after two to three months. Sometimes scarring in the vagina makes intercourse difficult or uncomfortable. This usually settles down with time.
More serious complications happen very rarely and can include severe bleeding or damage to your bladder, bowel and vessels and may require another operation to fix them.