What is a vaginal hysterectomy?

A vaginal hysterectomy is an operation to remove your uterus (womb) and cervix (neck of your womb) through your vagina.

It is possible also to remove your ovaries but they will usually be left alone.

What are the benefits of surgery?

There are common reasons for having a hysterectomy:

• Heavy or painful periods.
• Fibroids, where part of the muscle of your womb becomes overgrown.
• Uterine prolapse, where your womb drops down.

A hysterectomy may cure or improve your symptoms. You will no longer have periods.

Are there any alternatives to a vaginal hysterectomy?

• Symptoms may be improved by doing pelvic floor exercises.
• Heavy periods can be treated using a variety of non-hormonal and hormonal oral (by mouth) medications. Other alternatives include an IUS (intra-uterine system - an implant containing a synthetic form of the hormone progesterone that fits in your womb) or 'conservative surgery' to remove the lining of your womb or prevent it from growing each month.
• Depending on the size and position of fibroids, you can take medication to try to shrink them and control the symptoms. Other treatments include surgery to remove the fibroids only (myomectomy) or to shrink the fibroids by reducing their blood supply (uterine artery embolisation).

What will happen if I decide not to have the operation or the operation is delayed?

Your doctor will monitor your condition and try to control your symptoms.

You may feel that you would prefer to put up with your symptoms rather than have an operation. Your gynaecologist will tell you the risks of not having an operation.

If you experience any of the following symptoms, contact your healthcare team:

• Changes to your monthly bleeding pattern if you have periods.
• Increased abdominal (tummy) swelling.
• Worsening pain that needs more medication than you are currently taking.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation usually takes about 45 minutes.

Your gynaecologist will examine your vagina. They will make a cut around your cervix at the top of your vagina so they can remove your womb and cervix.

They will usually stitch the support ligaments of your womb to the top of your vagina to reduce the risk of a future prolapse and may place a pack (like a large tampon) in your vagina.

If the video doesn't load, try this Vaginal Hysterectomy.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• feeling or being sick
• bleeding
• venous thromboembolism
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• acute kidney injury
• chest infection

Specific complications of this operation

• pelvic infection or abscess
• developing an abnormal connection (fistula) between your bowel, bladder or ureters and your vagina
• damage to structures close to your womb
• conversion to an abdominal hysterectomy
• developing a collection of blood (haematoma) inside your abdomen
• vaginal cuff dehiscence
• recurrent prolapse
• new prolapse

Long-term problems

• developing a prolapse
• difficulty or pain having sex
• tissues can join together in an abnormal way
• passing urine more often, having uncontrolled urges to pass urine or urine leaking from your bladder when you exercise, laugh, cough or sneeze
• feelings of loss as a hysterectomy will make you infertile
• going through menopause

Consequences of this procedure:

• pain
• you will no longer have periods or be able to get pregnant

How soon will I recover?

You will be able to go home when your healthcare team decides you are medically fit enough, which is usually after 1 to 3 days.

Rest for 2 weeks and continue to do the exercises that you were shown in hospital.

You can return to work once your doctor has said you are well enough to do so (usually after 4 to 6 weeks, depending on your type of work). You should be feeling more or less back to normal after 2 to 3 months.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most women make a good recovery and return to normal activities.

Summary

A hysterectomy is a major operation usually recommended after simpler treatments have failed. Your symptoms should improve.

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