Hysterectomy: everything you need to know

Published April 2023 | 7 min read
Expert contributor Professor Alex Polyakov, clinical associate at the University of Melbourne and Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Words by Katherine Chatfield

Having a hysterectomy is a big decision for many women. Making sure you’ve got all the information you need can help you feel reassured and comfortable with your decision.

A hysterectomy is an operation to remove the uterus (womb). Although it’s a major operation, it’s relatively common; one in three women in Australia has had a hysterectomy by the time she’s 60, and around 32,000 Australian women have hysterectomies every year.

The procedure is most often performed on women between the age of 30 and 50, and common reasons your doctor may recommend you have a hysterectomy include:

• menstrual problems (like very heavy bleeding or excessive pain)
• endometriosis (when tissue similar to the tissue in the lining of the uterus grows outside of the uterus in other parts of the body)
• fibroids (benign tumours, also referred to as myomas)
• uterine prolapse (when pelvic floor muscles and ligaments stretch and weaken and allow the uterus to drop into the vagina)
• cancer of the cervix, uterus, ovaries or fallopian tubes
• adenomyosis (when the lining of your uterus grows into surrounding muscles).

"It can be life changing and liberating for women to get rid of symptoms such as heavy bleeding or pain, or the fear that cancer is growing inside them," says associate professor Dr Alex Polyakov, clinical senior lecturer at the University of Melbourne and fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

What are the different kinds of hysterectomy?

There are four different types of hysterectomies. "The type you have depends on why you need the operation, and how much of your womb can be left in place safely," says Dr Polyakov. "Your doctor will work with you to determine which one is best for you."

1. Partial or subtotal hysterectomy: Your doctor removes most of the uterus except for the neck of the womb (cervix). It may be recommended when there are non-cancerous reasons for hysterectomy, like uterine fibroids or heavy menstrual bleeding.
2. Total hysterectomy: This is the removal of your uterus and cervix. It doesn't include removing your ovaries and fallopian tubes. Because studies show that ovarian cancer can start in the fallopian tubes, nowadays a bilateral salpingectomy (removal of both fallopian tubes) may be recommended.
3. Total hysterectomy with salpingo-oophorectomy: This removes your uterus, cervix, ovaries and fallopian tubes. If you’re still having periods, removing your ovaries will cause you to go into menopause and you may get the associated symptoms.
4. Radical hysterectomy: Your gynaecologist removes your whole uterus, including tissue on the sides of your uterus, your cervix and the top part of your vagina. This is usually only done when cancer is present.

How is a hysterectomy performed?

There are different ways of performing a hysterectomy. "Vaginal and laparoscopic surgeries generally have lower risks of infection and blood loss than open abdominal surgeries, along with shorter hospital stays," says Dr Polyakov.

Abdominal hysterectomies may be recommended with some cancers like ovarian cancer.

Laparoscopic hysterectomy (keyhole surgery): A laparoscope is a tiny instrument with a light and camera attached. It’s inserted through a small cut in your navel, along with two or three other small cuts for other instruments. The laparoscope allows the surgeon to see your internal organs, then insert an instrument to remove your womb. These are carried out under general anaesthetic.

Vaginal hysterectomy: The womb is removed through a cut around the outside of the cervix. Then the incision is sewn up. Vaginal hysterectomies can be carried out under general or local anaesthetic and take around an hour to complete. These are often preferred over abdominal hysterectomies as they are less invasive and usually involve a shorter stay in hospital.

Abdominal hysterectomy: The womb is removed through a cut in your abdomen, usually along your bikini line, or from your bellybutton down to your bikini line. It’s performed under general anaesthetic.

How long will I be in hospital after a hysterectomy?

"After a vaginal or laparoscopic hysterectomy, most women spend around one to four days in hospital, and around five days if you’ve had an abdominal hysterectomy," says Dr Polyakov.

Going to hospital can be a source of anxiety. Our Preparing for Hospital tool gives peace of mind with information on how much you can expect to pay for your hysterectomy and an explainer video about the procedure. This resource helps members make informed decisions, ask the right questions and find out what they need to know and do before they head to hospital.

Do I still need a cervical screening test after a hysterectomy?

"Yes," says Dr Polyakov. "We believe cancer of the cervix is caused by the human papilloma virus (HPV), which can cause changes in the top part of the vagina. These can be picked up by cervical screenings. If you’ve had a hysterectomy for previous atypical cells or cancer of the cervix, you must continue to have cervical screenings." If you've had a hysterectomy for other reasons, regular screenings are still important.

"There are other parts of the female reproductive tract that can cause issues, so it's still worth having screenings done every five years," says Dr Polyakov.

How long does it take to recover from a hysterectomy?

It can take six to eight weeks to fully recover from a hysterectomy. "I always advise people to take as much time as they can off work," says Dr Polyakov. "Some people might feel okay after a couple of weeks, but your body does need time to recover. Light exercise is okay after around four weeks, although wait for six weeks before driving. You mustn’t lift anything heavy. Refrain from sex until you’ve had your post-op check-up, which is usually at around six to eight weeks."

You may experience some pain, burning or swelling at the incision sites. "During the first few weeks some women can experience bowel and bladder issues. Most women experience some mild vaginal bleeding and discharge, which can last up to six weeks."

There can be small scars from laparoscopic or vaginal hysterectomies. Abdominal hysterectomies leave a scar, usually around the bikini line.

What happens to your body after a hysterectomy?

"You don’t need to use contraception to prevent pregnancy after having a hysterectomy. However, if you need to protect yourself from sexually transmitted infections (STIs), you should still use condoms," says Dr Polyakov. 

"If you’ve had your ovaries removed, you will go into immediate menopause. This can result in menopause symptoms including hot flushes, vaginal dryness, night sweats and insomnia. Your doctor may prescribe HRT to help manage these symptoms."

What are the risks of a hysterectomy?

Hysterectomy is considered a relatively safe and low-risk surgery. However, as with any surgery, there are risks of complications like infection, bleeding and blood clots or issues from having a general anaesthetic. There’s also a small risk of damage to other pelvic organs like bowel, bladder, ureters (the tube that carries urine from the kidney to the bladder), blood vessels and nerves.

"It’s beneficial to make sure you’re as prepared as you can be for surgery," says Dr Polyakov. "Good health means you’re less at risk of developing any complications and can also speed up your recovery. Before a hysterectomy, make sure you’ve stopped smoking, are eating a balanced diet, are a healthy weight and are exercising regularly, if possible."

If you have had a hysterectomy and your ovaries and fallopian tubes have been removed before your periods have stopped, you may experience some vaginal dryness, particularly if you aren’t taking HRT (now also known as menopausal hormone therapy or MHT). Some women experience a loss of libido, but for most it returns after they’ve fully recovered. "Many women find that relief from their symptoms, such as bleeding or pain, actually enhances their sex drive," says Dr Polyakov.

How will I feel about having a hysterectomy?

Although physical changes are expected after a hysterectomy, for many women it’s also an emotional experience. "'Hysterectomy remorse' is a real syndrome," says Dr Polyakov. "For some women, the fact they can no longer get pregnant or have periods can bring up feelings of grief and sadness. When those things are taken away from you it can be upsetting. It’s important to get in the right headspace before the procedure and have an honest and open discussion with your gynaecologist before the operation, so they can help you through the treatment."

Other women may feel relieved to no longer have periods, particularly if they were experiencing pain. "For many women, a hysterectomy significantly boosts their quality of life, and means they can live pain or worry free afterwards."

Having a hysterectomy

Celine, 50

"After having my second baby when I was 35, my periods became really heavy. I was on strong medication and going to the emergency room every month as I was in so much pain.

"It became clear a hysterectomy was the best option for me, and I discussed it with my GP. I had a total hysterectomy when I was 42, which left my ovaries intact. I was in hospital for three nights, and my pain was minimal.

"Emotionally, because I knew I’d had my children, I wasn’t grieving for what might have been. The thought of not having periods any more was a huge relief. I’m now on HRT, which is working well. I’d advise other women to do lots of research. Get opinions from two to three specialists, ask lots of questions and understand exactly what will happen to your body."

Wondering if a hysterectomy is right for you?

Your GP is the best starting point for a discussion about whether a hysterectomy is the right decision for you, or if there is an alternative, non-surgical option to consider. It’s helpful to take in a list of questions to ask your doctor.

Through our partnership with GP2U, all HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50. See hcf.com.au/gp2u for more information.