 This fact sheet is available as a print friendly PDF in: English
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What is an abdominal hysterectomy?
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A hysterectomy is an operation to remove the uterus. Abdominal means the operation is performed through a surgical incision or cut to the abdomen.
Other methods of performing a hysterectomy include;
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- Vaginal hysterectomy where the uterus is removed through the vagina.
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- Laparoscopic hysterectomy which is performed using “keyhole” surgery. This involves several small cuts to the abdomen. See our fact sheet Total laparoscopic hysterectomy for more information.
You and your gynaecologist will discuss the most appropriate type of hysterectomy for you.
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What happens during an abdominal hysterectomy?
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During the hysterectomy the doctor will remove part or all of your reproductive organs. Whether you have a part or total hysterectomy will depend on your particular situation and will be discussed with you before your operation.
A sub-total or partial hysterectomy will remove the fallopian tubes and only the upper two-thirds of the uterus. The woman keeps her ovaries and cervix. This is not common.
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A total hysterectomy involves the removal of the Fallopian tubes, the whole uterus and the cervix. The woman keeps her ovaries.
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A hysterectomy with oophorectomy involves the removal of the Fallopian tubes, the whole uterus and cervix, together with one or both ovaries.
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Why is a hysterectomy recommended?
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The decision to have a hysterectomy is usually made with your gynaecologist. This major operation is recommended when other surgical treatments or medication treatments may not be possible, or have not helped your symptoms.
There are a number of uterine conditions for which a hysterectomy is recommended. Some are benign, others malignant.
Benign, or non cancerous conditions, include:
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- uterine fibroids
- endometriosis
- adenomyosis
- uterine prolapse
- heavy periods that cannot be controlled by other treatments.
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Malignant, or cancerous conditions, include:
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- cancer of the cervix
- cancer of the uterus.
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Will the ovaries be removed?
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The ovaries are not usually removed if you are having a hysterectomy to treat a benign condition. This means that if you are younger than the age of menopause, you will still produce female hormones from your ovaries and therefore will not need hormone replacement therapy.
However, your ovaries may need to be removed if you are being treated for a benign condition and also have:
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- ovarian cysts
- a strong family history of ovarian cancer
- experienced your menopause or will do so in the next few years.
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In these situations if you are younger than the age of menopause you and your gynaecologist will discuss hormone replacement therapy.
When the hysterectomy is performed for the treatment of cancer and your ovaries are to be removed, the management of menopausal symptoms will be discussed before the surgery.
Regardless of whether the hysterectomy is for the treatment of a benign or cancerous condition, treatment with hormone replacement therapy may not be suitable for some women.
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What happens during the surgery?
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A general anaesthetic will be given, which means that you will be asleep during the operation. To begin with, an incision (or cut) is made. Usually the incision is transverse (across) and is made low down on the abdomen. This is sometimes called a “bikini line” incision. Sometimes the incision will be vertical or “up and down". The type of incision depends mainly on the size of your uterus. Usually, you and the surgeon will discuss this before the operation. The uterus and any other organs, such as the Fallopian tubes and ovaries, are all removed through the incision. Once this is completed the wound is closed with either dissolvable sutures (which dissolve on their own) or sutures or staples that need to be removed in 5-7 days. The operation usually takes about one hour.
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What are the complications of abdominal hysterectomy?
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There are general complications with any operation, such as, problems with the anaesthetic, wound infections, blood clots in the legs or lungs and respiratory tract infections. There are also some specific complications for abdominal hysterectomy, these include;
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- excessive bleeding
- injury to the bladder or ureters, which are the tubes from the bladder to the kidneys
- injury to the bowel and blood vessels.
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All these complications are uncommon and your gynaecologist will discuss them with you before your surgery.
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What to expect after the operation
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There will be some pain and discomfort after the operation. To help you manage your pain you will be provided with a PCA, or “patient controlled analgesic” device. The PCA allows you to control the level of pain medication you receive by pressing a button. It also monitors the amount of medication you are getting to make sure you do not receive too much analgesia. After the first day or two, you will have less pain and analgesic tablets will be given for your pain relief.
You will also have an intravenous drip in your arm and a urinary catheter but these are usually removed the day after your operation. In most cases, you will be able to drink and eat small amounts the following day.
There is usually a tape and gauze dressing completely covering the abdominal wound. The nursing staff will remove this before you are discharged from hospital.
You can usually go home two to three days after the operation. At home you will need to keep the wound clean and dry. If you have sutures or staples that need to be removed, your local doctor can remove them five to seven days after the operation.
Most women will notice some bleeding or light spotting after the operation but this should settle in one to two weeks.
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Your routine appointment after the operation
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Before you leave hospital, you will be given an appointment to see a doctor in our Gynaecology Clinic. At this appointment (usually six weeks after your operation) we will check your wound, discuss any results from your operation and make sure you are recovering normally from your surgery. This appointment is also a good time for you to ask questions and to discuss with the doctor any concerns you may have.
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When do you need an urgent appointment?
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There are some circumstances when you should be seen by a doctor earlier than six weeks. If you experience heavy vaginal bleeding and pain, have a “smelly” vaginal discharge or a fever, please visit your local doctor, come to the Emergency Department at the Women’s or go to your nearest emergency department if more convenient.
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Special considerations after abdominal hysterectomy
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It is important that you give yourself time to heal after the operation. It will take at least six weeks before you can return to your normal activities. In particular you should;
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- avoid heavy lifting after your operation, e.g. anything more than 5 kilograms or about the same weight as a full bag of shopping
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- avoid any strenuous activities, e.g. sport or heavy housework
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- take sufficient time away from work to ensure your wound has completely healed
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Will you still need to have Pap smears?
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If your Pap smears have all been normal prior to the hysterectomy and your cervix has been removed, then you will no longer need to have any further Pap smears. However, if you have previously had abnormal Pap smears your gynaecologist will advise you about the need for further smears.
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Your sexual enjoyment after abdominal hysterectomy
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Whilst it is fine to enjoy close contact with your partner, penetration of the vagina should be avoided for six weeks after your operation. This will allow the wound at the top of the vagina to heal completely without the risk of damage or infection.
Once women resume sexual intercourse, many find that the hysterectomy improves their sexual experience as they are no longer troubled by the heavy bleeding or pain they had previously. There is usually no change in a woman’s sensation of sexual pleasure as the vulva, vaginal walls and clitoris will remain sensitive to sexual stimulation. However some women report a change in the nature of their orgasm after removal of their uterus.
Should you have any concerns it is important to discuss these with your gynaecologist. The Women’s also has a Sexual Counselling Clinic which provides specialist medical care and counselling.
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Any further questions?
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This is a general overview of the operation and may not apply to everyone. If you have any further questions please feel free to speak to your gynaecologist. The following organisations also provide useful information on hysterectomy and other women’s health issues:
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Women’s Health Information Centre
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Royal Women’s Hospital
Tel: (03) 8345 3045 or 1800 442 007 (rural callers)
Email: whic@thewomens.org.au
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www.thewomens.org.au
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Breacan
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Tel: 1300 781 500
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www.breacan.org.au
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Cancer Council Victoria
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Tel: 131 120
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www.cancervic.org.au
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Women’s Health Queensland Wide
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www.womhealth.org.au
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Important telephone numbers at the Women’s
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Emergency Department
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(03) 8345 3636
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Gynaecology Clinics
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(03) 8345 3129
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Sexual Counselling Clinic
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(03) 8345 3138
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We wish to thank Women’s Health Queensland Wide for the permission to use the diagrams from their Hysterectomy fact sheet.
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this booklet or incorporated into it by reference.
We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy.
Women are encouraged to discuss their health needs with a health practitioner.
If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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Published November 2010
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