What happens after a hysterectomy (removal of the uterus)?
A hysterectomy is the surgical removal of the uterus. It may be considered for conditions such as fibroids, bleeding that does not respond to treatment, uterine prolapse, and some precancerous lesions and cancers. The operation can be done as open (abdominal), laparoscopic, vaginal or vNOTES (through a natural opening) surgery; the approach is chosen based on the condition and the person. After the uterus is removed, there are no periods and pregnancy is not possible. If the ovaries are left in place, the operation alone does not cause menopause; however, in some women menopause may come a few years earlier.
A hysterectomy is one of the most common major operations in gynecology. When it is recommended, the questions that come to mind are usually the same: Will I go into menopause? How long will recovery take? Will my life change? The answers depend on why and how the operation is done.
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus. Whether the cervix, fallopian tubes and ovaries are also removed along with the uterus is decided separately, based on the reason for surgery and the person's age. After the uterus is removed, there is no menstrual bleeding and pregnancy is not possible.
When is it done?
- Fibroids: Fibroids that cause bleeding, pain or pressure symptoms and cannot be controlled with other treatments,
- Abnormal uterine bleeding: Bleeding that does not respond to medication or other methods,
- Adenomyosis and endometriosis: Selected cases with severe symptoms,
- Uterine prolapse,
- Precancerous lesions: For example, atypical endometrial hyperplasia,
- Gynecologic cancers: As part of the treatment of uterine, cervical and ovarian cancers.
In most benign conditions, a hysterectomy is not the first option; uterus-sparing options such as medication, a hormonal intrauterine device (IUD), or removing only the fibroid (myomectomy) are also considered.
Types
| Type | What is removed? | Common situations |
|---|---|---|
| Total hysterectomy | Uterus and cervix | Most benign conditions, precancerous lesions, early-stage uterine cancer |
| Subtotal hysterectomy | Uterus; the cervix is left in place | Selected benign conditions |
| Radical hysterectomy | Uterus, cervix, surrounding tissues and the upper part of the vagina | Some cervical cancers |
In cancer surgery, additional procedures such as lymph node assessment may be added to the hysterectomy; these decisions are made based on the type and stage of the disease. More details: Surgery and treatment for gynecologic cancers.
Surgical approaches
- Open (abdominal): Through an incision in the abdomen. It may be preferred for a very large uterus or in some cancer operations.
- Laparoscopic (minimally invasive): Through small openings in the abdomen, using a camera and thin instruments. It is generally associated with less pain and faster recovery.
- Vaginal: Through the vagina, with no incision in the abdomen. It is often used especially for uterine prolapse.
- vNOTES: A minimally invasive approach done through the vagina with a camera, with no incision in the abdomen; it is used in carefully selected patients.
- Robotic surgery: A robot-assisted form of laparoscopic surgery; it is used in some centers.
Which approach is suitable depends on the size of the uterus, previous surgery, adhesions and the type of disease. Each approach has its own advantages and limitations.
The ovaries and menopause
If the ovaries are left in place: Hormone production continues; the operation alone does not cause menopause. Only the menstrual bleeding stops. In some women, menopause may come a few years earlier.
If the ovaries are removed: In women who have not yet reached menopause, sudden menopausal symptoms (such as hot flashes and sleep problems) may begin. How these symptoms will be managed is discussed before surgery.
Today, in hysterectomies done for benign reasons, removal of the fallopian tubes is often considered, because it is thought that it may reduce the future risk of ovarian cancer. Whether the ovaries are removed is decided by looking at age, family history and genetic risk together. More details: Family history and genetic risk.
Recovery after surgery
- Hospital stay: Usually short with laparoscopic, vaginal and vNOTES approaches; somewhat longer after open surgery.
- Daily life: Walking early on supports recovery. Heavy lifting is avoided for a few weeks.
- Sex: Usually not advised for a few weeks (often around 6 weeks) so that the top of the vagina can heal.
- Spotting: Light spotting and discharge may occur for a few weeks.
Fever · abdominal pain that keeps getting worse · heavy vaginal bleeding · foul-smelling discharge · a sudden watery discharge from the vagina or sudden pain after sex · swelling and pain in a leg · shortness of breath · marked burning when urinating, or being unable to urinate.
As with any surgery, there are risks such as bleeding, infection, injury to nearby organs (bladder, bowel) and blood clots; these are uncommon and are discussed with you individually before surgery.
Life afterward
After surgery, there are no menstrual periods and pregnancy is not possible. Studies report that quality of life often improves in women who had surgery because of bleeding, pain or pressure symptoms.
Whether cervical screening continues after surgery depends on the reason for the operation; for details, see the screening schedule. After surgery for cancer, regular follow-up is planned; for details, see follow-up after treatment.
Frequently asked questions
Will I go into menopause after my uterus is removed?
If the ovaries are left in place, the operation alone does not cause menopause; the ovaries keep producing hormones, and only the menstrual bleeding stops. Even so, in some women menopause may come a few years earlier. If the ovaries are also removed and you have not yet reached menopause, menopausal symptoms may begin. This is discussed in detail with your doctor before surgery.
When can I go back to work after a hysterectomy?
It depends on the surgical approach and the type of work you do. With laparoscopic, vaginal or vNOTES surgery, recovery is usually faster, and you can return to daily life within a few weeks; after open surgery this takes longer. Your doctor will tell you the time that applies to you.
Will my sex life be affected after surgery?
Sex is usually not advised for a few weeks (often around 6 weeks) so that the top of the vagina can heal. Studies report that, after recovery, sex life is often not negatively affected. If you have any problems, you can talk to your doctor.
My uterus was removed. Should I keep having Pap tests?
If the uterus and cervix were removed for a benign reason and there is no prior history of high-grade cell changes, screening is usually stopped. If the surgery was done for a cervical precancerous lesion (CIN2 or higher) or cancer, or if there is a prior history of this, follow-up continues. If the cervix was left in place, screening continues as before.
Is laparoscopic surgery suitable for everyone?
In many cases, a laparoscopic, vaginal or vNOTES approach may be chosen; however, the size of the uterus, previous surgery, adhesions and the type of disease affect the choice. Which approach suits you is decided after an exam and imaging.
Does a hysterectomy cause weight gain?
There is no strong evidence that the operation itself directly causes weight gain. Being less active during recovery, or hormonal changes after removal of the ovaries, can affect weight; a balanced diet and gradually becoming more active help.
Sources
- ACOG — Hysterectomy (patient information)
- NHS — Hysterectomy
- ESGO — Gynecologic cancer guidelines
- National Cancer Institute (NCI) — Uterine (Endometrial) Cancer
Note: This content was written independently, based on current scientific information published by the institutions above; it is not a direct copy of any text.
This article is for general information only; it is not a diagnosis or treatment recommendation and does not replace a medical examination. Please consult your doctor about your own situation. The content reflects scientific knowledge as of the update date above.