Removing the Cervix

As well as the womb, you may need to decide whether to have your cervix or ovaries removed too, based on your medical history, your doctor's advice, and your own feelings. If you have cancer anywhere in the reproductive system, removing the cervix is often advised to stop it spreading. Even without cervical cancer, removing the cervix eliminates any future risk of it — there's no evidence that this affects sexual function, though some women prefer to keep as much of their reproductive system as possible, in which case it's worth discussing the risks of retaining the cervix with your surgeon. If your cervix is removed, you won't need further cervical screening; if it's kept, regular screening should continue.

Removing the Ovaries

NICE guidance recommends the ovaries should only be removed if there's a significant disease risk, such as a family history of ovarian or breast cancer. If you've already gone through menopause or are close to it, removing the ovaries may be recommended regardless of your reason for surgery, to protect against future ovarian cancer. Some surgeons prefer to leave healthy ovaries in place if cancer risk is low, since they continue to produce hormones that help protect bone health and support sexual desire and pleasure. If you'd prefer to keep your ovaries, make this clear to your surgeon beforehand — you may still be asked to consent to their removal if an abnormality is found unexpectedly during surgery.

Surgical Menopause and HRT

If both ovaries are removed during a total or radical hysterectomy, you'll experience menopause immediately afterwards, regardless of age — known as surgical menopause. If one or both ovaries are left in place, menopause may still arrive somewhat earlier than it otherwise would. Ovaries continue producing small amounts of testosterone for up to 20 years after menopause, supporting sexual desire, and oestrogen too — it's a lack of oestrogen that causes symptoms like hot flushes, low mood, vaginal dryness, sleep problems, fatigue and night sweats.

Hormone replacement therapy (HRT) is usually offered to help with these symptoms after ovary removal, though it won't exactly replicate your body's natural hormone levels, and finding the right dose or brand can take some trial. HRT isn't suitable for everyone — for example, those with hormone-dependent breast cancer or liver disease — so it's important to share your full health history with your surgeon. If you can take HRT and have had both ovaries removed, it's generally recommended to continue until around the average natural menopause age of 51.

Types of Hysterectomy

A total hysterectomy removes the womb and cervix, and is generally preferred since it eliminates future cervical cancer risk. A subtotal hysterectomy removes just the main body of the womb, leaving the cervix in place — regular cervical screening is still needed afterwards. A total hysterectomy with bilateral salpingo-oophorectomy also removes the fallopian tubes and ovaries, generally only recommended where there's a meaningful disease risk. A radical hysterectomy, usually carried out for cancer when other treatments haven't worked or aren't suitable, removes the womb, cervix, fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue.

How It's Carried Out

There are three surgical approaches. A laparoscopic (keyhole) hysterectomy uses a small camera and instruments inserted through tiny cuts in the tummy, with the womb removed via the vagina — this is done under general anaesthetic. A vaginal hysterectomy removes the womb and cervix through a cut at the top of the vagina, taking around an hour, under general, local, or spinal anaesthetic; it's often preferred since it's less invasive with a shorter hospital stay and quicker recovery. An abdominal hysterectomy involves a cut in the tummy (either along the bikini line or vertically), taking around an hour under general anaesthetic — this may be needed if the womb is enlarged by fibroids or tumours, or if the ovaries need removing too.

Getting Ready

Being as fit and healthy as possible beforehand reduces your risk of complications and speeds up recovery — this means stopping smoking, eating a balanced diet, exercising regularly, and losing weight if you're overweight. You'll usually have a pre-assessment appointment a few days beforehand, involving blood tests and a general health check, and a good opportunity to ask any questions.

In Hospital

It's normal to wake feeling tired and sore — painkillers will help, along with anti-sickness medicine if needed. You may have dressings, a drip, a catheter, and (depending on the type of surgery) a drainage tube or vaginal gauze pack for the first day or two. You'll be encouraged to take a short walk the day after surgery to support circulation and reduce blood clot risk, and a physiotherapist may guide you through mobility and pelvic floor exercises. Stitches, if not dissolvable, are usually removed after 5 to 7 days.

Hospital stays are typically 1 to 4 days after a vaginal or laparoscopic hysterectomy, or up to 5 days after an abdominal one. Full recovery takes around 6 to 8 weeks for an abdominal hysterectomy, often somewhat quicker for vaginal or laparoscopic approaches. Rest as much as possible during this time, and avoid lifting anything heavy while your abdominal muscles and tissues heal.

Possible Side Effects

Bowel and bladder changes, including urinary tract infections or constipation, are common but treatable — drinking plenty of fluids and eating more fruit and fibre can help, and laxatives are sometimes needed for the first few bowel movements. Some vaginal bleeding and discharge is normal for up to 6 weeks, lighter than a period — see a GP if bleeding is heavy, you pass clots, or notice a strong smell. If your ovaries were removed, you may experience significant menopausal symptoms such as hot flushes, anxiety, weepiness and sweating, and HRT (as an implant, injection or tablet) may be offered.

It's also common to feel a sense of loss or sadness afterwards, particularly if you haven't yet gone through menopause and can no longer have children, or if surgery was needed for advanced cancer with no other options. This can occasionally trigger depression — see a GP if low feelings persist, and consider connecting with others who've had a hysterectomy for support, which your GP or hospital may be able to help arrange.

Getting Back to Normal

Returning to work may be possible after 6 to 8 weeks if your job doesn't involve manual labour, though your doctor will advise based on your recovery. Avoid driving until you can comfortably wear a seatbelt and perform an emergency stop, usually 2 to 6 weeks afterwards — check with your GP and your insurance policy. Walking is encouraged, and swimming is fine once wounds have healed, but avoid overexertion and heavy lifting, bending your knees rather than your back for lighter items. It's generally recommended to avoid sex until scars have healed and discharge has stopped, usually at least 4 to 6 weeks — some vaginal dryness or reduced libido afterwards is common and usually improves with time. You won't need contraception to prevent pregnancy afterwards, but will still need condoms to protect against STIs.

General Surgical Risks

As with any major surgery, there's a small risk of complications. Serious complications from general anaesthetic, such as nerve damage or a severe allergic reaction, are very rare — being fit and healthy beforehand helps reduce this risk. There's also a small chance of heavy bleeding, occasionally needing a blood transfusion, and rarely, damage to the ureter (the tube carrying urine from the kidney), which is usually repaired during the same operation.

Other Possible Complications

Rarely, the bladder or bowel can be damaged during surgery, potentially causing infection, incontinence, or more frequent urination — repairs can often be made during the same procedure, sometimes with a temporary catheter or colostomy. Infection, whether of the wound or urinary tract, is a general surgical risk, usually straightforward to treat with antibiotics. Blood clots (thrombosis) are a risk after any major surgery or period of reduced mobility — getting moving as soon as possible afterwards, and sometimes a blood-thinning injection, help reduce this risk.

After a vaginal hysterectomy specifically, there's a small risk of problems at the top of the vagina where the cervix was removed, ranging from infection or slow healing to prolapse developing years later. Even with one or both ovaries left in place, menopause symptoms can sometimes still appear earlier than expected. If both ovaries are removed, menopausal symptoms such as hot flushes, sweating, vaginal dryness and disturbed sleep typically begin soon after surgery — this is a particularly important consideration under age 40, since early menopause raises the risk of osteoporosis, and additional medicine may be needed to help protect bone health depending on your circumstances.