Hysterectomy - Why it is necessary 

Why a hysterectomy is necessary 

A hysterectomy is a major operation for a woman that will only be recommended if other treatment options have been unsuccessful.

The most common reasons for having a hysterectomy include:

  • heavy periods (menorrhagia), which can be caused by fibroids, for example
  • pelvic pain, which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids
  • prolapse of the uterus 
  • cancer of the womb, ovaries or cervix 

Heavy periods

Many women lose a large amount of blood during their monthly periods. They may also experience other symptoms, such as pain and stomach cramps.

For some women, the symptoms can have a significant impact on their quality of life. Sometimes heavy periods can be caused by fibroids, but in many cases there is no obvious cause.

In some cases, removing the womb may be the only way of stopping persistent heavy menstrual bleeding when:

  • other treatments have proved ineffective
  • the bleeding has a significant impact on quality of life and it is preferable for periods to stop
  • the woman no longer wishes to have children

Read more about heavy periods.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a bacterial infection of the female reproductive system.

If detected early, the infection can be treated with antibiotics. However, if it spreads, it can damage the womb and fallopian tubes, resulting in long-term pain.

A hysterectomy to remove the womb and fallopian tubes may be recommended if a woman has severe pain from PID and no longer wants children.

Read more about pelvic inflammatory disease.

Endometriosis

Endometriosis is a condition where cells that line the womb are also found in other areas of the body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum.

If the cells that make up the lining of the womb become trapped in other areas of the body, it can cause the surrounding tissue to become inflamed and damaged. This can lead to pain, heavy and irregular periods, and infertility (inability to conceive).

A hysterectomy may remove the areas of endometrial tissue causing the pain. However, it will usually only be considered if other less invasive treatments have not worked and the woman decides not to have any more children.

Read more about endometriosis.

Fibroids

Fibroids are non-cancerous tumours that grow in or around the womb (uterus). The growths are made up of muscle and fibrous tissue and vary in size.

The symptoms of fibroids can include:

  • heavy or painful periods
  • pelvic pain
  • frequent urination or constipation
  • pain or discomfort during sex

A hysterectomy may be recommended if you have large fibroids or severe bleeding and you do not wish to have any more children.

Read more about fibroids.

Adenomyosis

Adenomyosis is a common condition where the tissue that normally lines the womb starts to grow within the muscular wall of the womb. This extra tissue can make your periods particularly painful and cause pelvic pain.

A hysterectomy can cure adenomyosis but will only be considered if all other treatments have failed and you do not wish to have any more children.

Prolapse of the uterus

A prolapsed uterus happens when the tissues and ligaments that support the womb become weak, causing it to drop down from its normal position.

Symptoms can include back pain, a feeling that something is coming down out of your vagina, leaking urine (urinary incontinence) and difficulty having sex. A prolapsed uterus can often occur as a result of childbirth.

A hysterectomy resolves the symptoms of a prolapse because it removes the entire womb. It may be recommended if the tissues and ligaments that support the womb are severely weakened and the woman does not want any more children.

Read more about prolapse of the uterus.

Cancer

A hysterectomy may be recommended for the following cancers:

If the cancer has spread and reached an advanced stage, a hysterectomy may be the only viable treatment option.

Page last reviewed: 09/04/2014

Next review due: 09/04/2016

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Deciding to have a hysterectomy

If you have cancer, a hysterectomy may be the only treatment option. For other conditions, it's a good idea to ask yourself the questions listed below before deciding to have the procedure.

  • Are my symptoms seriously affecting my quality of life?
  • Have I explored all other alternative treatment options?
  • Am I prepared for the possibility of an early menopause?
  • Do I still want to have children?

Don't be afraid to ask your doctor as many questions as you want.