My name is Lesley Regan.
I'm professor of obstetrics and gynaecology
at St Mary's Hospital campus, part of Imperial College, London.
If I was a patient who was contemplating having to undergo a hysterectomy,
either abdominal hysterectomy or a vaginal one,
the questions I would want to ask my surgeon would be
how long is the operation going to take?
What am I likely to need to do beforehand to prepare for it?
Will I have a wound?
How long will that wound take to heal?
How long will I have to stay in hospital?
And after I leave hospital,
how long do I need to factor in for convalescence
so that I can make preparations for my family and for my work?
An abdominal hysterectomy is an operation
in which the tummy is opened
and the womb and the neck of the womb are removed.
In a vaginal hysterectomy,
the neck of the womb and the body of the womb are removed,
but the operation is carried out through the vagina
so there is no abdominal cut.
Vaginal hysterectomy is a particularly suitable route or method of hysterectomy
for a woman who's had several children
because it's likely that the pelvic ligaments
or pelvic supports around the uterus and other pelvic organs
are a little more relaxed,
and therefore it's much easier to draw the organs downwards through the vagina.
By contrast, it would be particularly difficult
to perform a vaginal hysterectomy
in a woman who'd never had children
or who'd had a child delivered by Caesarean section
or had had previous abdominal surgery which might have resulted in scarring,
and therefore less possibility of descent of the organs
as they're pulled through the vagina.
Whether a woman needs to have a hysterectomy
is obviously dependent on a lot of different factors.
As a general rule, nowadays we try not to operate on women
unless it's absolutely necessary.
There are some occasions when it is necessary,
for example if there was a tumour of the uterus that needed to come out
or if the woman was in very severe pain or had uncontrolled bleeding.
But the reality is that there are many other options
that one can try first before having to resort to surgery.
Medical treatments to stop bleeding or reduce pain,
a variety of other things that can be done.
After a hysterectomy, most women do feel better
because they probably haven't undergone the procedure
unless they've experienced quite unpleasant symptoms,
probably for quite a long period of time.
So having heavy, painful periods is quite debilitating
if they go on for a long time,
and many women who undergo a hysterectomy
after having tried lots of other medical treatments
or less invasive treatments may well say at the postoperative visit,
"I wish I'd done this before. It's such a relief."