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."