Hysterectomy is dead!

Of course this is an overstatement, but even though an exaggeration, it makes a firm point. I have been a gynaecologist for over 30 years and in that time-span, the practice of gynaecology has been transformed. It is now a great rarity to need to remove a uterus other than for malignant disease, severe endometriosis, prolapse, or enormous size. There are simply less risky, less painful ways of dealing with period problems and pelvic pain.

The statistics bear this out. In 2002, around 33,000 women per annum had total abdominal hysterectomies in the UK and by 2011 that number had fallen to 26,000. The same rate of fall has been noted in all other Western Countries, including the USA. The falling rate in total abdominal hysterectomies (with the rate of subtotal abdominal, probably for endometriosis, and vaginal, probably for prolapse, hysterectomy remaining relatively constant) has plateaued since 2009. This suggests that the remaining operations are for indications which could not be dealt with by hormonal treatments, the Mirena or equivalent IUS, endometrial ablation using one technique or another, or fibroid embolization. Hysterectomy rates in countries such as India remain controversially high.

It is not just the immediate peri- and post-operative risks, pain and time spent recovering that concern me, although experiencing a woman die of a postoperative pulmonary embolus at the age of 42 years, leaving a young family, certainly focuses the mind. The only comfort in that case was that both a Mirena and a thermal ablation had been tried and failed.

No, it is the impact on the pelvic floor which really concerns me, and which I feel gets far too little attention. I have coined an expression which is that ‘Women embark upon their surgical prolapse (and this is the important word) career’. It is a career. So when women come to see me with a prolapse of their vagina, with bladder or bowel problems, I tell them that they started their surgical prolapse career when they had their uterus out in their 40s. Of course if there was no alternative and they were chronically anaemic, then all well and good. But nowadays there are so many alternatives, and they should all be discussed according to the specific circumstances of the woman.

  • Is her family complete?
  • Does she need contraception?
  • Is the uterus a normal size or are there significant fibroids?
  • If there are fibroids can they be resected from inside the uterus or perhaps killed by embolization?
  • Is pain a major part of the story?

And so on and so on.

Information and choice is what it is all about. Having said that, it is near enough impossible for non-medical people to understand ‘risk’.

“I’ve been referred for my hysterectomy” remains a not infrequent statement when a woman enters my gynaecology outpatient clinic. I feel it would be like me taking my car to the garage and saying,

“I’ve come for my new gearbox” when I have absolutely no understanding of cars.

These consultations are very difficult and not infrequently lead to a complaint that I didn’t listen to the woman, when in fact nothing could be further from the truth. I was doing my best to make her better, but minimising risk of every kind.

I often say “I am a surgeon. I like being a surgeon. I like the actual process of being in the operating theatre and doing the operation. Making the wound look nice and seeing the lady get better afterwards, and being pleased with the result. But I would never have an operation unless I absolutely had to.”

So…. hysterectomy is not dead, but (for period problems) it should certainly be a last resort.


dr mortonsDr Karen Morton is founder of Dr Morton’s – the medical helpline© a service for busy people wanting speedy access to an experienced doctor for confidential reassurance or advice by phone or email. When needed, Dr Morton’s doctors are able to prescribe for a wide variety of medical issues and arrange for medication to be sent to the customer’s door. For more information call 012 123 123 123 www.drmortons.co.uk

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  1. Hi Krista
    I am 4 weeks post op. I had adenomyosis which left me constantly anaemic , horrendous bleeding every month with lots of pain too. I researched the options and decided at 48 with 2 teenage boys and no thoughts of having anymore, it was right for me. I had the marena coil fitted 12 years ago but it caused me other problems so it was removed 2 years later.
    I had to have open surgery due to my very enlarged uterus but it’s actually not been too bad. The long term outcome will be worth the pain, wind and soreness.
    I too worried about not waking up and talked about writing my will! However, the anethetist is with you through the whole procedure, monitoring you and ensuring all is ok.

    I have to say I feel totally rejuvenated! I no longer have to take a cocktail of drugs every month to stop the bleeding and pain or iron tablets. I now realise how ill I felt for a long time before the operation. Even though I am still sore and not back to full fitness, I feel better than I did before the operation.
    I know we are all different, and will recover at different rates but all I can say is , it has not been as bad as I thought it would be. Drink loads of water, especially whilst you still have the catheter in, drink cranberry juice and be as mobile as you can without overdoing it.
    Re wind pain, it can collect under your shoulder blades so be careful. Drink peppermint tea and suck peppermints!

    Good luck and take care.

  2. I had TAH in January 2016.
    I had the same fears of …not coming round from anasthesia.
    You will see Anaesthetist, Consultant and Nurse prior to going to theatre. There were alot getting done on my day & I waited about an hour then your theatre nurse gets you all ready for anaesthetist. I rember thinking when will i fall asleep ..then was out … I woke up back of three saw the clock in recovery room which was near on spot on the 11/2 hrs the Consultant said it would take. You be on a morphine drip you press yourself for pain for the day / night after op.
    I was sore, but the staff were really good & the press pain control was good at controlling the pain. I felt as though I was pressing it alot that’s ok because you can”t overdose on it.You want get much sleep 1st night as you get observations done alot. I didn’t feel up to any visitors the 1st night. Next day nurse helps you up to shower & physiotherapist visits. I didn’t realise how everything gets done for you in hospital – did too much and wound stich burst-at beginning.
    Three weeks ago (81/2 weeks post-op)I heaved on carpet cleaner and pain was real bad and leaking clear fluid came back.
    I see Gp & Consultant in the next 2 weeks.
    Just saying please please take it easy easy it really is a major op. it will save you and the worrying about what has happened. It has been so good not to have that menstrual cyclical depression &endless weeks of bleeding .

  3. I am 16 days post partial hysterectomy. If I could tell any woman If they asked. In hind site I wouldn’t have done it. Since I’m 42, I probably just would have had my 9 fibroid removed. The largest the size of a lemon. And if they’d come back prior to menopause. I would have let menopause shrink them the natural way. These past 16 days have been the worst of my life. I even had a hematoma form and a second surgery for that. Thank God I went back to the hospital for really really bad trapped gas and inability to urinate. However, every woman’s body is different. This is just my own experience and decision I should have made. I hope it helps.

  4. Hi I’m waiting for a hysterectomy having been told I have ? Adenomyosis. I am starting to worry about it, ie what if I die, what if I get a PE. … Etc. I felt very pressured into trying a mirena coil which ultimately I refused . I have never liked the idea of one and having tried numerous contraceptive pills which did nothing for the pain just made me turn into a crazy woman , I have now opted for the operation. I suppose I’m just looking for reassurance. It’s weird because when I’m not on a period and not in pain I forget how horrible I feel when I am. I just read the doctors ‘is hysterectomy dead’ on this site which quite frankly has put the fear of God into me. Did you have same worries? Thanks

  5. I must say that at age 44 years and having recently undergone TAH, I much prefer living with the ‘possibility’ of future gynaelogical problems than the ‘alternative career’ that I have occupied over the last decade enduring constant pain, bleeding, bloating, fatigue and countless medical interventions and surgical procedures that ultimately brought no improvement to my overall health related quality of life and if anything, simply exacerbated my symptomatology.

  6. Dear SMH
    If your fibroid is very large;have you thought about discussing the option of a subtotal hysterectomy; leaving the cervix intact?After the recovery time you will feel more comfortable & able to do the pelvic floor exercises.

  7. I looked into trend in hysterectomy stratifying by indications in England over 12 years period using HES data. I found that while there was a decrease in number of hysterectomies for abnormal uterine bleeding (dysfunctional uterine bleeding with no underlying pathogies) the number of hysterectomy for fibroid was increasing and for endometriosis and pelvic pain the number was stable.

  8. My GP refused to refer me for a hysterectomy after suffering with terrible periods for 8 years, I’d finally had enough. I did not want the coil, nor did I want to take the pill, etc., or even have laser treatment, especially as the success rate is only 70% and to be honest, I may not have even been a suitable candidate after having 3 c sections. In the end, I had my hysterectomy privately, as we are covered under my husband’s private medical insurance with his job. Best thing I ever did – it was hard at first, but I am 8 months in and I feel so much better. I do suffer with hot flushes and insomnia, but am loathe to start a course of HRT as I don’t know the medical history of my mum, so will try and cope with this for now. Women should be given a choice re what they want to do and not be dictated to or even forced to have the Mirena Coil fitted.

  9. Well said Sara! I cannot believe how awful this woman sounds, clearly not had any personal experience of Adenomyosis or Endometriosis and how debilitating these diseases are, having suffered for 20 years and trying all sorts of ‘ treatments ‘ I’m now finally being allowed- ?!- a hysterectomy! No one wants to have major surgery- but if this ignorant woman had ever been through this hell on earth like we have , I’m pretty sure she’d change her haughty attitude and opinion pronto!!!

  10. I found this article extremely arrogant and as woman facing seeing a consultant to discuss having a hysterectomy, it did me no favours. At no point does the article take into account what the woman is going through, the pain she is in or how that impacts on her life. It looks at the problems as merely mechanical, as if in a car,not affecting a person. The whole attitude is “what do you know, I am the expert and therefore you will do what I say.” Where’s the compassion, where’s the understanding and as for the “I told you so” about woman who have problems after the hysterectomy, that’s unprofessional. I pray that I see a consultant who see’s me as a human being, as a person and not an disruption to their perfectly pre-planned course of action that they’ve decided upon before they even see me.

  11. Hi thank you I’ve been told embolization isn’t an option, I think it/they are too big but I will check again if and when I get another consultation (the wheels of the NHS are grinding exceedingly slowly round here!)

  12. Hi – I don’t feel that this blog post is terribly helpful to the majority of women who use this site to provide them with support at a difficult point in their life.

    Yes having a hysterectomy increases the risk of prolapse but so does having children, being overweight etc. The level of increased risk needs to be weighed up against the benefits of having the surgery and this article fails to address the level of increased risk.

    The evidence I’ve found indicates that the level of risk isn’t significantly higher assuming no existing prolapse at the time of the hysterectomy eg this article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562278/
    which indicates that “…the overall incidence of severe pelvic organ prolapse following hysterectomy (ie, 2 to 3.6 per 1000 woman-years) is similar to the rates of surgically corrected pelvic organ prolapse and incontinence in the general population (ie, 2.04 to 2.63 per 1000 women-years)”

  13. May I just suggest that you ask about the possibility of fibroid embolisation? It is not suitable for everybody, but it is particularly good when there are lots of fibroids up to 5 cm diameter

  14. A very interesting read!!

    I was never made aware that I’m potentially more at risk of getting a prolapse, after having my abdominal hysterectomy nearly 3 years ago, until someone mentioned it to me a few weeks ago. Much as I feel better after having my womb removed, it’s the fact that I have to deal with adhesions that can’t be dealt with (due to where they at) for the rest of my life that upsets me, as they’re causing some issues. You win some, you lose some ☹️

  15. I find this blog a bit harsh considering we are talking a “professional consultant”. Can this consultant really put themselves In the woman’s position here, I doubt it? I can understand there may be ways to try ease problems first & in my opinion having spoken to others and including my own experience, surgeons normally do this & use full hysterectomy as a last resort. In my case a coil & abrasion could not be used because the fibroids had distorted my womb & were pressing on my cervix, not allowing entry to be gained to do any of these things after 3 tries. I haven’t looked back after my hysterectomy & as far as pelvic floor & prolapses are concerned these are natural things that can happen after giving birth, through bowel disorders amongst other things. My mother never had a hysterectomy but ended up with a prolapsed womb, on top of her ALZHEIMERS, meant surgeons would not operate so mum lived with this discomfort for quite a while.

  16. I’ve explored every avenue for my heavy periods/fibroid problems, Mirena coil, the pill (too old for that now and unpleasant side effects) tranexamic acid, I’ve been told my fibroid/s are too big to remove vaginally or other method so I’m left with putting up with the periods or an abdominal hysterectomy, I’ve opted for my uterus being removed. Now I’ve had this article pop into my mail box and I’m worrying about starting my vaginal prolapse career, in all my consultations no one has ever mentioned this to me.

  17. Hi Linda,
    Great article,keep up the good work,im so glad i had a good experience here in Italy,and they took their time explaining what was going to happen ,what they may have to do which in my case came about as i haemorrhage.The after care was very good indeed was in 8 days very poorly ,couldnt eat,was like a rag doll ,in the end after trying iron tabs i had to have a blood transfusion i was like a new woman the following day,they never let me out till i could go to the toilet properly ,could not criticise at all.

  18. What a high-handed and misrepresentative article! There are *not* good effective treatments for everyone’s period problems, unless you want to stay forever on the conveyor belt of failed attempts. I’ve been given endless tablets by doctors who assured me that this one would definitely cure it (and it made it 10 times worse). I’ve seen friends have the excruciating Mirena treatment, and I’ve read of women who have ablations and their scarred womb grows back more painful than ever. Of course all these approaches have more ‘sales value’ than the ultimate solution of hysterectomy, but I got fed up with being fobbed off, and now I have no uterus I couldn’t be happier about it. If there are other problems with uterus removal such as other things prolapsing, gynaecologists should be told to explain this to us in the process of deciding. For myself I’m just glad this writer wasn’t my doctor. And I’m not sure she should be offering an ‘advisory service’ when her outlook is so atypical.

  19. Hooray!

    This message needs to circulate fast. It was quite hard in the face of a medical consensus ‘you don’t need them, they do nothing now’ to hold onto my ‘bits’. Happily the surgeon did a great prolapse repair (+rectocele & cystocele), but I researched very thoroughly to understand and argue the pros & cons

  20. I’m afraid you’re a little premature with this.

    I almost typed a very detailed reply about my interections with NHS gynaecolgists in recent years, but I won’t

    Suffice it to say, I was offered hysterectomy for fibroids that were found incidental to another problem. No mention of embolisation, only a Mirena coil as an alternative, and one that would probably only delay the inevitable surgery. Which was presented to me as low risk, routine, quick to recover from, with no ongoing effects.

    I resisted for ~3 years, but finally made the difficult decision to have surgery, knowing full well it could worsen the slight bladder problems I already had, and also might bring menopause forward — a fact my surgeon flatly denied, and was a big concern to me given family history of angina/heart attacks and hints of osteoporesis.

    The surgery successfully ended the fibroid symptoms and low-level anaemia. (It would have been a bit worrying if it hadn’t.) But I had 8/9 months of cystitis post-op. Never had it before, no idea if the surgical team even know, there seemed to be no follow up. Now, 20 months later, I have worsening bladder symptoms. So I wholeheartedly agree with your comments about a ‘career’ of that.

    I went into the surgery eyes wide open, knowing all the potential hazards, so on balance I would make the same decision again. But if I’d only gone on what the docs/GP told me, then I’d be very disappointed with the outcome.

    By the way, I think you’ll find it’s statisticians that understand risk the best, not medics, and it’s rather patronising of you to lump all non-medical people together as incapable of understanding. If you’d said lay people, yes, perhaps. But those patients who are mathematically literate are perfectly capable of understanding risk.

    If someone bothers to explain it to them.

  21. As someone who has just undergone a hysterectomy for “period problems” which at the end were leading me to have to change tampons and towels every 15 minutes and be absent from work, I have to say I find this article unhelpful and quite astonishing. My post op diagnosis was adenomyosis and I was advised by my (highly qualified) consultant that ablation or embolisation would not have helped – neither did 2 mirena coils and a host of tablets over the preceding 3 years. To be told I have now embarked on my “prolapse career” is very upsetting, as is the implication that I and many others like me have had unnecessary and damaging surgery.

    I thought the Hysterectomy Association was here to support women on their hysterectomy journey, not make them feel as if it is the wrong thing to undertake, with significant potential consequences. I hope the ladies on here who are going through and have been through their operations pay no notice to this blog, and instead have faith in their consultants who, if they have followed the NICE guidelines, will have ruled out the other potential remedies along the way to a hysterectomy conclusion.