Recovery after a keyhole hysterectomy: a week-by-week guide

Most women recover from a keyhole hysterectomy over about six weeks. You are likely to stay one night in hospital, feel much better by the end of the second week, return to work after about four weeks, wait around six weeks before heavy lifting, and around eight weeks before sex. How quickly you recover depends on how complex your operation was, so you may need longer, or less time, than this guide suggests.

Before your operation I give you a personal recovery plan in writing; this guide explains what each stage is usually like.

Keyhole surgery shortens recovery

A hysterectomy is an operation to remove the womb (uterus). In a keyhole hysterectomy I work through a few small incisions and usually remove the womb through the vagina. “Keyhole” covers laparoscopic surgery, in which I hold the instruments directly, and robotic surgery, in which I control them from a console beside you.

A Cochrane review, which brings together the randomised trials, found that women returned to normal activities about two weeks sooner after a laparoscopic hysterectomy than after an open one. The trials were small, and the review grades this evidence as low quality ^[1].

Recovery after a laparoscopic and a robotic hysterectomy is broadly similar ^[1]. For a large womb or a complex operation I prefer robotic surgery, because the wrist-like instruments make precise stitching deep in the pelvis easier, including closing the top of the vagina, which is the part that takes longest to heal. Keyhole surgery is not suitable for everyone, and recovery after open surgery takes longer. Since 2013, around one in a thousand of my keyhole operations has needed to be changed to open surgery (about these figures).

If you are still deciding, the alternatives depend on why a hysterectomy has been suggested, and for some women they include no treatment at all. The fibroids, adenomyosis and general gynaecology pages set them out, and we go through the options together before you decide.

The first day and night are in hospital

When you wake, you may have a drip (a fine tube into a vein) for fluids and a catheter (a thin tube draining the bladder), which is usually removed within hours or the next morning. Light vaginal bleeding, like a period, is normal, and so is soreness around the small incisions.

You may also feel pain in the tip of one or both shoulders. It comes from the carbon dioxide gas used to make space inside the abdomen, which irritates the diaphragm (the muscle beneath the lungs), and it usually settles within a day or two. Moving about helps.

You will be encouraged to eat, drink and walk the same day or the next morning. Walking early helps your bowels recover and lowers the risk of blood clots, and you may also wear compression stockings or, for some women, have injections to thin the blood. You will usually go home the next day.

The first week is for rest and short walks

Expect to feel tired and sore. Take the painkillers you are given regularly at first, because pain is easier to keep under control than to catch up with. Walk around the house several times a day, a little further each time, and rest in between. In this first week I ask you to lift nothing heavier than a full kettle.

The small wounds are closed with dissolvable stitches. You can usually shower the day after surgery and pat the wounds dry. I take infection after keyhole surgery seriously, which is why my written information before the operation includes advice on washing beforehand. Constipation is common, from the painkillers and from moving less, so drink plenty, eat fruit and fibre, and use a gentle laxative from the pharmacy if you need one.

Energy returns in weeks two to four

By the second week there is usually a clear improvement. Light household tasks, longer walks and short trips out become manageable, although an afternoon rest still helps.

Vaginal bleeding or a brownish discharge can continue for several weeks. Some women notice a little more bleeding around ten days to two weeks after the operation, when the stitches at the top of the vagina (the vaginal vault) begin to dissolve. If it is light and settles, this is usually normal. Use pads rather than tampons until the bleeding has stopped.

There is no set week for driving. You are ready when you can wear a seatbelt comfortably, make an emergency stop without hesitating, and are no longer taking painkillers that make you drowsy. For many women that is between two and four weeks, and for some it is later. Some car insurers have their own conditions after surgery, so check your policy.

I usually advise about four weeks before returning to work. If you work from home and need to, light desk work after about two weeks is often possible, and many women start back with shorter days. If your job is physical, or involves lifting or long hours on your feet, expect to need six weeks or longer.

Weeks four to six are for building up

Walking and gentle stretching can increase week by week. Swimming is usually fine once the bleeding has stopped and the wounds have healed. Heavy lifting and high-impact exercise should wait for around six weeks.

Sex involving penetration should wait longer, for around eight weeks, until the top of the vagina has healed fully and the bleeding has stopped. Rarely, the vaginal vault opens if it is put under strain too soon, which is the main reason for this longer wait.

Six weeks and beyond

By six weeks you will usually be back to your usual routine, although the tissues inside continue to heal for some months and tiredness can linger. I see you at about six weeks after the operation to check on your recovery and to go through the results of the laboratory examination of the womb (histology).

If your ovaries were removed before the menopause, menopausal symptoms such as hot flushes can begin within days, and we will have talked about hormone replacement therapy (HRT) beforehand. If your ovaries were kept, your periods stop but the ovaries usually keep working. The hysterectomy page explains these choices in full.

Mixed feelings are normal too. Many women feel relief; some also feel a sense of loss, even when the decision was right for them. Talking it through with family, friends, your GP or me can help.

Some things can slow recovery

Recovery can take longer after a complex operation, for example for large fibroids or deep endometriosis, after a complication, or with other health problems. Smoking also slows healing.

Complications such as bleeding, infection, blood clots and injury to nearby organs are uncommon, and the hysterectomy page explains each of them. The ureters (the tubes that carry urine from the kidneys to the bladder) lie close to the womb. In a complex operation I first free them from the tissue around them, an approach I developed and published ^[2]. I will explain how each risk applies to you before you decide.

When to call for help

Contact the hospital ward straight away, using the number on your discharge letter, or call NHS 111, if you have:

• heavy vaginal bleeding or large clots
• a fever, or feel hot and shivery
• a smelly or discoloured discharge
• pain that is getting worse rather than better, or is not controlled by your painkillers
• a wound that is red, hot, swollen or leaking
• pain or difficulty passing urine, or urine leaking from the vagina
• repeated vomiting, a swollen abdomen, or being unable to pass wind
• pain or swelling in one calf

If you have chest pain or sudden breathlessness, or in any other emergency, call 999. For questions that are not urgent, my practice manager, Helen, can help.

You can read more about the operation on the hysterectomy and robotic and keyhole surgery pages, or book an appointment.