Total abdominal hysterectomy

Summary

A total abdominal hysterectomy (TAH) is an operation to remove the womb and cervix through a cut in the abdomen. It is the traditional, open route of hysterectomy — chosen today for the situations where the keyhole or vaginal routes are not the safer option, such as a very large womb or extensive previous surgery.

• The operation is done under general anaesthetic through a single abdominal cut — usually a bikini-line cut; occasionally an up-and-down cut is needed.
• The whole womb including the cervix is removed. The ovaries may be kept or removed — this is decided and agreed with you beforehand.
• The usual hospital stay is 1–3 days, with a full recovery of about 6 weeks.
• Periods stop permanently and pregnancy is no longer possible.
• Where the keyhole route is suitable, we usually recommend it instead — see our laparoscopic hysterectomy guide. This page is for when the open route is the recommended one.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

"Total" means the womb and the cervix are removed together; "abdominal" means the route is a cut in the abdominal wall, rather than keyhole cuts or the vaginal route. Through this cut the surgeon frees the womb from its supports and blood vessels under direct vision and removes it whole — no division of tissue inside the abdomen is needed, which is one reason this route is chosen for very large wombs or where cancer is suspected.

What happens to the ovaries? The ovaries and fallopian tubes can be removed at the same time (bilateral salpingo-oophorectomy) or conserved:

• Ovaries kept — your hormones continue as before; you will not go through menopause because of the surgery.
• Ovaries removed — recommended in some situations (for example, some ovarian conditions, or to reduce cancer risk). Before menopause this causes immediate surgical menopause, and hormone replacement is usually discussed.
• The fallopian tubes are often removed even when the ovaries are kept, as this lowers future ovarian cancer risk without affecting hormones.

What is planned for your ovaries is a separate decision from the hysterectomy itself, and is agreed with you before the operation.

Why it is performed

A hysterectomy is considered when a womb condition causes symptoms that simpler treatments have not controlled and your family is complete. The abdominal route in particular is chosen when:

• The womb is very large — usually from large fibroids — making keyhole or vaginal surgery unsafe
• There is extensive previous surgery or adhesions expected in the pelvis
• Cancer or suspected cancer requires the womb to be removed intact with wide access
• Personal preference or financial reasons — when laparoscopic or robotic surgery is not affordable
• Other individual factors make open surgery the safer plan for you

The underlying reasons are the same as for any hysterectomy: fibroids, adenomyosis, heavy bleeding, chronic pelvic pain, endometriosis, prolapse, or cancer of the womb, cervix or ovaries.

Benefits

• A permanent cure for the womb problem — bleeding, pressure and pain from the womb end with its removal; the condition cannot come back.
• Direct, open access — the safest route when the womb is very large, anatomy is distorted, or the tissue must be removed whole — especially in cancer surgery.
• No cervical smears needed afterwards in most cases, as the cervix is removed (women treated for cervical abnormalities may still need vault checks — ask what applies to you).

Alternatives

• No treatment now — symptoms from fibroids often ease after menopause; watchful waiting can be reasonable.
• Medicines and the hormonal coil (LNG-IUS) — control heavy bleeding for many women without surgery.
• Myomectomy — removal of fibroids keeping the womb, by keyhole or open surgery, if you wish to keep your womb.
• Laparoscopic hysterectomy — the keyhole route, with a shorter stay and faster recovery, where the womb size and your circumstances allow — see our guide.
• Vaginal hysterectomy — removal through the vagina with no abdominal cut, most suitable with prolapse — see our guide.

Preparing for surgery

You will have an ultrasound assessment, a physical examination, blood tests (anaemia from heavy bleeding is corrected first where possible), blood pressure checks and a review of your medicines and general health. An up-to-date cervical smear history is checked, and further imaging or biopsies are arranged where the diagnosis needs confirming. Tell the team about all medicines you take — blood thinners may need adjusting — and any previous surgery or anaesthetic problems.

• Smoking: stopping even a few weeks before surgery reduces chest and wound complications — especially important for open surgery.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange help for the first 1–2 weeks — cooking, lifting and childcare — and someone to take you home.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — including confirming exactly what is planned for your ovaries.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you. You can still change your mind at this point. Compression stockings are usually fitted, and a dose of antibiotics is given at the start of surgery.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. A catheter is placed in the bladder. The surgeon opens the abdomen — usually through a bikini-line cut about 10–15 cm long; a larger or up-and-down cut is occasionally needed for a very large womb.

The womb's supporting ligaments and blood vessels are secured and divided, the bladder is protected and moved clear, and the womb and cervix are removed. The top of the vagina (the vault) is closed with dissolvable stitches, and the abdominal wall is closed in layers. The operation commonly takes about 1–2 hours.

After the operation

You will wake in the recovery room with a drip and a bladder catheter, both usually removed the next day.

• Pain relief: open surgery is more painful than keyhole surgery in the first days; regular painkillers, and stronger medication where needed, keep it controlled.
• Eating and drinking: fluids the same day, building up as comfortable.
• Moving: you will be helped out of bed by the next morning — early walking speeds recovery and protects against clots. Daily blood-thinning injections are often given during the stay.
• Going home: usually after 1–3 days.
• Bleeding: light vaginal bleeding or discharge for up to 6 weeks can be normal as the vault heals.

Recovery at home

• Weeks 1–2: rest with gentle activity; short walks, no lifting heavier than a kettle. Tiredness is normal and can last weeks.
• Weeks 3–4: gradually increasing activity and light household tasks.
• Week 6 onwards: most women are back to normal activity and work; heavy physical work may need longer.
• Driving: usually after 4–6 weeks — when you can wear a seatbelt comfortably and perform an emergency stop without hesitation. Check your insurer's policy.
• Sex: wait until vault healing is confirmed — usually about 6 weeks and after your follow-up check.
• Follow-up: attend your follow-up appointment so the wound, the vault and (where relevant) laboratory results can be reviewed.

These are typical figures; your own advice may differ and comes first.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on the reason for surgery, the size of the womb, your health and previous surgery, and will be discussed with you.

Expected, temporary effects

• Wound pain and tiredness for some weeks
• Light vaginal bleeding or discharge for up to 6 weeks
• Constipation and wind in the first days

Complications

• Bleeding — heavy enough to need a transfusion in a small proportion of women (uncommon).
• Infection — of the wound, urine, chest or vault; most cases settle with antibiotics (common but usually minor).
• Injury to the bladder, bowel or ureters — recognised injuries are repaired (rare).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Wound problems — haematoma, slow healing, or later an incisional hernia needing repair (uncommon).
• Vault problems — granulation tissue or, years later, vault prolapse (uncommon).
• Early menopause — if the ovaries are removed before menopause this is immediate; even with ovaries kept, menopause may arrive somewhat earlier than it otherwise would.
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women.

And to state the obvious plainly: after a hysterectomy periods stop permanently and pregnancy is not possible. Be certain your family is complete before consenting.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• A wound that becomes red, swollen, hot, opens or leaks fluid
• Burning on passing urine, being unable to pass urine, or leaking urine constantly
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why this operation — and this route — is recommended for you, what the realistic alternatives are, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Health Service (UK). Hysterectomy. Available from: https://www.nhs.uk/conditions/hysterectomy/ [last checked 9 August 2026].
2. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline NG88. Available from: https://www.nice.org.uk/guidance/ng88 [last checked 9 August 2026].
3. Royal College of Obstetricians and Gynaecologists. Patient information — abdominal hysterectomy. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 9 August 2026].

Patient information from our own clinics

1. Sugabi Clinic Ragama. Laparoscopic hysterectomy — surgery guide. Available from: https://sugabi.lk/surgery-guide/laparoscopic-hysterectomy/
2. Sugabi Clinic Ragama. Vaginal hysterectomy — surgery guide. Available from: https://sugabi.lk/surgery-guide/vaginal-hysterectomy/