Uterine Preservation Surgery Sheffield
Professor Swati Jha
At a glance: Uterine Preservation Surgery Sheffield
I offer specialist assessment for women with uterine prolapse who want to understand whether their prolapse can be treated without removing the womb. Uterine preservation surgery, also called hysteropexy, may be suitable for some women with womb prolapse, depending on the type and severity of prolapse, symptoms, previous surgery, future pregnancy plans, cervical and uterine health, and personal preference.
In my private practice in Sheffield, I provide consultant-led assessment, explain non-surgical and surgical options clearly, and help women decide whether uterus-preserving prolapse repair, vaginal pessary treatment, pelvic floor physiotherapy, or hysterectomy with prolapse repair is the most appropriate option.
What Is Uterine Prolapse?
Uterine prolapse happens when the womb drops down from its normal position and descends into the vaginal canal. One of the most common questions I am asked at assessment is whether the prolapse can be corrected without removing the uterus. That question is exactly what uterine preservation surgery in Sheffield addresses, and it is the focus of this page.
The uterus is normally held in place by a combination of ligaments, fascia and the pelvic floor. When these supports weaken — typically after childbirth, with age, after the menopause, or due to sustained raised intra-abdominal pressure — the uterus can descend into the vaginal canal, producing the characteristic symptoms of prolapse.
Many women are told they need a hysterectomy for prolapse. This is not always the case. Whether uterine preservation is appropriate depends on a proper assessment — not a default assumption.
Symptoms of Uterine Prolapse
Uterine prolapse can produce a range of symptoms depending on the degree of descent and whether other pelvic floor compartments are also affected.
- A feeling of something coming down from the vagina, or a vaginal bulge or lump
- Pelvic heaviness, dragging or pressure — often worse after prolonged standing or walking
- Bladder symptoms: urgency, frequency, difficulty emptying or incomplete emptying
- Bowel symptoms: constipation, difficulty emptying, or the need to support the vagina to defaecate
- Discomfort or altered sensation during sexual intercourse
- Lower back or pelvic aching, typically worse towards the end of the day
Many women have prolapse affecting more than one compartment. The bladder, bowel and vaginal walls may all need assessment alongside the uterus before any treatment decision is made. BSUG notes that prolapse can involve the uterus, bladder, bowel or vaginal walls, and that treatment should follow proper discussion of the type, extent and impact of symptoms on quality of life.
What Is Uterine Preservation Surgery (Hysteropexy)?
Uterine preservation surgery is prolapse surgery that supports the womb without removing it. The medical term is hysteropexy — derived from the Greek words for uterus and fixation. The aim is to lift and restore the uterus to its correct anatomical position so that the prolapse is corrected while the womb remains intact.
Depending on the degree of prolapse, the pelvic anatomy and the individual's clinical history, hysteropexy may be performed using native tissue techniques — where the uterus is supported using the body's own ligaments and permanent sutures — or using laparoscopic (keyhole) approaches. Some national centres perform laparoscopic sacrohysteropexy, in which mesh is used to attach the cervix or uterus to the sacral ligament. NICE guidance (IPG583) on uterine suspension using mesh sets out the specific requirements and risks for this technique.
How Is Hysteropexy Performed?
The operative details depend on the technique selected, but the general principle for laparoscopic hysteropexy is as follows. Under general anaesthesia, three or four small keyhole incisions are made on the abdomen. A camera and fine instruments are introduced to allow the uterus to be identified, mobilised and suspended. The cervix or uterus is then attached to a ligament or the anterior sacrum — either using the body's own tissue and sutures, or in certain techniques using a strip of mesh. The peritoneal layer is usually closed over the repair. Hospital stay is typically one to two nights.
The distinction I explain to every patient is that not all uterus-preserving operations are the same procedure. The decision is not simply whether the uterus can be preserved — it is which operation is safest and most appropriate for you individually, based on the prolapse pattern, anatomy, clinical history and your own preferences.
Hysteropexy — At a Glance
Not the same as hysterectomy
Hysteropexy preserves the uterus. Hysterectomy removes it. These are entirely different operations with different indications, risks and long-term implications. Which is appropriate for you depends on your individual assessment — it is never assumed in advance.
Why Some Women Want to Keep Their Uterus
Women may wish to preserve their womb for a range of reasons. Some feel strongly about keeping the uterus as part of their identity or personal wellbeing. Others want to keep the option of pregnancy open, particularly if their family is not yet complete. Many simply want to understand all reasonable alternatives before making any decision — and that is entirely reasonable.
I take these preferences seriously and explore them as part of every consultation. At the same time, I am clear about the clinical limits. Uterine preservation is not automatically the better option for every woman with prolapse, and hysterectomy is not automatically necessary for every woman with uterine prolapse. The right choice emerges from a proper individual assessment, not from a default surgical pathway.
What the Decision Depends On
The discussion about whether to preserve the uterus or proceed to hysterectomy is shaped by several clinical factors, all of which I assess before making any recommendation:
- The degree of uterine descent and the overall prolapse pattern
- Whether the bladder or bowel compartments are also prolapsing
- Cervical length and the health of the uterus on examination
- Bleeding history and whether any investigation is outstanding
- Cervical screening history and currency
- Previous prolapse surgery and the resulting anatomy
- Sexual function, menopausal status and future pregnancy intentions
- Medical fitness for surgery and anaesthetic risk
- Whether non-surgical options have been tried or are still appropriate
Uterine Preservation Surgery versus Hysterectomy for Prolapse
Neither operation is universally superior. The right choice depends on individual anatomy, uterine health and clinical history. The comparison below sets out the key considerations I discuss with every patient. BSUG patient information also compares the main surgical options for uterine prolapse — including vaginal hysterectomy, Manchester repair and sacrohysteropexy — and notes that no single operation guarantees relief of all symptoms.
- You wish to keep your uterus
- The uterus and cervix are healthy on examination
- There is no unexplained or postmenopausal bleeding
- Cervical screening is up to date and normal
- The prolapse pattern is anatomically suitable for suspension
- You understand the ongoing need for cervical and uterine surveillance
- Preserves the uterus
- Avoids hysterectomy where it is not clinically necessary
- Can maintain vaginal anatomy in selected women
- May be part of a personalised, multi-compartment repair plan
- Not suitable for every prolapse pattern
- Future uterine or cervical problems may still require investigation or further surgery
- Prolapse can recur after any prolapse operation, including hysteropexy
- Some techniques nationally involve mesh, requiring a separate consent discussion
- The uterus should be removed for clinical reasons
- There is abnormal or postmenopausal bleeding requiring investigation
- Cervical or uterine findings make preservation clinically inappropriate
- The prolapse anatomy is better addressed by hysterectomy and vault support
- The patient prefers definitive removal of the womb
- Removes future risk of uterine or cervical disease
- May be the more appropriate procedure when uterine pathology is present
- Can be combined with anterior, posterior or vault repair in the same operation
- The uterus is permanently removed
- Vault prolapse can still occur after hysterectomy
- Hysterectomy is not always necessary when prolapse is the only indication
Do I Need Surgery at All?
Not always. I do not recommend surgery simply because prolapse is visible on examination. I recommend treatment — surgical or otherwise — based on how much the prolapse affects your quality of life, what symptoms it is causing, and whether conservative treatment is likely to help.
Before any surgical discussion, I typically explore the following options:
- Pelvic floor physiotherapy — supervised rehabilitation from a specialist pelvic health physiotherapist
- Vaginal pessary treatment — a non-surgical device to support the prolapse and relieve symptoms
- Vaginal oestrogen — particularly relevant for postmenopausal women with tissue atrophy
- Bowel optimisation — fibre, hydration and laxative management to reduce straining
- Lifestyle modifications — weight, lifting habits and high-impact activity
- Observation — where symptoms are mild and a watchful approach is the patient's preference
NICE guidance on pelvic organ prolapse (NG210) recommends surgery only when symptoms have not improved with, or when women decline, non-surgical treatment.
Non-Surgical Prolapse Treatment
I offer a full range of conservative prolapse management options, including pelvic floor optimisation, vaginal oestrogen review and pessary fitting, at Spire Claremont and Circle Thornbury.
Non-Surgical Treatment →Vaginal Pessary Clinic
A pessary can control prolapse symptoms effectively without surgery and is a valid long-term option for many women. I discuss pessary treatment as part of every consultation where surgery is being considered.
Vaginal Pessary Clinic →Who May Be Suitable for Uterine Preservation Surgery?
Hysteropexy is not appropriate for every woman with uterine prolapse. A careful assessment is required to determine whether it is the right operation — and this is precisely why a thorough urogynaecology consultation matters before any decision is made.
You may be suitable if:
- Your main problem is uterine prolapse
- You wish to preserve your uterus
- Your cervical screening is up to date and normal
- There is no unexplained or postmenopausal bleeding
- There is no suspected uterine or cervical disease
- You understand the ongoing need for cervical and uterine surveillance
- Examination confirms that hysteropexy is technically suitable for your prolapse pattern
- You are medically fit for a general anaesthetic
Postmenopausal women
Some postmenopausal women are suitable for uterus-preserving prolapse surgery, but uterine and cervical health must be confirmed before this is appropriate. Any history of postmenopausal bleeding requires investigation before this type of surgery can be considered — this is a non-negotiable safety step, not a formality.
You may not be suitable if:
- There is abnormal, postmenopausal or uninvestigated uterine bleeding
- Cervical or uterine findings are concerning on examination or investigation
- There is significant uterine enlargement or fibroid disease that complicates the operation
- There is a known or suspected gynaecological cancer risk
- The prolapse pattern is better treated by hysterectomy with vault support
- Conservative treatment has not yet been adequately tried and surgery is premature
This is why a proper assessment matters
The criteria above cannot be established from symptoms alone. A physical examination and a review of your complete clinical history are required before any recommendation can be made. I do not advise any operation without first completing a thorough assessment.
My Approach to Uterine Preservation Surgery in Sheffield
When I assess a woman for prolapse, I do not begin with the operation — I begin with the diagnosis. Understanding exactly what is prolapsing, to what degree, and how it affects daily life is the foundation of any sensible surgical recommendation.
At your consultation, I will:
- Take a detailed symptom history, including bladder, bowel and sexual function
- Review childbirth, menopausal, surgical and full medical history
- Perform a pelvic examination where appropriate
- Identify which compartments are prolapsing and to what degree
- Explain whether the uterus is the primary problem or part of a wider pelvic floor issue
- Discuss non-surgical and surgical options in detail
- Provide a clear recommendation and written management plan
I hold RCOG subspecialty accreditation in urogynaecology — one of a small number of consultants in the UK with this qualification — and I perform hysteropexy and advanced pelvic reconstructive surgery as a central part of my private practice. No GP referral is required to arrange an appointment.
No GP Referral Required
You can arrange a private consultation directly. Same-week appointments are frequently available at both hospitals.
Contact My Secretary →Recovery After Hysteropexy
Although laparoscopic hysteropexy is performed through small incisions, the body still requires time to heal internally. The timeline below is a general guide for laparoscopic approaches. Individual recovery varies depending on whether additional vaginal repairs were performed at the same time, your general health and fitness, and how quickly your body heals.
In hospital — 1 to 2 nights
Most women are discharged the morning after surgery or after one overnight stay. Where additional vaginal repairs are performed at the same time, a slightly longer stay may be required. Pain in the first day is managed with regular analgesia and typically settles quickly.
First 2 weeks — rest and gentle activity
Short walks are encouraged from day one at home. Avoid lifting, strenuous household tasks and driving in the early weeks. Abdominal soreness and bloating are normal and usually resolve within ten to fourteen days. Dissolvable sutures on the skin incisions typically dissolve within two to three weeks.
4 to 6 weeks — return to daily activities
Most women return to desk-based work and light daily activities around four to six weeks. Driving is usually comfortable once you can perform an emergency stop without discomfort — typically around three to four weeks post-operatively.
6 weeks — sexual intercourse
Penetrative intercourse is generally avoided until at least six weeks post-operatively, or until after your follow-up appointment. Many women find that sexual comfort improves after prolapse surgery once the prolapse has been corrected, though individual outcomes vary.
12 weeks — return to full activity
Heavy lifting, strenuous exercise and high-impact sport are restricted for twelve weeks to allow the pelvic floor repair to consolidate. I give personalised advice on return to exercise at your follow-up appointment.
Ongoing requirements when the uterus is preserved
Because the uterus and cervix remain in place, surveillance continues as normal:
- Continue cervical screening as per your normal national recall schedule, unless specifically advised otherwise
- Any unusual bleeding after surgery — particularly postmenopausal bleeding — must be investigated, as it would in any woman with an intact uterus
- If pregnancy is still a possibility, it must be discussed at consultation: pregnancy can cause prolapse recurrence and may complicate future management
Can the prolapse come back?
Yes. Prolapse can recur after any prolapse operation, including hysteropexy. Recurrence risk depends on tissue quality, the original degree of prolapse, the type of repair, and subsequent factors such as heavy lifting, constipation, chronic cough, raised BMI and future pregnancies. I discuss realistic recurrence rates as part of the consent process before any surgery.
If you are concerned about prolapse that has returned after a previous repair, see recurrent prolapse assessment in Sheffield.
Full Prolapse Surgery Overview
For a complete overview of all prolapse surgery I offer — including native-tissue repair, sacrospinous fixation and laparoscopic sacrocolpopexy — see the main prolapse surgery page.
Prolapse Surgery Sheffield →An Important Note About Mesh in Prolapse Surgery
Some national techniques for uterine preservation surgery — in particular laparoscopic sacrohysteropexy — use abdominal mesh to attach the uterus to the sacrum. This is a different type of procedure from the vaginal mesh operations that were widely restricted or withdrawn following NICE guidance. NICE interventional procedure guidance (IPG583) on uterine suspension using mesh covers the specific indications, requirements and risks for this approach.
Other forms of hysteropexy use native tissue — the body's own ligaments and sutures — without any prosthetic material. The technique appropriate for any individual depends on the prolapse pattern, the anatomy and a careful risk-benefit discussion.
In my practice, I explain clearly and explicitly to every patient whether any proposed operation involves mesh or native tissue, the clinical reason for the recommendation, what the specific risks are, and what alternatives exist. I do not believe any woman should arrive in the operating theatre uncertain about whether mesh is involved in her surgery.
If you have been recommended mesh-based uterine suspension elsewhere and would like a second opinion, or if you want to understand your options in full before making a decision, I am happy to discuss this at a private consultation in Sheffield.
Key points on mesh in prolapse surgery
Abdominal mesh used in sacrohysteropexy is a different procedure from the vaginal mesh operations affected by NICE guidance NG210.
Native tissue hysteropexy techniques are available and appropriate for the majority of women with uterine prolapse.
Any procedure involving mesh requires specific informed consent and a detailed risk discussion. I follow NICE and NICE prolapse guideline (NG210) standards in all consent discussions involving mesh.
Frequently Asked Questions About Uterine Preservation Surgery in Sheffield
Questions I am regularly asked about hysteropexy and uterine preservation for prolapse — answered in plain terms.
Yes, in selected women. Uterine preservation surgery — also called hysteropexy — is designed to support the prolapsed womb without removing it. The operation lifts and suspends the uterus back to its normal position. It is not suitable for every woman, which is why I assess the type of prolapse, uterine and cervical health, bleeding history and personal goals before making any recommendation.
Hysteropexy is the medical term for an operation that lifts and supports the uterus without removing it. It is one form of uterine preservation surgery for prolapse. The word hysteropexy covers several different techniques — including vaginal sacrospinous hysteropexy, laparoscopic uterine suspension and sacrohysteropexy — but the shared principle is prolapse correction while preserving the womb.
Not universally. Uterine preservation may be the right choice when the uterus is healthy and you wish to keep it. Hysterectomy may be more appropriate when there is abnormal or postmenopausal bleeding, uterine or cervical disease, or when the prolapse anatomy is better corrected by removing the uterus and supporting the vaginal vault. The right answer depends on a proper individual assessment — there is no default that applies to every woman.
Yes, some postmenopausal women are suitable for uterus-preserving prolapse surgery. However, the health of the uterus and cervix must be confirmed beforehand. Postmenopausal bleeding requires investigation and exclusion before this type of surgery can be considered — this is a fundamental safety requirement, not an optional step, and applies regardless of how mild the bleeding history appears to be.
It depends on the technique. Some national approaches — such as laparoscopic sacrohysteropexy — involve abdominal mesh to attach the uterus to the sacrum. Other approaches use native tissue (your own ligaments and sutures) without any mesh. I explain clearly whether mesh is involved in any proposed operation, the clinical reason for its use, the specific risks, and what alternatives exist. This discussion is a required part of the consent process before any surgery involving mesh.
Yes. If your cervix remains in place after uterus-preserving surgery, you should continue cervical screening according to your national recall schedule, unless you have been specifically advised otherwise. The cervix is not removed in hysteropexy, so routine cervical screening requirements continue to apply exactly as they would in any woman with an intact uterus and cervix.
Yes. Prolapse can recur after any prolapse operation, including hysteropexy or hysterectomy with repair. The risk of recurrence depends on tissue quality, the original severity of the prolapse, the type of repair performed, and subsequent factors such as heavy lifting, chronic constipation, a persistent cough, raised BMI and future pregnancies. I discuss realistic recurrence rates as part of the consent process before any surgery is planned.
In many cases, yes. A vaginal pessary can control prolapse symptoms effectively without surgery and may be an excellent option if you want to avoid or delay an operation. I discuss pessary treatment as part of the decision-making process at every consultation where surgery is being considered. NICE guidance supports offering conservative treatment before recommending surgery for pelvic organ prolapse.
For laparoscopic hysteropexy, most women stay one to two nights in hospital. Return to light daily activities and desk-based work typically takes four to six weeks. Driving is usually comfortable around three to four weeks post-operatively. Sexual intercourse is avoided for at least six weeks. Heavy lifting and strenuous exercise are restricted for twelve weeks to allow the repair to consolidate. If additional vaginal repairs were performed at the same time, recovery may be slightly longer — I provide personalised guidance at your follow-up appointment.
These are two different surgical techniques for uterine preservation. Sacrospinous hysteropexy is a vaginal operation in which the uterus or cervix is attached to the sacrospinous ligament in the pelvis using permanent sutures. No mesh is used and there are no abdominal incisions. Sacrohysteropexy is a laparoscopic operation in which the uterus is attached to the anterior sacrum using a strip of mesh placed through the abdomen. The choice between techniques depends on the degree of prolapse, the anatomy, the involvement of other compartments and an individual risk-benefit discussion.
Bladder function can be affected after any pelvic floor operation. Temporary difficulty passing urine in the first 24 to 48 hours is not uncommon and usually resolves without intervention. A small proportion of women develop new or worsened urinary symptoms — including stress urinary incontinence — after prolapse surgery, even when this was not anticipated beforehand. If bladder symptoms form part of your presentation before surgery, they will be assessed and discussed in detail as part of your consultation and consent process.
Pregnancy may be possible after some uterus-preserving operations, but pregnancy significantly increases the risk of prolapse recurrence and may complicate future management. In most cases, prolapse surgery is best considered once your family is complete. If you are considering future pregnancy, this must be discussed explicitly at consultation before any surgical plan is agreed.
Uterine preservation prolapse surgery is available within the NHS, though waiting times can be significant and the specific technique offered will depend on local service availability and the referring consultant's practice. In private practice, I offer assessment and surgery with short waiting times at Spire Claremont Hospital and Circle Thornbury Hospital in Sheffield. A GP referral is not required to arrange a private consultation.
No. You can arrange a private consultation directly, without a GP referral. If you wish to discuss your options for uterine prolapse — including whether uterine preservation surgery is appropriate for you — you are welcome to contact my secretary to arrange an appointment at Spire Claremont or Circle Thornbury Hospital in Sheffield.