It is the first question most women ask when they are told the uterus has dropped — and the honest answer is that it depends on what the examination finds, not on the diagnosis alone. Uterine-preserving repair is a real option for many women. This page explains how the choice is made.
No, not always. Uterine prolapse can often be repaired with the uterus left in place. Techniques that lift and re-anchor the uterus to the ligaments of the pelvis — rather than removing it — are established practice, and for a woman who wants to keep her uterus they are the first thing to discuss, not a concession.
There are situations where removing it is the better operation, and a surgeon who never says so is not being kind. Those include abnormal bleeding that has not been explained, a uterus enlarged by fibroids, any abnormality found on cervical screening or a biopsy, and some cases of severe prolapse where the supporting tissue itself will not hold a repair.
The part that matters: this is decided after an internal examination and staging, not from symptoms and not over a message. Anyone who tells you which operation you need before examining you is guessing.
Uterine-preserving prolapse surgery, sometimes called hysteropexy, re-suspends the uterus using the body's own ligaments or a support placed by the surgeon. The uterus stays. The approach depends on which compartment has descended and how far.
Reasons women choose it: wanting a future pregnancy; not wanting an organ removed that is not itself diseased; a preference to avoid the longer operation; and for some women, what the uterus means to them, which is a legitimate reason and is treated as one here.
The trade-off, stated plainly: the uterus remains, so it remains capable of the problems a uterus can have — bleeding, fibroids, and the need for continued cervical screening. Prolapse can also recur after any repair, preserving or not. Which carries more risk of recurrence in your case depends on your tissue and your stage, and is a question for the surgeon who examined you.
Vaginal hysterectomy — removal through the vagina — is the route most often used when prolapse is the reason for surgery. It is frequently combined with repair of the vaginal walls, because prolapse rarely involves only one compartment.
It tends to be advised when there is unexplained bleeding, when the uterus is enlarged or contains fibroids that are themselves causing symptoms, when screening or biopsy has found something that needs addressing, and in some advanced prolapse where the uterus is part of what has failed.
What it means afterwards: periods stop and pregnancy is no longer possible. If the ovaries are left — which is usual when there is no reason to remove them — hormones continue and this is not surgical menopause. Whether the ovaries stay is a separate decision from whether the uterus does, and should be discussed separately rather than assumed.
Most prolapse surgery, including vaginal hysterectomy, is done through the vagina. There is no abdominal incision and no external scar. This is the standard route for this indication, not a special technique.
Where an abdominal or laparoscopic (keyhole) route is used instead, it is because of something specific — the size of the uterus, previous surgery and adhesions, or the particular repair being planned.
Recovery differs between the routes and between women, and the surgeon who assesses you will say what to expect for the operation actually planned. A time in days quoted on a website before anyone has examined you is not information, and none is given here.
Prolapse repair is an operation for symptoms, and it is reasonable to ask exactly which ones. The symptoms it is performed to address are: the dragging or heavy feeling that worsens through the day; a bulge that can be felt or seen; having to press with a finger to empty the bladder or bowel; discomfort during sex; and the restriction many women accept quietly — avoiding exercise, avoiding lifting, planning the day around it.
Those are the terms on which the operation should be judged, and on which you should judge whether it was worth it. Results differ between individuals and no outcome is guaranteed.
Surgery is not the first step for mild to moderate prolapse. Correct pelvic floor training and a pessary are non-surgical options that suit many women, and stage 1-2 is usually managed without an operation at all.
Fibroids and chocolate cysts (ovarian endometrioma) are a separate reason for uterine or pelvic surgery, with a separate logic. They are included here because women often search for them alongside prolapse, but the decision is not the same one.
Fibroids do not all need removing. Many cause no symptoms and are managed by observation. Surgery is considered when they cause heavy bleeding, pressure, or pain — and where the uterus is to be kept, removal of the fibroid alone (myomectomy) rather than the uterus may be possible, depending on their number, size and position.
Endometrioma is assessed for size, symptoms, effect on fertility and imaging characteristics. Surgery here is weighed against its effect on ovarian reserve, which is why it is not an automatic recommendation.
Both are assessed with examination and imaging before anything is planned. Anything suspicious on imaging changes the pathway and is referred appropriately.
The clinic is where the assessment, the staging and the surgical decision happen. The operation itself is performed at a partner hospital, where there is an operating theatre, anaesthesia and inpatient care. That is said here rather than left to be discovered: this is a clinic on the eighth floor of a shopping centre, and surgery belongs in a hospital.
The partner hospitals are Praram 9 Hospital and Vimut Hospital. Which one is used depends on the operation planned, your surgeon's operating schedule and, where relevant, which hospital your insurance works with.
Your surgeon is the specialist who assessed you. Costs for the hospital admission and the operation are quoted by the hospital and are separate from the clinic's consultation fee; you will have the figures before you agree to anything.
Asst. Prof. Dr. Komkrit Aimjirakul — urogynecology; vaginal hysterectomy and vaginal wall repair are among his stated areas of practice.
Assoc. Prof. Dr. Orawee Chinthakanan (ว.33071) — Female Pelvic Medicine and Reconstructive Surgery; certified in gynecological endoscopy; fellowship at Atlanta Urogynecology Associates.
Dr. Varisara Chantarasorn (ว.26575) — prolapse and incontinence surgery; urogynecology fellowship, University of Sydney.
Dr. Wanchat Komon — Female Pelvic Medicine and Reconstructive Surgery; certificate in gynecologic endoscopic surgery.
Registration numbers can be checked with the Thai Medical Council. Female specialists are available — say so when you book.
Do not wait for a routine appointment if you have bleeding after the menopause, bleeding after sex, a sore or infection on the tissue that is protruding, or you cannot pass urine. Those need assessment now.
Otherwise, the useful first appointment is an examination and staging. It is not complicated: history, an internal examination to identify which compartment has descended and how far, and sometimes a bladder function test. That examination is what determines every option above.
No. Uterine prolapse can often be repaired with the uterus left in place, using techniques that re-suspend it to the ligaments of the pelvis. Removal is advised in specific situations — unexplained bleeding, a uterus enlarged by fibroids, an abnormality found on screening or biopsy, and some severe prolapse where the supporting tissue will not hold a repair. Which applies is decided after an internal examination and staging, not from symptoms.
Usually not. Most prolapse surgery, including vaginal hysterectomy, is performed through the vagina, with no abdominal incision and no external scar. An abdominal or laparoscopic route is used when there is a specific reason, such as the size of the uterus, previous surgery and adhesions, or the particular repair planned.
Not if the ovaries are left, which is usual when there is no reason to remove them — hormones continue and this is not surgical menopause. Periods stop and pregnancy is no longer possible. Whether the ovaries stay is a separate decision from whether the uterus does, and should be discussed separately.
No. Many fibroids cause no symptoms and are managed by observation. Surgery is considered when they cause heavy bleeding, pressure or pain. Where the uterus is to be kept, removing the fibroid alone (myomectomy) may be possible depending on their number, size and position.
At a partner hospital — Praram 9 Hospital or Vimut Hospital — which is where the operating theatre, anaesthesia and inpatient care are. The clinic at EMSPHERE is where the assessment, staging and surgical decision happen. Hospital and operation costs are quoted by the hospital and are separate from the clinic's consultation fee.
Message us with what you are experiencing and we will tell you whether an examination is worth making, and what the appointment involves.
This page is general information to aid understanding. It is not a diagnosis or individual treatment advice. Which option is appropriate is decided individually after examination, and results differ between individuals. Surgery is performed at a partner hospital, not at the clinic. THE FIT CLINIC, 8th Floor, EM Tower, EMSPHERE, 628 Sukhumvit Road, Bangkok 10110. Open daily 10:00–19:00.