- Uterine prolapse is staged 1–4.
- Uterus-preserving surgery is a genuine modern option, not a compromise.
- The choice between preserving and removing the uterus should be a shared decision.
What is uterine prolapse?
The uterus is held in the pelvis by a set of ligaments (uterosacral, cardinal, round) and the pelvic floor. When these supports weaken the uterus descends into the vaginal canal. Depending on how far it descends the condition is staged from 1 to 4.
Common symptoms
Women describe a heavy, dragging feeling in the pelvis, low back pain that eases when lying down, a visible or palpable bulge, discomfort during sex, and — in advanced stages — the cervix being felt at or outside the vaginal opening.
Do you have to have a hysterectomy?
For decades, vaginal hysterectomy was the default answer for uterine prolapse. That is no longer the case. Modern uterus-sparing operations — sacrohysteropexy, Manchester repair, high uterosacral suspension — restore the supports and preserve the uterus. They are the right choice for many women who want to keep their uterus for anatomical, personal, cultural or fertility reasons.
Whether the uterus is preserved or removed is a shared decision, not a default. It should be discussed on its own merits, not assumed.
Surgical options at a glance
The right operation depends on the stage of prolapse, your age, your fertility plans, whether you have had previous surgery, and your goals for sexual function.
- Sacrohysteropexy — laparoscopic uterus-preserving suspension using a thin mesh tape to the sacrum. Excellent long-term durability.
- Manchester repair — vaginal approach that shortens the cervix and lifts the uterus. No mesh.
- High uterosacral ligament suspension — restores the natural ligament support after removing the uterus, when hysterectomy is chosen.
- Vaginal hysterectomy with pelvic floor repair — the traditional operation, still appropriate in selected cases.
For patients travelling from the UK
British women often tell us that NHS pathways default very quickly to hysterectomy without discussing uterus-sparing alternatives. A specialist second opinion — even a video consultation — can change the plan entirely.
Frequently asked questions
Do I have to have my uterus removed?
No. Modern uterus-sparing repairs give equivalent or better outcomes in many stage 2–3 prolapses.
Can I still have children after prolapse surgery?
Some uterus-sparing operations preserve fertility; this is discussed individually and depends on the exact repair.
How is uterine prolapse diagnosed?
By pelvic examination in the standing and lying position, using the POP-Q staging system.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms, any UK imaging or referral notes, and giving you a clear, personalised next step. Suitable for women considering treatment from anywhere in the UK.
Request a video consultation