JINC · Personal · Women's Health
Four months on from my hysterectomy, I want to be honest: this past month has been one of the hardest. Not because anything has gone dramatically wrong, but because recovery is slower, stranger and less tidy than anyone prepared me for — and because I spent a chunk of it feeling like I'd somehow failed at it. This is where I really am at four months — the HRT that isn't sitting right, the pain that has moved, the swelling that won't quit, the comparison trap, and the small but important decision I made this week to climb back out of it.
If you've followed my story this far — through the years it took to be diagnosed, the weeks before my surgery, and the honest three-month update — thank you. This is the next instalment, written at four months, and I've thought hard about whether to share how low parts of this month have been. I decided to, because the tidy, "back on my feet" version helps no one. The real one might.
The honest truth at four months
I think a part of me believed that by four months I'd be turning a clear corner. In some ways I am — but this past month has actually been tougher than the ones before it, and that surprised me. I've felt strange. Not myself. A bit untethered, in a way that's hard to put into words. And feeling worse at four months than I did at, say, ten weeks brought a wave of "should I not be better than this by now?" that I've had to work hard to talk myself out of.
So if you're further down this road than the leaflet promised and quietly wondering the same thing — you are not behind, and you have not done anything wrong. Recovery genuinely is not a straight line, and four months is still early for major surgery, however much the world expects otherwise.
The HRT question — wondering if I felt better without it
I'm now on three pumps of HRT gel a day, and I have to be honest: I feel really strange on it. Not myself. It's got to the point where I've started to wonder whether I actually felt better before the dose went up — which is not at all what I expected to be saying.
I'm not making any changes on my own, because I know HRT is a process of finding the right type and dose, and that "not right yet" doesn't mean "not right for me." But it's firmly on the list to talk through properly, because how you feel day to day matters enormously, and I don't think I should just put up with feeling like a stranger to myself. If you're in the same place — adjusting, second-guessing, wondering — please don't suffer in silence with it either. It's a conversation to have, not a thing to endure.
The pain that moved
Here's the thing that's bothering me most. I'm still in pain — but it has moved. It's no longer the deep, internal pain I had before surgery. Now it's at the front, across my hips, almost underneath my old caesarean scar. And it's there every single day.
It isn't the kind of pain I need medication for, which I'm grateful for. But "you don't need painkillers" and "it's fine" are not the same thing. It's just there — daily, nagging, and unwelcome — and the honest truth is that not knowing what it is, and whether it might get worse, is bothering me more than the pain itself. I don't have an answer for you on this one yet, because I don't have one for myself. What I've done is the only sensible thing: I've made sure it's top of the list to be looked at, rather than quietly worrying about it alone (which is exactly what I'd have done a couple of years ago).
Still swelling, still wiped out
The swelling I wrote about at three months hasn't gone. My belly still swells every single day. And the fatigue is still very real — I try to do normal things, and they still wipe me out completely.
The clearest example: last weekend I went to a Take That concert. Normally we'd queue for hours to get a good spot down the front — that's part of the fun for us. This time I knew I couldn't, so I went in just for the show. The venue were lovely about it; I explained, asked about seating even though I only had a standing ticket, and they moved me without any fuss. I'm so glad I went. But it cost me — the next day I was completely wiped out again, the way one big day still seems to demand a flat one in return.
I'm sharing that because it's the honest shape of month four: I can do lovely, normal things now, which is real progress. But each one still comes with a bill, and the bill arrives the next day.
Everyone knows someone who had a hysterectomy and "was back to work in no time." What nobody tells you is how heavy that one sentence can sit on a person who is four months in and still swelling every day.
The comparison trap
Work has been really hard this month. And one of the hardest parts isn't the work itself — it's that everyone seems to know someone who had a hysterectomy and bounced straight back. It's said kindly, always, but it lands like a measuring stick I keep falling short of.
What I've had to keep reminding myself is that no two surgeries are the same. As I wrote at three months, mine turned out to be more complex than planned — adenomyosis, endometriosis, and significant scarring from my caesareans all dealt with at once. You cannot compare that recovery to someone else's, any more than you'd compare two completely different operations. The woman who was "back in three weeks" is not ahead of me, and I am not behind her. We just had different surgeries, different bodies, different roads.
My histology appointment — and why I'm glad of it
There's an appointment coming up that I'm genuinely glad about. After surgery, the tissue that's removed is sent off for analysis — a histology report. I'd gone to my GP, who had a copy, and when I rang my surgeon's team they asked me to come in to go through it.
A few months ago that phone call might have frightened me. Now, honestly, I'm relieved — because I have a proper list of things I need to discuss: the HRT that doesn't feel right, the new pain across my hips, the swelling, and simply where I am at four months versus where I expected to be. Going in with that list written down (a very JINC thing to do) means I won't forget half of it the moment I sit down. If you've got a review coming up, write your list now, while you're thinking clearly — it makes all the difference.
Choosing a better headspace
I'm going to be honest about the low part, because I think it matters. For a good stretch of this month I felt like a failure. Like I'd somehow messed this up — that the pain, the swelling, the exhaustion were all evidence I'd done recovery wrong. I know, written down, how unfair that is to myself. But that's where my head went.
And then this week, something shifted. I started it more positive, because I realised that while I can't control the swelling or the pain or how the HRT feels, I can have a say in where my head sits with it all. Feeling defeated was starting to feel like a choice I kept making — and that means choosing differently is also within reach. Only I can do that bit, and this week I've started to.
I want to be clear that this isn't me pretending I'm fine, or telling anyone to just "think positive." Feeling low while your body slowly mends is not weakness, and it's not failure — it's a completely human response to a hard, drawn-out thing, and if it tips into something heavier it's absolutely worth telling your GP (low mood can be part of the hormonal picture too, which is another reason I'm glad of my appointment). But for me, right now, gently refusing the word "failure" has helped. I'm pushing myself to walk a little more each day. I'm looking forward to my appointment instead of dreading it. Small things — but they're mine, and they're pointing the right way.
And there's something this weekend that I could never have imagined back in that hospital bed: my very first market stall, selling JINC, right here in town. The journal that grew out of this whole journey, out in the world and in my hands, for people to pick up and hold. I'm proud and genuinely excited. I'm also being realistic with myself — a full day on my feet is going to be hard at four months, and I'll very likely pay for it the next day. So I'm planning around it rather than pretending I won't: a chair to sit on when I need it, water, breaks, and absolutely no guilt about resting. Recovery and real life don't always wait politely for one another — sometimes you do the meaningful thing anyway, gently, and rest hard afterwards.
What I know now — at four months
The biggest realisation of this month is a simple one: I think I probably need until the end of the year to fully recover from this. Nearly a year. And that was never explained to me before my surgery.
Would knowing have changed my decision? Honestly, probably not. The relentless period pain that ran my life is gone, I don't need daily medication, and I wouldn't undo that. But there's a real difference between choosing something with your eyes open and being quietly blindsided by how long and how non-linear the road is. If someone had simply said, "Angela, give yourself a year, and don't measure month four against anyone else," I'd have spent these weeks being far kinder to myself.
So that's the thing I'd pass on, if you're somewhere behind me: plan for the long version. Hope to feel wonderful by eight weeks, but give yourself permission to still be mending at eight months. The pain that moves, the strange HRT weeks, the day in bed after the good day out — none of it means you've failed. It means you're healing from something major, at the pace your own body has chosen. I'm still learning to let that be enough. Some weeks I manage it better than others. This week, I'm managing.
Four months on, honestly answered
Is it normal to still be recovering at four months — or even to feel worse?
Yes. The standard "six to eight weeks" describes when many women can resume light activity, not when they feel fully recovered. For a more complex operation — additional findings, adhesions, surgical menopause — fuller recovery commonly takes anywhere up to a year, and it is rarely linear. It's genuinely common to have a harder month after an easier one. Feeling worse at four months than at ten weeks does not mean something has gone wrong or that you've done anything wrong; it means you're still healing from major surgery. If you're worried about any specific symptom, though, always get it checked rather than waiting it out.
Can HRT make you feel strange or "not yourself"?
Finding the right HRT is often a process rather than an instant fix, and the type, dose and delivery (gel, patch, tablet) can all affect how you feel day to day. Some women feel better quickly; others go through a stretch of feeling "off" while things are adjusted. Feeling not-yourself is a very valid reason to go back to your GP or specialist — it is not something you simply have to put up with, and it does not mean HRT is wrong for you, only that the balance may not be right yet. Never stop or change a dose on your own; raise it at a review so it can be adjusted safely.
What is a histology report after a hysterectomy?
When the womb (and any other tissue) is removed during surgery, it's sent to a laboratory to be examined under a microscope. That analysis is the histology report. It's a routine part of the process and confirms what was found and removed. Your GP or surgical team can talk you through it. If your team has asked you to come in to discuss it, that's a normal and good opportunity to go through your wider recovery too — take a written list of everything you want to raise.
Why might I have new pain at the front of my hips or near my C-section scar after a hysterectomy?
Pain can change and move during recovery, and it can feel different from the pain you had before surgery — internal cramping may settle while new aches appear elsewhere, including around old scar tissue. There are several possible reasons and I'm not in a position to diagnose anyone (I'm working out my own with my team). The important thing is not to sit and worry about new or persistent pain alone: write down where it is, when it happens and how it feels, and raise it at your review so it can be properly assessed.
Is everyone really "back to work quickly" after a hysterectomy?
No — and the stories that travel are usually the fast ones. Recovery depends hugely on the type of hysterectomy, what else was found and dealt with during surgery, whether surgical menopause is involved, the nature of your job, and your own body. Comparing your recovery to someone else's can be genuinely disheartening and isn't a fair measure. The woman who returned in three weeks isn't ahead of you; she simply had a different operation and a different road.
UK resources for women navigating hysterectomy & recovery
The following organisations offer trusted information and support (links open in a new tab):
A quiet note from JINC
Recovery has taught me to take my own advice: write things down while your head is clear, so the right questions get asked at the right moment. I walked into this month's appointment with a list — the HRT, the pain, the swelling, where I really am — because foggy, tired, worried me can't be relied on to remember it all. That, in the smallest way, is what JINC is for.