The Fitness Pilates Blog

Hysterectomy and Fitness Pilates do’s and dont’s

I hope you’re all having a great weekend.

Wow It has been a busy week I travelled to Gloucester to deliver Reformer training, Friday I presented Hot FP and Saturday a Step Masterclass so looking forward to a nice rest today!

Thank you so much to everyone who commented on last week’s newsletter — I was honestly shocked by how many messages I received from people saying they have this condition. It’s clearly incredibly common, and I’m still working my way through all your messages.

This week, I felt it would be really timely to talk about hysterectomy, especially as our amazing tutor Kelly has recently undergone this surgery and is kindly sharing her experience.

How common is a hysterectomy in the UK?

Around 55,000 hysterectomies are performed in the UK each year, making it one of the more common gynaecological operations.

Between 30,000 and 40,000 of these procedures take place annually on the NHS, mainly in women aged 40–50.

It’s estimated that about 1 in 5 women in the UK will have a hysterectomy at some point in their life

These surgeries are usually carried out when other treatments (e.g., for heavy bleeding, fibroids, endometriosis or pelvic pain) haven’t been effective.

Quick context

Hysterectomy rates have decreased over time in the NHS as less invasive alternatives (like intrauterine systems or endometrial treatments) have become available. (Wikipedia)
It remains more common among women in their 40s and 50s than at younger age

Types of Hysterectomy (and what they mean for movement)

Total hysterectomy

What’s removed:

Uterus
Cervix
(Ovaries may or may not be removed)

Most common type

Implications for Pilates:

Pelvic floor support still required
Vaginal cuff healing is a key consideration
Increased sensitivity to intra-abdominal pressure early on
Gradual return to core loading essential

Pilates focus: breath, coordination, pressure management

Subtotal / Partial hysterectomy

What’s removed:

Uterus
Cervix remains

Implications for Pilates:

Pelvic floor still intact but altered
Some women feel more “stable” early on, but healing rules still apply
Core and pelvic floor retraining still needed

Pilates focus: same care as total hysterectomy — don’t rush

Radical hysterectomy

What’s removed:

Uterus
Cervix
Upper vagina
Supporting ligaments
(often for cancer treatment)

Implications for Pilates:

Significant pelvic support changes
Higher risk of pelvic floor dysfunction
Longer recovery timeline
Often combined with radiation or chemotherapy

Pilates focus: highly individual, slow, rehab-style progression
Often best with pelvic health physio involvement

Ovaries: a BIG distinction

Hysterectomy with ovaries preserved

Hormones continue naturally
No immediate surgical menopause
Still hormonal shifts due to surgery stress

Movement tolerance usually better long-term, but recovery still matters.

Hysterectomy with oophorectomy (ovaries removed)

Immediate surgical menopause
Sudden drop in oestrogen

Implications:

Increased fatigue
Joint stiffness
Muscle loss risk
Bone density concerns
Temperature regulation issues

Pilates focus:

Strength for bones and joints
Recovery time
Temperature awareness
Nervous system regulation

Surgical approach (this affects recovery speed)

Abdominal hysterectomy

Large incision (often bikini or vertical)

Implications:

Longer healing time
Greater scar and fascial involvement
Core reconnection takes longer

Pilates: slower return, scar-aware work essential

Laparoscopic (keyhole)

Small incisions in abdomen

Implications:

Faster recovery than abdominal
Still deep internal healing
Easy to underestimate recovery needs

Pilates: don’t be fooled by “small scars”

Vaginal hysterectomy

No abdominal incision

Implications:

Quicker surface healing
Pelvic floor still heavily affected
Vaginal cuff healing crucial

Pilates: pelvic floor coordination still priority

Why this matters in Fitness Pilates

Two clients may both say:

“I’ve had a hysterectomy”

…but have completely different needs depending on:

What was removed
How it was removed
How long ago
Hormonal impact
Complications

Key questions teachers should ask (or encourage clients to reflect on)

How long ago was your surgery?
Was it abdominal, laparoscopic, or vaginal?
Were your ovaries removed?
Do you experience pelvic heaviness, pain, or fatigue?

Red flags (always refer)

Pelvic heaviness or dragging
Incontinence
Pain at the scar or deep pelvis
Abdominal bulging
Persistent fatigue or flare-ups

Not all hysterectomies are the same — recovery, hormones, and pelvic support all matter.

DOs in Fitness Pilates classes

1. Respect healing timelines

Always check:

How long post-surgery
Type of hysterectomy
Medical clearance (especially before load or impact)

2. Start with breath and nervous system regulation

Early and ongoing priorities:

Diaphragmatic breathing
Gentle rib mobility
Parasympathetic (calming) work

Breath supports:

Scar healing
Pelvic floor coordination
Core reconnection

3. Cue gentle core support, not bracing

Use language like:

“Wrap and support”
“Gentle lift”
“Support without gripping”

The aim is coordination, not strength early on.

4. Use supported positions first

Best early choices:

Supine with head/torso support
Side-lying with cushions
Seated work
Quadruped (later, if comfortable)

These reduce pressure through the pelvic floor and scar.

DON’Ts in Fitness Pilates classes

1. Don’t rush core or pelvic floor loading

Avoid early:

Planks
Strong curl-ups
Roll-ups
Double leg lifts
Aggressive rotational work

Healing tissues need time.

2. Don’t increase intra-abdominal pressure early

Avoid:

Breath holding
Strong bracing
Heavy resistance
Long lever movements

Pressure management is key post-surgery.

3. Don’t assume “no uterus = no pelvic floor issues”

Even without a uterus:

Pelvic floor still needs support
Prolapse risk can still exist
Coordination matters more than strength

4. Don’t overstretch scars or fascia

Avoid:

Long static stretches
Aggressive spinal extension or flexion early
Forcing end ranges

Scar tissue responds best to gentle, progressive movement.

5. Don’t ignore red flags

Stop and refer if clients report:

Pelvic heaviness or dragging
New incontinence
Pain at the scar
Bulging around the abdomen
Persistent fatigue or pain flare-ups

What works especially well

Breath-led Pilates
Slow, controlled mat work
Side-lying and seated sequences
Gentle mobility + stability
Short, frequent sessions
Long-term progressive strength

Feel free to use this information in your own Fitness Pilates info and I really hope they are helpful.

Everyday we strive to be better teachers.

Have a wonderful day,
Rachel

Whats app 07976 268672

I have been filming a weekly vlog on Youtube as an experiment check it out here https://www.youtube.com/watch?v=iPEMqiNz3Hg

Coming up this month…

Both Level 3 Pilates Mat & Level 3 Reformer courses are full in Feb, but there are limited spaces in March & April

I’m travelling to Nuffield Gloucester this week to deliver Fitness Pilates reformer which is full so we’ve added another course on 5th March which only has a few spaces left.

2 spaces for this weeks 12th February Fitness Pilates Reformer course.

Resources

If you’d like support with marketing, sales, social media, and business growth, you’re very welcome to join my Supporters Group.
Click here to find out more.