The Duchess of Cornwall will be 60 in July. By this age most women will have passed the time in their lives when they are most likely to need a hysterectomy. The common reason for hysterectomy in women in their forties and early fifties are multiple fibroids (benign tumours) that are causing heavy periods. These are now more often treated by myomectomy, the removal of the individual fibroids or the deliberate blocking of the blood vessels leading to the fibroid so that they shrivel. Heavy periods without fibroids, dysfunctional uterine bleeding, is now more likely to be treated by endometrial ablation, the removal of the lining of the uterine cavity.

Among the usual reasons why a woman beyond the menopause has an hysterectomy is as part of surgery to correct prolapse and, as a result, incontinence with recurrent urinary tract infections.

The Duchess has apparently had attacks of gastroenteritis recently that have prevented her from carrying out appointments.

It is possible that these are the equivalent of Russian presidents having flu. Both could be euphemisms. In the case of the Duchess, to avoid an embarrassing discussion about a condition such as a urinary tract infection.

The other common cause of hysterectomies postmenopausally is the presence of a tumour in the ovaries, or uterus but this has been denied by Clarence House. Occasionally, women women will need a hysterectomy after the menopause because, although they don’t have a cancer, they may have persistent cellular changes (CIN 3) in the cervix that are premalignant, and could cause trouble later.

Hysterectomies may either be done vaginally or abdominally. Both ways have their advantages and disadvantages, and both are standard, straightforward operations that shouldn’t give rise to any problems.

As in any surgery, emphasis is now on making certain that the patient is in good condition before she is operated on. The Duchess rides and has an active life and should be fit. However it is not certain if she is still smoking; anaesthetists like their patients to be non-smokers.

Like any pelvic surgery, especially gynaecological surgery, there is always the danger of deep-vein thromboses and pulmonary embolism, but now specific precautions are taken before and during surgery to avoid the hazard.

Although it is such a routine procedure nobody should regard any form of abdominal surgery as being of minor significance.

Not only will the Duchess be likely to be moving around soon after the operation but she will also be able to have food and fluids by mouth by the end of the first day. Provided there is no postoperative infection — it is not unusual to have urinary tract infections and a temperature after a gynaecological operation — she will probably go home within a week.

After she is at home, she will have to take life easily. It will probably be six to eight weeks before she is back to normal.

In the case of the Duchess, there is always the thought of her mother’s osteoporosis. However, the risk will not be increased because this hysterectomy is postmenopausal.

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