Exercise after gynaecological cancer and hysterectomy

You can start gentle movement straight away: your team will encourage you to get up and move around as soon as possible after a hysterectomy, and full recovery takes about 6 to 12 weeks [1].

Macmillan advises: "Try to do some gentle exercise every day, such as walking. You can slowly increase how much you do" [1]. You may meet a physiotherapist who talks to you about exercise and pelvic floor exercises [1][2]. Expect to tire easily: the Royal College of Obstetricians and Gynaecologists says you may feel "much more tired than usual" while your body heals [2].

After vulval cancer surgery, Cancer Research UK says it is important to do the leg exercises your nurse or physiotherapist taught you, and "to move around as much as possible", to prevent blood clots [13].

The main limits after a hysterectomy are on heavy lifting, strenuous exercise and swimming, and they depend on the type of operation [1].

Activity	What UK sources say
Walking	As soon as possible after surgery, then gentle daily walking that you build up slowly [1]
Strenuous activity and heavy lifting	After a hysterectomy, avoid for about 6 weeks after a laparoscopic, robotic or vaginal hysterectomy, and about 12 weeks after an open (abdominal) hysterectomy [1]. After other operations, ask your surgical team
Lifting light objects	Have your feet slightly apart, bend your knees and keep your back straight [2]
Swimming	Avoid at first so the area can heal and to reduce infection risk [1]; ask your team when you can start again

Macmillan gives no set week for running, weights or classes [1], so agree that with your surgical team.

It probably helps, but the research is smaller than for breast or bowel cancer. A 2023 review of 12 randomised trials found exercise "may have beneficial effects on the fatigue, depression, and health-related quality of life" of people with gynaecological cancer, and the authors say the evidence "must be regarded as preliminary" [5].

Cancer Research UK lists cervical, womb and ovarian cancer among the cancers where "Physical activity after diagnosis may reduce the risk of dying" [4]. This does not mean exercise prevents cancer coming back.

For the longer term, Cancer Research UK suggests working towards "150 minutes of moderate intensity activity per week" or 75 minutes of vigorous activity, plus strength training twice a week, starting "with short chunks (10 to 15 minutes) of gentle activity" [4]. For a step-by-step plan once treatment ends, see exercise after cancer treatment.

Yes, for many people with bladder leakage. Cancer Research UK says "Learning pelvic floor exercises, re-training your bladder or following lifestyle changes can help" [9], and Macmillan calls pelvic floor exercises "the most common treatment for leaking urine (incontinence)" [8].

Macmillan says "Radiotherapy can weaken the pelvic floor muscles and the urethral sphincter (opening)", and that late effects can "start months or years after pelvic radiotherapy" [7]. Cancer Research UK adds that treatment "can make the bladder less elastic" [9]. For staying active while treatment is still going on, see exercise during radiotherapy.

Macmillan describes the basic exercise [10]:

• Squeeze and relax the muscles around your anus "as if you are trying to stop yourself passing wind", then squeeze "as if you are trying to stop a flow of urine halfway through". Then try both together and hold.
• "Try not to squeeze your buttocks, thighs or tummy muscles or hold your breath."
• "It is easier to start doing them lying down with your knees bent up."
• Build up to "10 slow squeezes lasting 10 seconds each with a 4-second rest between each squeeze" and "10 fast squeezes at a speed of 1 per second."
• "Aim to do the sets of slow and quick squeezes 3 times every day." "It takes at least 3 months to strengthen pelvic floor muscles."

Macmillan says "A continence adviser can teach you how to do the exercises correctly" [8]. Specialist pelvic health physiotherapists can help too; the Pelvic, Obstetric and Gynaecological Physiotherapy network lists its members [11]. Your GP or cancer team can refer you to a bladder specialist or continence adviser [8].

Keep moving, do the leg exercises you are shown, and report any swelling early. Cancer Research UK says "Lymphoedema is easier to control if treated early" and that you should be referred to a lymphoedema specialist if you have signs of swelling [13].

Leg lymphoedema (swelling caused by a build-up of lymph fluid) can follow removal of pelvic or groin lymph nodes, or radiotherapy to them [1][9][12][13]. Cancer Research UK lists vulval, cervical and womb cancers among the cancers where it is more likely [12].

If you have a compression garment, Macmillan says "you usually need to wear it when you exercise", and advises avoiding static holds such as "the plank position" [3]. Most lymphoedema exercise research is in arm swelling after breast cancer, and international exercise guidelines (ACSM, 2019) say those findings "may not translate" to lymphoedema after gynaecological cancers [6]. If you notice swelling, tell your cancer team early [13]. See lymphoedema exercises for leg exercises and infection signs.

An early menopause can cause bone and heart problems, and Cancer Research UK says "you may have thinning and weakening of the bones (osteoporosis) over time" [14]. Surgery to remove the ovaries, radiotherapy to the pelvis and chemotherapy can all cause an early menopause [14].

Cancer Research UK notes that "A sudden menopause, due to treatment, can cause more severe symptoms than a natural menopause" [14]. For bones in general, the Royal Osteoporosis Society says "The best way to help your bone strength is to do both impact and strength exercises" [20].

Pelvic radiotherapy can also change the pelvic bones and cause "pelvic insufficiency fractures (PIFs)" [7]. Ask your team before high-impact exercise if you have had pelvic radiotherapy or have been told your bones are thin. See bone health after cancer. Whether hormone replacement therapy (HRT) is right for you is a question for your doctor, who "should discuss the risks and benefits of HRT with you" [14].

Weight is closely linked to womb cancer, but no one yet knows whether losing weight after treatment changes survival. Cancer Research UK says "Being overweight or obese causes around a third of womb cancers", because fatty tissue produces more oestrogen [15].

A 2023 Cochrane review (a careful summary of all the trials) of 12 trials with 610 women with womb cancer and overweight or obesity found that diet and activity programmes were not linked to better survival, quality of life or significant weight loss, and concluded that "the true effect of weight-loss interventions in women with endometrial cancer and obesity is currently unknown" [16]. The evidence was low or very low certainty [16].

Treat promises about weight loss and recurrence with caution. A London pilot trial (DEUS) randomised 60 womb cancer survivors to a diet and exercise programme or usual care; 77% of the programme group stuck with it, and "No intervention-related adverse events were reported" [17]. For practical help, see weight gain after cancer treatment.

Stop and speak to a doctor straight away if you get sudden symptoms during exercise [3]. Macmillan lists "feeling dizzy", "chest pain", "a racing heart", "breathing problems", "feeling sick", "unusual back or bone pain", "unusual muscle pain" and "a headache that does not go away" [3].

After surgery, contact your doctor or nurse straight away on the number you were given if you have signs of infection [1], such as:

• heat, pain, swelling or redness around the wound, or fluid coming from it
• "a temperature above 37.5°C or above 99.5°F (a fever)"
• feeling shivery and shaky, or generally unwell [1].

Macmillan advises contacting the hospital ward or NHS 111 straight away if vaginal discharge becomes bright red, heavier, smells bad or contains clots [1].

For a possible blood clot in the leg (throbbing pain or swelling, usually in one leg), ask for an urgent GP appointment or get help from NHS 111 [18]. Call 999 or go to A&E if you also "feel short of breath" or "have chest pain" [18].

Your NHS team comes first: physiotherapists after surgery, continence advisers for the pelvic floor, and lymphoedema specialists for swelling, reached through your cancer team or GP [1][8][13].

Clinical exercise physiologists (CEPs) are healthcare professionals "responsible for prescribing and delivering evidence-based exercise", and in oncology they work "with patients with different types of cancer and at different stages of treatment" [19]. Once your surgical limits are lifted, a CEP can build a gradual strength and fitness plan around your pelvic floor, leg swelling and bones, alongside your NHS team. Read about your cancer rehabilitation team, or see cancer rehabilitation in London.

Request a match with a verified clinical exercise physiologist through The Health Nav.