What Your Doctor May Not Tell You
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Although hysterectomy is one of the most common surgeries for women living in the United States, misconceptions about removal of the uterus abound.
According to one study, as many as 600,000 hysterectomies are performed each year, making it the second most common surgery (after C-sections) for women in the United States. If you are about to be one of them, a frank discussion with your gynecologist is an essential first step.
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Hysterectomy may be performed to treat fibroids (noncancerous tumors), excessively heavy periods, uterine prolapse (a dropped uterus), or cancer of the reproductive organs — the uterus, cervix, vagina, fallopian tubes, or ovaries, according to the Cleveland Clinic.
There are several different procedures. A supracervical hysterectomy (partial hysterectomy) is surgical removal of the uterus alone, and a myomectomy is removal of only fibroids, says Cara King, DO, a gynecologist at the Cleveland Clinic. A total hysterectomy removes the cervix as well as the uterus. In certain cancer cases, the upper vagina is also taken out in a procedure known as radical hysterectomy.
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Do You Really Need a Hysterectomy?
The recommendations around when a hysterectomy is necessary have evolved in the last few decades, says Mary Kinyoun, MD, an ob-gyn at Nebraska Medicine in Omaha. “We now have better methods to medically manage gynecologic conditions that previously were only treated with surgery,” she says.
These include broader use of hormonal IUDs for abnormal uterine bleeding and newer medications for endometriosis and fibroids that can help minimize symptoms, she says.
Hysterectomy surgery can be medically necessary in cases of gynecologic cancer, abnormal uterine bleeding that has failed medical management, endometriosis that has failed medical management, or the need for gender-affirming care, says Dr. Kinyoun. In other cases, the procedure may be considered elective.
“Depending on the scenario, some physicians may choose not to offer surgery. Additionally, an important factor to consider is that insurance likely will not cover a hysterectomy without a medical indication,” says Kinyoun.
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If a hysterectomy is in your future, it’s important to feel empowered to speak up and ask questions, says Dr. King. “Don’t be afraid to ask your surgeon about the volume of hysterectomies they perform and keep in mind that it’s okay to seek out a second opinion,” she says.
Are you wondering what a hysterectomy means for your sex life, hormones, and future health risks? Here are the top 10 things you need to know before you have surgery.
1. Your Sex Life Isn’t Over
While the surgery can have lasting effects on your body, and you’ll need time to heal, this does not mean that you’ll never have sex again. How soon you can have sex after a hysterectomy really depends on the type of hysterectomy: partial, total, or radical. Waiting two to four weeks to get back to sex is generally okay, with your doctor’s go-ahead, if your cervix was not removed along with your uterus, says Lauren Streicher, MD, an associate clinical professor of obstetrics and gynecology at Northwestern University in Chicago, and the author of Sex Rx: Hormones, Health, and Your Best Sex Ever. But if your cervix was removed, it takes about six weeks for the back of the vagina to heal.
“Ask your doctor to define what they mean by sex,” advises Dr. Streicher. What doctors usually mean is vaginal intercourse. Orgasm may be fine, oral sex too, and vibrator use as well — your questions need to be specific.
2. Hysterectomy Doesn’t Cure Endometriosis
“Not a day goes by in which I don’t wish, with every fiber of my being, that my doctor had stressed to me the vital fact that having a hysterectomy is absolutely not a cure for endometriosis,” says Rachel Cohen, 33, of Woodmere, New York, about her total hysterectomy.
In fact, endometriosis — a condition that can be marked by severe menstrual cramps, chronic pain, and painful intercourse — can come back after removal of the uterus, according to Mayo Clinic. And of the many treatment options (which include pain medications and hormone therapies), hysterectomy with removal of the ovaries is not a first-line treatment. Conservative surgery using a minimally invasive method may be one option, and will preserve the uterus. Cohen’s hysterectomy at age 28, recommended by her gynecologist, did not even diminish her endometriosis symptoms.
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3. You Won’t Necessarily Go Into Menopause
“I expected to have crazy hot flashes, mood swings, and night sweats all the time, and was pleasantly surprised to find out that I barely had any of those symptoms,” Cohen says about her experience after hysterectomy.
The myth about hysterectomy Streicher hears most often in her medical practice is that a woman will go into menopause afterward. You won’t have periods, and can’t get pregnant after your uterus is removed. But that doesn’t necessarily mean menopause.
Hysterectomy may increase the likelihood that you’ll go through menopause a few years earlier than you would have naturally, but that’s still not clear, says King. A review of more than 30 years of research, published in 2023, found that the surgery was associated with reduced ovarian function and earlier menopause. But King says more research is needed to know for certain. “It could be that the factors that made the hysterectomy necessary in the first place, such as fibroids or heavy bleeding, may make menopause come sooner in some women,” she says.
4. Hysterectomy May Include Your Ovaries
Depending on your medical issue, you may also get an oophorectomy (removal of one or both of your ovaries) when you get your hysterectomy. Ovaries are the source of the female hormones estrogen and progesterone. These are critical for both sexual health and bone health.
Losing both ovaries means these hormones are also lost abruptly, a condition known as surgical menopause. “If you have your ovaries removed, you will go into menopause that evening, and you can begin having symptoms within a week,” says King. Those symptoms of menopause may include hot flashes and loss of sex drive.
5. Hormone Therapy Could Help With Physical Changes After Surgery
If you have a hysterectomy that removes your ovaries, you should talk about the pros and cons of estrogen therapy with your doctor, Streicher says. If you have hot flashes, night sweats, or sleep issues after the ovaries are removed, estrogen therapy can help.
“Hormone therapy is indicated if the ovaries are removed at the time of hysterectomy and the patient is less than the average age of menopause (51 years old) or they are older and having unacceptable symptoms like hot flashes,” says Kinyoun. Transdermal estrogen is preferred because the way the body metabolizes estrogen through the skin puts people at lower risk of a blood clot than if they take the estrogen orally, she adds.
6. You May Be Able to Avoid a Hysterectomy
Depending on the condition you are facing, you may be able to keep your uterus intact. Alternatives are out there for about 90 percent of hysterectomies surgeons do, according to Streicher in her book The Essential Guide to Hysterectomy. Fibroids, for example, may be treated using a nonsurgical procedure called uterine artery embolization that cuts off the fibroids’ blood supply. Another option is myomectomy, which removes fibroids but spares the uterus. For heavy bleeding, an ablation procedure — which freezes or burns the uterine lining — may be a treatment option. Have a discussion with your doctor about the alternative treatments for your condition.
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7. Less-Invasive Surgery May Be the Right Option for You
Ask your doctor whether it’s necessary to cut through your abdomen for the hysterectomy, or whether you can have a minimally invasive procedure. “There are many different types of hysterectomy, including abdominal, vaginal, laparoscopic, and robot-assisted laparoscopic. There is also a new hybrid method between vaginal and laparoscopic hysterectomy, called vNOTES,” says Kinyoun.
VNOTES (vaginal natural orifice transluminal endoscopic surgery) is a minimally invasive procedure that combines the laparoscopic and vaginal approaches to gynecologic surgery. The surgeon accesses the pelvic cavity through an incision inside the vagina, then uses specialized instruments, guided by a camera, to operate on the uterus, fallopian tubes, or ovaries without an abdominal incision.
According to the American College of Obstetricians and Gynecologists (ACOG), vaginal hysterectomy is the preferred method when feasible. Abdominal hysterectomy requires a large incision and more downtime. But there are situations where it’s recommended, says King.
If your doctor says you aren’t a candidate for minimally invasive surgery, find out why, and consider getting a second opinion. Streicher notes not all gynecologists are comfortable with the newer procedures.
8. The Morcellation Technique Has Both Advantages and Risks
To be able to remove the uterus during a minimally invasive surgery, surgeons cut it into small pieces, a process called morcellation. It can be done with a power tool, a technique that has been criticized because of its potential to spread cancerous cells inside the abdominal cavity, according to ACOG.
In response to these concerns, researchers developed new approaches to the procedure that contain the uterine tissue.
Streicher believes that many women undergo unnecessary open procedures, when morcellation is a better option. “It’s a real disservice to women,” she says.
“Morcellation doesn’t cause cancer,” adds Streicher, “but if the person had a specific kind of cancer, you could potentially spread the cancer by morcellation.” Informed consent is a must before anyone goes ahead with this procedure, she says. Ask your doctor about your specific risk.
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9. Hysterectomy May Prevent Certain Types of Cancer
Hysterectomy can reduce the risk of uterine and cervical cancer, says Kinyoun. “We also know that removing the fallopian tubes or undergoing tubal ligation (surgery that closes the fallopian tubes) can reduce the risk of ovarian cancer,” she says.
Patients at high risk for ovarian cancer, such as BRCA 1 and 2 genetic mutation carriers can undergo removal of tubes and ovaries to reduce their risk, says Kinyoun. Called prophylactic salpingo-oophorectomy, this can be done either alone or at the time of hysterectomy. Studies show the surgery lowers risk of death from ovarian cancer by 80 percent.
10. The Psychological Impact of Hysterectomy Can Vary
For some, it may take longer to heal emotionally than physically from a hysterectomy. “I have to struggle with the heartbreaking reality that I can no longer menstruate or have children,” says Cohen. For her, the hysterectomy was an emotionally painful experience. “Each woman who undergoes one deals with it in a way that is uniquely hers,” she says.
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King agrees, adding that a woman’s feelings about hysterectomy can depend on family history, cultural factors, and even what part of the country she lives in. “For some women, it’s more of an emotional discussion — it feels different than surgery to get their appendix or gallbladder removed,” she says. But for others, the surgery means relief from symptoms that have had a major impact on their health and quality of life.
Feeling a little down or having a sense of loss after a surgery is normal. But be on the lookout for postoperative depression, and get professional help if you need it to deal with insomnia, loss of appetite, or hopeless feelings that may come up. “Thinking and talking about your feelings about having a hysterectomy, before and after the surgery, can help you through the process,” she says.
Additional reporting by Barbara Kean.
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