When is a hysterectomy necessary?

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Hysterectomy: Facts Every Woman Should Know

  • Uniquely Female

Women. Wisdom. Wellness. Jan 10, 2019

Approximately 600,000 hysterectomies are performed annually in the U.S., and approximately 20 million women in this country have had a hysterectomy. This makes hysterectomies one of the most common surgeries performed in the U.S. In fact, according to the Centers for Disease Control (CDC), they’re the second most frequently performed surgery, after Cesarean section, for women of reproductive age in the U.S.

If you are one of the many women whose doctor has recommended this common procedure, read on for an overview of hysterectomy basics, including the why, what and how of these procedures.

What Is a Hysterectomy?

A hysterectomy is a surgery to remove the uterus (the womb). After a hysterectomy, a woman can no longer get pregnant and will no longer experience menstrual periods.

Why Are Hysterectomies Performed?

Hysterectomies are performed to treat a wide range of gynecologic problems, including:

  • Uterine fibroids. These are benign (non-cancerous) growths in the wall of the uterus. In some women they cause pain or heavy bleeding. Uterine fibroids are the most common reason for hysterectomies.
  • Endometriosis. This is a condition in which the tissue that typically lines the inside of the uterus grows outside of the uterus on the ovaries instead. It can cause severe pain and bleeding between periods.
  • Uterine prolapse. This occurs when the uterus slips from its usual place down into the vagina. It is more common in women who had several vaginal births, but it can also happen after menopause or because of obesity.
  • Heavy or abnormal uterine bleeding. This can be caused by changes in hormone levels, infection, cancer or fibroids.
  • Gynecologic cancer. This includes cancer of the ovary, cervix, uterus, or endometrium (the lining of the uterus).

What Are the Different Types of Hysterectomies?

  • Total hysterectomy. The most common type of hysterectomy, this surgery removes the entire uterus, including the cervix. The ovaries and the fallopian tubes may or may not be removed.
  • Partial hysterectomy, also called subtotal or supracervical hysterectomy. In this procedure, only the upper part of the uterus is removed. The cervix is left in place. The ovaries may or may not be removed.
  • Radical hysterectomy. All of the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina are removed. This is often used to treat certain types of cancer, like cervical cancer. The fallopian tubes and the ovaries may or may not be removed.

Thanks to advancements in minimally invasive and laser surgeries, the number of hysterectomies performed in the U.S. has declined substantially over the last 15 years, according to researchers.

How Are These Hysterectomies Performed, and What Are the Risks?

The type of hysterectomy performed depends on the reason you’re having the surgery, your health history and other factors.

  • Abdominal hysterectomy. Your doctor removes the uterus through a cut in your lower abdomen. Abdominal hysterectomy may be performed if adhesions are present or if the uterus is very large. (Adhesions are scars that band tissue together.) Abdominal hysterectomy carries a greater risk of complications, such as wound infection, bleeding, blood clots, and nerve and tissue damage, than a vaginal or laparoscopic procedure. It typically results in a longer hospital stay (three to five days) and longer recovery time (six to eight weeks).
  • Vaginal hysterectomy. The uterus is removed through the vagina. This generally causes fewer complications than abdominal or laparoscopic hysterectomy, with a shorter healing time than abdominal surgery and a faster return to normal activities. It is recommended as the first choice for hysterectomy when possible.
  • Laparoscopic hysterectomy. A laparoscope is an instrument with a thin, lighted tube and a small camera that allows your doctor to see your pelvic organs. Laparoscopic surgery is when the doctor makes very small cuts to put the laparoscope and surgical tools inside of you. During a laparoscopic hysterectomy the uterus is removed in small pieces through the cuts in either your abdomen or your vagina.

Robotic hysterectomy is a type of laparoscopic surgery. Your doctor guides a robotic arm to do the surgery through small cuts in your lower abdomen.

Laparoscopic surgery usually brings about less pain, a lower risk of infection, a shorter hospital stay and possibly a quicker return to normal activities than abdominal surgery. But, laparoscopic surgery (including robotic) can take longer to perform than traditional surgery, and there’s an increased risk of injury to the urinary tract and other organs.

What Should I Expect During Recovery?

The recovery time varies, depending on the type of procedure and your overall health. You could be in the hospital for up to several days. Overall, abdominal surgery can take from four to six weeks to recover. Vaginal, laparoscopic, or robotic surgery can take from three to four weeks to recover.

Meantime, you’ll be encouraged to get up and walk around as soon as possible to minimize the risk of blood clots. You might also be given medication to help lower the clot risk and cope with pain.

After surgery, you might experience:

  • Bleeding and discharge from your vagina
  • Constipation
  • Short-term problems with emptying the bladder
  • Emotional effects. You may feel depressed that you are no longer able to bear children; on the other hand, you may be relieved that your former symptoms are gone.

After recovery, you’ll still need to see your physician for routine gynecologic exams as well as general health care.

Moving Forward

Thanks to advancements in minimally invasive and laser surgeries, the number of hysterectomies performed in the U.S. has declined substantially over the last 15 years, according to researchers. This is good news for many women experiencing gynecologic problems.

If you are experiencing heavy or abnormal bleeding, severe pain during or between periods, or any other gynecologic problems that concern you, schedule an appointment to see your primary care physician or obstetrician/gynecologist. The sooner you are seen and diagnosed, the more treatment options you and your doctor will be able to explore.

Source: Centers for Disease Control; American College of Obstetrics and Gynecology; Gynsurgeryinfo.org; Office of Women’s Health, U.S. Department of Health and Human Services.

Hysterectomy: Do You Really Need It?

In most cases, hysterectomy, or surgical removal of the uterus, is elective rather than medically necessary.

Learn about all treatment options before agreeing to have your uterus removed. Masterfile

A hysterectomy is a surgical operation to remove the uterus, the organ known as the “womb” that is located in the female pelvis.

During pregnancy, a fertilized egg implants itself in the lining of the uterus, where the developing fetus is nourished prior to birth.

Hysterectomy Is a Permanent, Irreversible Removal of the Uterus

After undergoing hysterectomy, a woman cannot become pregnant.

Few Hysterectomies Are Done to Treat Cancer or Life-Threatening Conditions

Only about 10 percent of the more than 600,000 hysterectomies performed in the United States each year are for cancer treatment and are considered potentially lifesaving. (1) The rest are essentially elective procedures, and some believe that many of them are unnecessary.

How Common Is Hysterectomy or Surgical Removal of the Uterus?

After cesarean section, it is the second most frequently performed surgical procedure for women who are of reproductive age in the United States.

According to the Centers for Disease Control and Prevention (CDC) approximately 20 million women in the United States have had a hysterectomy. (2)

The majority are performed as a treatment for health conditions when alternate therapies, such as medication, hormone treatments, or less invasive surgical procedures, have been unsuccessful in completely alleviating symptoms such as severe bleeding and pain.

When Is Watchful Waiting a Treatment Option For Fibroids?

The National Institutes of Health estimate that more than 200,000 hysterectomies are performed each year for fibroids. Because they often cause no symptoms, fibroids are usually detected incidentally during a pelvic exam or a prenatal ultrasound.

And treatment is not always warranted.

“Uterine fibroids can be completely asymptomatic, causing no problems, or they can cause severe pain, loss of blood, and significantly affect quality of life.” explains Beth Battaglino, RN, CEO of HealthyWomen, a women’s health information and advocacy organization.

“The mere presence of fibroids is generally not enough of a reason to have them treated. Your gynecologist should be able to tell if your symptoms are related to your fibroids and whether the symptoms are significant enough to seek treatment,” she adds.

Problematic Uterine Fibroids May Resolve With Menopause

For some women, fibroids do become problematic, causing heavy bleeding during menstruation. Large fibroids can push on the bladder or rectum or cause abdominal distention.

But their growth patterns vary; they may grow slowly, rapidly, or remain the same size. Some may shrink on their own. In most cases fibroids stop growing or shrink once a woman goes through menopause.

So even if a woman hasn’t found complete relief from her symptoms after trying medication or undergoing minimally invasive procedures, but she is close to menopause, she may want to wait and see if her symptoms improve before choosing hysterectomy.

You Don’t Have to Wait for Menopause to Stop Pain

Watchful waiting should be considered an option, not an obligation.

“A woman who is miserable from her fibroids, or is experiencing life-threatening bleeding, should not wait until menopause,” says Kate White, MD, assistant professor of obstetrics and gynecology at Boston University in Massachusetts.

Alternative Treatments to Hysterectomy: What to Consider

There are lots of alternatives to consider before undergoing hysterectomy, an operation to remove the uterus. Options depend on the root problem causing symptoms:

  • Fibroid treatments include hormonal medication, uterine artery embolization, and myomectomy.
  • Endometriosis treatments include oral contraceptives, laparoscopy, and laparotomy.
  • Uterine prolapse can be improved with Kegel exercises or treated with a pessary device.
  • Abnormal uterine bleeding can be treated with a dilatation and curettage (D&C), progestions, GnRH agonists, oral contraceptive pills, or an IUD.

Not Everyone Will Feel Better After Hysterectomy

Many women falsely believe that endometriosis can be cured through having a hysterectomy, yet this isn’t true. Endometriosis is a chronic inflammatory disease defined by the presence of tissue similar to that which lines the uterine cavity appears as in other places, such as the lining of the pelvis, fallopian tubes, ovaries, bowel, bladder, or even the lung.

If all the endometriosis is not removed at the same time as the removal of your uterus and your ovaries, you may still have endometriosis and its symptoms.

Even less invasive procedures aren’t always the solution for symptoms attributed to endometriosis.

The only way to determine for sure that you have endometriosis is through a minor surgical procedure called a laparoscopy. Many women with pelvic pain believed to be caused by endometriosis learn that they do not, in fact, have endometriosis after undergoing this diagnostic surgery.

Hysterectomy Won’t Cure Endometriosis

“Women need to be counseled that surgery and suppression go hand in hand,” says Rebecca Flyckt, MD, assistant professor of surgery at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University in Ohio. “Although every woman is hopeful that this one surgery will “clean it out for good,” and that they will never need another surgery, this is very improbable,” she adds.

Urinary Incontinence: A Hysterectomy Risk to Consider

“There is definite risk of developing urinary incontinence after a hysterectomy,” says Antonio R. Gargiulo, MD, medical director of the center for robotic surgery at Brigham and Women’s Hospital in Boston. The risk can be as high as 8.5 percent, and is more common in patients who are obese, have had at least one vaginal delivery, and have a large uterus, according to a study published in January 2017 in the American Journal of Obstetrics & Gynecology. (3)

Is Hysterectomy Right For You? Be Your Own Best Advocate

Not too long ago, many doctors believed that uterus-sparing treatments couldn’t trump the traditional hysterectomy. But today, many experts are willing to work with women who want to consider alternative therapies instead of the surgical removal of the uterus.

Do You Know All Your Options Besides Hysterectomy?

There is also evidence that some women may be opting for surgery without fully exploring other options. A study published in March 2015 in the American Journal of Obstetrics & Gynecology found that the majority of women consider at most one alternative treatment prior to hysterectomy. (4)

Furthermore, the study found that nearly 1 in 5 women (18.3 percent) had postsurgical pathologic findings that did not support having undergone a hysterectomy. In other words, some women had surgery that they did not need.

Is the Uterus, or Any Human Organ, Useless?

What’s more, there is still a misconception that the uterus is merely a reproductive organ and somehow if a you’ve already borne children or decided you don’t plan to in the future, your uterus is somehow “disposable.”

Nina Coffey, the president of HERS Foundation, a women’s health advocacy group based in Bala Cynwyd, Pennsylvania, which has counseled women since 1982, stresses that women need more accurate and clear advice about the female anatomy. (HERS stands for Hysterectomy Education Resources and Services.)

Understand the Role of Female Organs in Long-Term Health

Coffey believes that the number of unwarranted hysterectomies continues to grow in part because, “Women have not been educated about the critically important functions of the female organs and the consequences of their removal.” As she points out, “There is no age or time when the female organs no longer function.”

And some question the judgment of removing any healthy organ from a person’s body.

If You Opt for Hysterectomy, Choose the Best Surgical Method for You

If you do decide to go ahead with a hysterectomy, you should consider which route may be the best choice for you. Many surgeons are more comfortable with doing abdominal hysterectomy, and most are still performed this way. “This is no longer a tenable situation,” says Dr. Gargiulo, who believes that modern medicine has to be patient-centered, not surgeon centered.

Choosing Hysterectomy Doesn’t Mean Choosing Abdominal Hysterectomy

“Physicians today are often more willing to partner with their patients to help find strategies to treat their disease that meet their individual goals and desires,” adds Dr. Flyckt.

Get a Second Opinion if Abdominal Hysterectomy Is the Only Treatment Offered

If your surgeon insists on an open abdominal surgery, you should probably get a second opinion. In fact, it is always wise to seek out a second opinion, particularly when you are deciding on a surgery that can’t be reversed.

What you need to know about hysterectomy

In the United States, nearly 500,000 women undergo a hysterectomy each year, making it the second most common surgery after cesarean delivery. Even though the surgery is performed quite frequently, there are still misconceptions about. To address these myths, we spoke with Sandra Laveaux, MD, MPH. Laveaux provides expert care for women at all life stages and specializes in treating abnormal uterine bleeding, uterine fibroids, endometriosis and chronic pelvic pain.

What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus and cervix. During the surgery, the entire uterus is removed. Afterwards, the patient will no longer have a menstrual period and cannot become pregnant.

Why do I have to have a hysterectomy?

A hysterectomy is a definitive treatment, meaning it’s the best option for a patient after all others have been tried or considered. The most common non-cancer reason for hysterectomy in the United States is uterine fibroids; however, the surgery is also used to treat:

  • Heavy or unusual vaginal bleeding
  • Uterine fibroids
  • Endometriosis
  • Uterine prolapse
  • Adenomyosis, when the inner lining of the uterus breaks through the wall of the uterus and causes cramps, lower stomach pressure and bloating
  • Cancer (or precancer) of the uterus, ovary, cervix or endometrium (the uterus lining)

What is a partial hysterectomy?

It can be confusing but a partial hysterectomy is when only the uterus is removed and not the cervix. This is also called a supracervical hysterectomy. If you keep your cervix, you will still need to have pap smears.

How is a hysterectomy performed?

Depending on the reason for the surgery and size of the uterus, a hysterectomy can be performed with minimally invasive laparoscopy, robotic surgery, or vaginal surgery or with open surgery through a large incision in the abdominal wall.

How long does it take to recover?

It depends on the surgery. With the minimally invasive approaches, patients can go home the same day and return to work (if it’s low impact) within two weeks, though I’ve had patients return to work sooner. With the abdominal approach, patients stay in the hospital for about two nights and recover in about four to six weeks. In both cases, it takes about four to six weeks for the vagina to heal, so it’s important to abstain from sex until cleared by a doctor.

Do I have to have my ovaries removed?

The procedure to remove the ovaries is called an oophorectomy. Generally, when a hysterectomy is performed for non-cancer reasons in a patient who hasn’t reached menopause or is younger than 60 years old, the ovaries should be left as long as they appear normal. However, every case is different.

Will I go into menopause after a hysterectomy?

If your ovaries aren’t removed, you won’t go into menopause. However, if you have a hysterectomy during perimenopause, when your reproductive hormones begin to decline, it may accelerate the onset of menopause by a few months to a year.

Will my voice get deeper? Will I get facial hair or mood swings?

Your voice, hair growth and mood aren’t affected by your uterus and cervix. If you’re perimenopausal or are experiencing mood swings prior to your hysterectomy, you shouldn’t expect much difference after the surgery.

Will sex feel different for me or my partner?

Surgeons make every effort to maintain the vaginal length to enjoy pleasurable intercourse. While you won’t have contractions in your uterus during orgasms anymore, you will still have orgasms. In fact, many feel that sex after a hysterectomy is better since the surgery oftentimes solves issues that led to sex being uncomfortable in the first place.

At what age do doctors allow women in the USA to have a hysterectomy?

For women of reproductive age, hysterectomies are the second most often performed procedure in the U.S. There are several reasons why a woman might choose to have a hysterectomy. It can be because of uterine fibroids, heavy and persistent vaginal bleeding, cancer, or conditions like endometriosis. Basically, it can be because of any severe and chronic ailment concerning the uterus, ovaries, cervix, or endometrium that is majorly detrimental to a woman’s health and quality of life. A hysterectomy is a major, life-altering surgery, so it is not a procedure that should be taken lightly.

Technically, any woman of legal age can consent to the procedure, but it should be medically justified. It’s incredibly unlikely that a doctor will perform a hysterectomy on women ages 18-35 unless it is absolutely necessary for their well-being and no other options will suffice. This is because of possible physical and emotional risks. Complications during surgery can include infection, hemorrhaging, or bladder or bowel damage, but the risks of these are rather low. Long-term, it can increase the risk of stroke, bone loss, heart attacks, urinary issues, and early onset menopause in younger women. Possible complications that can impact a woman’s sex life includes vaginal dryness and a lack of interest in sex. It also prevents the possibility of a biological pregnancy, which can cause depression and psychological stress in some women.

The National Women’s Health Network believes that many hysterectomies are unnecessarily putting women at risk and that all alternatives should be considered before the procedure is done. If you are a woman, particularly of a younger age, looking into having a hysterectomy, make sure you consider the long term complications and consequences listed above. Seek out a doctor that listens carefully to your concerns and respects your decisions about your body.

Check out NWHN’s fact sheet on hysterectomies for more information on the risks of this procedure. There is also more information on the types of hysterectomies performed.

If you or a woman you know has had a hysterectomy or considering one and needs emotional support and advice from women who are in a similar position, here is a forum that might be helpful.

Visit these women’s health sites for additional information on hysterectomies.

Women to Women

Office on Women’s Health

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only.

Hysterectomy in the United States: Background

Hysterectomy is the second most frequently performed surgical procedure (after cesarean section) for U.S. women who are of reproductive age. According to the Centers for Disease Control and Prevention (CDC), from 2006-2010, 11.7 percent of women between the ages of 40-44 had a hysterectomy.1 Approximately 600,000 hysterectomies are performed annually in the United States, and approximately 20 million American women have had a hysterectomy.2 By the age of 60, more than one-third of all women have had a hysterectomy. The National Women’s Health Network (NWHN) believes that unnecessary hysterectomies have put women at risk needlessly and that health care providers should recognize the value of a woman’s reproductive organs beyond their reproductive capacity and search for hysterectomy alternatives before resorting to life-changing operations. Quoted in the Los Angeles Times, NWHN Executive Director Cindy Pearson says, “I advise any woman who is not in a life-threatening situation to see someone else besides a surgeon to explore nonsurgical options first.”

When a Hysterectomy Seems Necessary

So, when is a hysterectomy medically necessary? It may be a medically necessary procedure in the case of several life-threatening conditions:

  • Invasive cancer of the uterus, cervix, vagina, fallopian tubes, and or ovaries
  • Unmanageable infection
  • Unmanageable bleeding
  • Serious complications during childbirth, such as a rupture of the uterus

If alternative treatment options (see “Hysterectomy Alternatives” section below) are not viable and a hysterectomy is necessary, it is important to initiate open communication with your health care provider regarding the specifics of your situation. Here are some important questions (adapted from The Woman’s Guide to Hysterectomy by Adelaide Haas and Susan L. Puretz) that you may want to ask your health care provider before you decide on a hysterectomy:

  • What are the risks involved with this type of hysterectomy, and what is the success rate?
  • How long will I be in the hospital? Can this procedure be performed on an outpatient basis? What type of surgery will be needed?
  • How much will the operation and the follow-up care cost? Will these be covered by my insurance? Will the care of any medical complications resulting from this operation be covered by my insurance?
  • When can I expect to be fully recovered from the surgery?
  • How will this surgery affect my sexual functioning?
  • What might happen if I choose not to have surgery, or wait awhile to decide?
  • How many of these surgeries have you performed? When was the most recent one?
  • What type of anesthesia will be needed?
  • Can someone (my partner/friend) stay with me while the surgery is being performed?
  • Am I at risk for ovarian cancer and if not, is it necessary to remove my ovaries?

Types of Hysterectomy

  • Partial Hysterectomy – removes the body of the uterus while the cervix is left in place.
  • Total or Simple Hysterectomy – removes the entire uterus and cervix.
  • Hysterectomy with Bilateral Salpingo-Oophorectomy – removes the uterus, cervix, and fallopian tubes.
  • Radical Hysterectomy – removes the uterus, cervix, ovaries, fallopian tubes and possible upper portions of the vagina and affected lymph glands.

Hysterectomy Surgical Options

Your healthcare provider will discuss different potential surgical options for hysterectomies. You may have a hysterectomy performed as an in-patient procedure, or you may have a hysterectomy performed as an outpatient procedure. In 2008, approximately 18% of all hysterectomies were performed as a same-day outpatient surgery.3 If you and your healthcare provider decide that a hysterectomy is the best treatment option, you can read about the four different types of hysterectomies below. Most of the research literature indicates that vaginal hysterectomies have better outcomes and fewer complications, but whether you can choose this procedure is dependent on feasibility and the condition for which you are being treated.4

  1. Vaginal Hysterectomy describes a surgical procedure in which the uterus is removed through the vagina. One or both ovaries and fallopian tubes may be removed during the procedure, as well. This surgical approach avoids visible scarring and typically allows for a quicker recovery, as well as less postoperative pain and complications as compared with other types of hysterectomy. Risks associated with the vaginal approach include a slight but serious risk of shortening or damaging the vagina. Vaginal hysterectomy has also been shown to be the most cost effective form of procedure.
  2. Laparoscopic-Assisted Vaginal Hysterectomy employs video technology to provide the surgeon with greater visibility when removing the uterus through the vagina. The laparoscopic-assisted approach entails three small external incisions: one in the navel, through which the laparoscope (small video camera) is inserted, and two others in the lower abdomen for the use of surgical instruments. This procedure may be preferred because of the rapid healing time, a less noticeable scar, and less pain, although actual surgery time is longer than the abdominal approach. Because of the longer time in the operation room and the use of extra electronic equipment, this procedure is also costlier than others Risks associated with the laparoscopic-assisted vaginal approach include a slight risk of bladder injury and urinary tract infection.
  3. Abdominal Hysterectomy is fairly standard and remains the most common approach for removing the uterus and other reproductive organs. When performing an abdominal hysterectomy, surgeons can either use a vertical incision or a “bikini cut” incision depending on the scope of the surgery. The vertical incision cuts vertically from the navel to the pubic hairline, while the “bikini cut” is a horizontal incision made directly above the pubic hairline. The abdominal hysterectomy approach results in a longer recovery period and more noticeable external scarring but requires less specialty surgical skill.
  4. Laparoscopic-Assisted Abdominal Hysterectomy requires only one incision for both the and the removal of the uterus. This approach is an alternative to the three-puncture laparoscopic-assisted vaginal approach; however, the laparoscopic-assisted abdominal approach is only appropriate for a supracervical hysterectomy (meaning the cervix is healthy and does not need removal). The laparoscope has the potential to be a useful tool for total and radical hysterectomies as well, however, most surgeons prefer the traditional abdominal approach for these procedures.
  5. Robotic-Assisted Laparoscopic Hysterectomy requires three to four incisions near the belly button. A laparoscope is inserted, and the surgeon performs the procedure from a remote control area. This procedure results in smaller scars, but the procedure has not been shown to have better surgical outcomes. Rates of discharge from the hospital to a nursing facility were similar to other surgical options for hysterectomies. It is also significantly more costly than the other types of hysterectomies.5

Surgical and Post-Surgical Risks

Although the death rate from a hysterectomy is low (less than 1 percent) surgical complications are very real and can result in any of the following: infection, hemorrhage during or following surgery and/or damage to internal organs such as the urinary tract or bowel. Patients have a 30% chance of complication (typically infection or fever) while in the hospital and a significantly lower risk of more serious complications such as hemorrhage or bladder and bowel damage depending on the individual’s condition and the surgical approach taken.

“I advise any woman who is not in a life-threatening situation to see someone else besides a surgeon to explore nonsurgical options first,” says Cindy Pearson, NWHN Executive Director.

Long-term Risks

Removal of the uterus and ovaries at a young age (early forties and younger) may increase the risk of a heart attack, stroke, and (even when ovaries are not removed) the chances of experiencing an earlier menopause. Hysterectomy has also been associated with urinary problems, such as increased frequency of urination, incontinence, fistula, and urinary tract infections; sexual function problems, such as decrease in sexual sensations and lack of lubrication; depression or psychological stress (stemming from feelings associated with losing reproductive organs); hormone deficiencies (which may be caused by removal of the ovaries), or a decrease in blood supply to the ovaries. There is not enough consistent evidence to know what the effects that a hysterectomy has on sexual function.

Long-term consequences

All four types of hysterectomies require the removal of the uterus. Therefore, once a woman receives a hysterectomy, she can no longer have a biological pregnancy.

Hysterectomy Alternatives

For each of the conditions listed below, you may want to talk to your physician about an approach called “watchful waiting.” If your condition is not causing problematic symptoms, you may want to closely observe your symptoms without initiating active treatment. Many women are treated for conditions that do not necessarily require treatment, and the side effects of these treatments can cause more health problems than the actual condition. In many circumstances, you can carefully observe if and how the condition changes or is, hopefully, naturally eliminated.

Fibroids

There are many treatment options for shrinking or removing uterine fibroids without removing reproductive organs. These include using anti-estrogen drugs, uterine artery embolization (UAE) laser ablation of uterine fibroids, cryosurgery, and myomectomy. For more information on fibroids,

Cancer

Hysterectomy is often necessary and life preserving when invasive cancer is diagnosed; however, hysterectomy is frequently recommended when cancer is neither invasive nor life threatening. For pre-cancerous cells, there are a few options that you and your health care provider should discuss. Loop Electrosurgical Excisional Procedure (LEEP) can be used to remove pre-cancerous cells, and cryosurgery can be used to treat non-cancerous growths and abnormal tissue. For early invasive cervical cancer that has not spread to other regions, a radical trachelectomy (the removal of the cervix or the neck of the uterus) can be performed in lieu of a total hysterectomy.

Excessive Endometrial Lining

Endometrial ablation can be used to remove the excess endometrial lining. Dilation and Curettage (D&C) can also be used to remove the lining or abnormal tissue.

Endometriosis

Vaginal pessaries can be used for cases of uterine prolapse.

Operative laparoscopy is a surgical procedure that can generally be done on an outpatient basis to remove endometrial growths and adhesions. Pain medication, hormone therapy, and other conservative surgical procedures can also be used to control any discomfort associated with endometriosis.

Uterine Prolapse

According to MedlinePlus, an information service of the National Institutes of Health (NIH) a vaginal pessary (an object inserted into the vagina to hold the uterus in place) can be used as a temporary or permanent form of treatment for a prolapsed uterus (MedlinePlus). Vaginal pessaries are available in many shapes and sizes and must be individually fitted. A surgical procedure called a “suspension operation” can also be performed to lift and reattach a descended uterus, and often a fallen bladder or rectum as well. Health practitioners suggest that Kegel exercises can be a powerful prevention and treatment tool for strengthening uterine muscles and avoiding prolapse.

Removing Ovaries

Often when getting a hysterectomy, doctors might suggest removing the ovaries to prevent ovarian cancer down the road. This, however, is not always medically necessary unless you are at risk for ovarian cancer or have a family history of ovarian cancer. While removing the ovaries does eliminate the risk of ovarian cancer, it may contribute to increased risks of heart disease and death. According to Our Bodies, Ourselves, ovarian cancer accounts for 14,700 deaths per year in the United States but heart disease accounts for considerably more at 326,900 per year and strokes causing 86,900. Conserving the ovaries during a hysterectomy should be carefully considered based on personal medical history and should be discussed with a physician before opting for removal.

Contact Us

The National Women’s Health Network is committed to ensuring that women have access to accurate, balanced information about hysterectomies. If you have a question you would like to ask NWHN, submit it on our weekly Q & A column, “Since You Asked.” Stay informed, connect with us on Facebook and Twitter.

1. Centers for Disease Control and Prevention Website, Key Statistics from the National Survey of Family Growth, Atlanta, GA: Centers for Disease Control and Prevention 2015. Retrieved on June 23, 2015 from: http://www.cdc.gov/nchs/nsfg/key_statistics/h.htm#hysterectomy.

5. Wright J, Ananth C, Lewis S et al., “Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease,” JAMA 2013; 309(7): 689-98.

Updated 2015

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