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Do I Need to Get a Hysterectomy?
A hysterectomy is surgery to remove the uterus, also known as the womb. After this procedure, a person will no longer have a menstrual period or be able to become pregnant. Hysterectomy may be chosen as a treatment option for uterine fibroids, endometriosis, or uterine cancer. But it is a major surgical procedure, and less invasive options may be available to help resolve your health issue.
According to Shawana Sharee Moore, PhD, a board-certified women’s health nurse practitioner and associate professor at Emory University’s Nell Hodgson Woodruff School of Nursing, the treatment that’s right for you and your specific health issue should be based on your personal experience and how your condition is impacting your quality of life. In many cases, “there are both medication and surgical options that can preserve the uterus,” she says.
A hysterectomy can put a definitive end to uterine troubles — and can be life-saving for certain medical problems — but this type of surgery does have implications for reproductive health and overall well-being.
Hysterectomies are second only to C-sections as the most commonly performed surgeries among women in the United States. Every year, nearly half a million American people have their uterus removed. Hysterectomies are often performed for the following medical reasons, but there are also other treatments that may help improve or manage these health issues.
“Today we have multiple tiers of medical therapeutics in addition to a wide range of surgical options that can be implemented,” says Arnold P. Advincula, MD, a specialist in minimally invasive gynecologic surgery at New York-Presbyterian/Columbia University Irving Medical Center. “Patients should always seek a second opinion if someone is pushing a hysterectomy when they are in their 20s."
Uterine Fibroids
Fibroids, which are noncancerous growths in the uterine wall, can grow quite large and lead to heavy menstrual bleeding and pain. A hysterectomy is the only surefire way to remove fibroids, but one of these other less invasive methods may also manage the issue:
- Drug treatment, such as pain relievers, hormonal birth control, and gonadotropin-releasing hormone agonists (GnRH agonists), such as Lupron, which can shrink fibroids
- Surgery, such as a myomectomy, which removes only the fibroids; endometrial ablation, which uses a laser to destroy the lining of the uterus; myolysis, where a needle is inserted into the fibroids to destroy them; or uterine artery embolization, which destroys fibroids by cutting off their blood supply
Heavy or Unusual Vaginal Bleeding
A hysterectomy is one option to treat heavy bleeding, which is known as menorrhagia, and can result from fibroids, cancer, hormonal changes, an infection, or for no clear reason.
Alternate treatment options will depend on the cause, but they may include:
- Medication, such as tranexamic acid (Lysteda) to reduce blood loss, hormonal birth control, and GnRH agonists
- Endometrial ablation
- Myomectomy
- Uterine artery embolization
Uterine Prolapse
A uterine prolapse happens when the pelvic floor stretches and weakens. When the muscles and ligaments no longer provide enough support for the uterus, it can slip into — or partially out of — the vagina. It can lead to pelvic pressure and bowel and bladder problems, and a mild form of it is common after childbirth. More serious cases tend to impact people after menopause who delivered babies vaginally.
Beyond having a hysterectomy, there are several other treatment options.
- A pessary, which is a removable device inserted into the vagina to provide support for your pelvic organs
- Pelvic floor exercises
- Surgery to strengthen a weak pelvic floor or to close the vagina
Endometriosis
Endometriosis is a condition that happens when tissue that’s similar to the lining of the uterus grows outside of it, resulting in severe pain, bleeding, or spotting between menstrual periods. It can have a negative impact on fertility. The cause of endometriosis is unknown, but risk factors include hormonal imbalances and a family history of the disease.
Treatment options for endometriosis beyond hysterectomy include:
- Hormonal birth control
- GnRH agonists
- Pain relievers
- Surgery to remove endometriotic tissue and scar tissue
- Complementary therapies, such as acupuncture or licorice root
Cancer Diagnosis and Cancer Risk
For endometrial, uterine, cervical, and other types of cancer that grow in the reproductive organs, a hysterectomy may be a life-saving medical procedure. It can also help prevent these types of cancer if you are at high risk for developing them. The type of hysterectomy for cancer therapy or prevention will depend on the type and stage of the cancer.
For endometrial cancer, a total hysterectomy may be recommended, which removes the uterus and cervix. Cervical cancer may require a radical hysterectomy, which removes the uterus and cervix as well as part of the vagina and nearby ligaments and tissues. For ovarian cancer, a total hysterectomy may also be paired with removing one or both ovaries and the fallopian tubes.
Gender Affirmation Surgery
Gender affirmation surgery includes several medical procedures that help transgender, nonbinary, and gender-diverse people align their bodies with their gender identity. It also may be a treatment option if you suffer from gender dysphoria.
A hysterectomy is one option within this range of treatment, and hormone therapy is another potential medical intervention. Other types of gender-affirming treatment include:
- Voice therapy
- Facial reconstruction surgery
- Genital surgery
Around 25 to 35 percent of trans and nonbinary people in the United States opt for gender affirmation surgery of various types, and the most common surgeries are top surgeries, bottom surgeries, and facial reconstruction procedures.
A hysterectomy comes with physical, emotional, social, and economic risks. It can affect a person’s self-image and how they feel about themselves sexually, says Moore. After a hysterectomy:
- You will no longer be able to bear children.
- You may have a sense of grief and a higher risk of depression due to the loss of fertility and a part of your body.
- You enter menopause immediately if the ovaries are removed or potentially experience earlier menopause if your ovaries were kept in place.
- If the ovaries are also removed, you may experience menopausal symptoms like hot flashes, mood changes, vaginal dryness, and reduced libido.
- If the ovaries are also removed, you have a higher risk of urinary incontinence, osteoporosis, heart disease, and other chronic health issues.
All surgery carries a risk of complications, and hysterectomy is no different. The more invasive the procedure is, the higher the risk for these side effects.
- Pain and discomfort
- Infection
- Blood clots and a risk of deep vein thrombosis (DVT)
- Accidental damage to nearby organs
- Bleeding
- Nerve injury
- Vaginal cuff separation, possibly years later
Following the surgery, you may not be able to lift heavy objects or have sex for four to six weeks. You may also not be able to drive or work, and it can be difficult to manage everyday tasks.
Despite the downsides, a hysterectomy is typically performed to improve a person’s quality of life. Removing the uterus from your body may be drastic, but it will put an end to all uterine pain, bleeding, and other unwelcome symptoms.
Hysterectomy may be the right treatment choice for people who:
- Have a life-threatening condition, such as endometrial cancer
- Have a high risk for certain cancers, such as ovarian cancer
- Have tried other treatment approaches that did not help
- Want a fully effective birth control method
However, it’s essential to be aware of the full implications of a hysterectomy, the types available, and the other medical interventions you can try first.
If you decide on a hysterectomy, several options are available.
Total Hysterectomy
For this procedure, the surgeon removes the whole uterus and the cervix. If you are at high risk for breast or ovarian cancer, they may also remove the ovaries and fallopian tubes, which is known as a bilateral salpingo-oophorectomy.
Partial, Subtotal, or Supracervical Hysterectomy
The surgeon removes the upper part of the uterus, without the cervix. They may or may not remove the ovaries and fallopian tubes.
Radical Hysterectomy
The whole uterus, cervix, surrounding tissues, and the upper part of the vagina are removed. The surgeon may also remove the ovaries and fallopian tubes. Doctors mostly use this to treat cervical and other types of reproductive cancer.
Laparoscopy Versus Open Surgery
There are three ways of performing a hysterectomy. The choice will largely depend on the extent of the procedure. It can be performed completely through the vagina, which is considered the route of choice when it’s feasible. In laparoscopic or minimally invasive surgery, the surgeon makes small incisions and uses specialized instruments during the procedure. In open surgery, they use larger abdominal incisions to access the uterus directly.
Laparoscopic surgery involves smaller scars and a shorter recovery time, but it may not be suitable in complex cases, such as cancer.
Over the past few decades, hysterectomies have become much less invasive and more manageable. After a hysterectomy, many people are able to go home the same day, depending on the procedure and other factors. Others may need to stay in the hospital for a few days.
You’ll need to arrange for a ride home from surgery, and it may be a wise choice to have someone stay with you at home for a day or two while you recover. For the first few days after you’re home, make a point to:
- Walk around and wear compression stockings to prevent blood clots
- Stay hydrated
- Take a laxative if you’re constipated
- Keep your incisions dry
- Manage pain with over-the-counter medication and a heating pad
- Avoid tampons, douching, and sex as your doctor recommends
- Talk with friends or your healthcare provider if you’re feeling depressed
- A hysterectomy, which is the surgical removal of the uterus, can be a definitive or life-saving cure for some diseases. But this type of surgery isn’t always necessary to resolve painful and inconvenient uterine health issues like endometriosis or fibroids.
- Hysterectomy is an irreversible procedure that permanently ends your fertility. If you have any doubts about getting this procedure to address an existing health problem, talk to your doctor about other treatment options and seek a second opinion.
- Hysterectomy may be the best choice for those who have endometrial, uterine, or cervical cancer or a family history of it.
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