Hysterectomy is a surgical procedure that involves removing the uterus, the organ in which a baby grows during pregnancy. Sometimes, the fallopian tubes and ovaries are also removed. There are several health conditions that can be treated with a hysterectomy, including fibroids, cancer, endometriosis, adenomyosis, infection, hyperplasia, abnormal bleeding, prolapse of the uterus, and delivery complications. For some transgender men, a hysterectomy can also be part of their gender-affirming care.
Hysterectomy is a major surgery with risks and benefits. It has a long-term effect on your health, so it is important to discuss the reasons, types, and outcomes of a hysterectomy beforehand.
There are many reasons why your doctor may recommend a hysterectomy. Some of the most common ones are:
Uterine fibroids. These are noncancerous growths that form in the uterus. They can cause heavy bleeding, pain, or stomach distention. They may also affect fertility. A hysterectomy can remove all the fibroids and prevent them from regrowing.
Cancer. A hysterectomy can treat cancer of the uterus, cervix, ovary, or endometrium (the lining of the uterus). The type and stage of cancer will determine the extent of surgery and whether other treatments, such as chemotherapy or radiation, are needed.
Endometriosis. This is a condition where tissue that normally lines the uterus grows outside of it. Endometriosis can cause extreme pain and irregular periods. It can also lead to infertility. A hysterectomy can often reduce or eliminate symptoms from endometriosis, but it does not cure it.
Adenomyosis. This is a condition where the endometrial tissue grows into the muscular wall of the uterus. Adenomyosis can cause heavy bleeding, cramps, and bloating. A hysterectomy can cure adenomyosis by removing the affected tissue.
Infection. A severe infection of the uterus, such as pelvic inflammatory disease (PID), can damage the uterus and cause chronic pain or infertility. A hysterectomy can remove the source of infection and prevent further complications.
Hyperplasia. This is a condition where the endometrium becomes abnormally thickened. Hyperplasia can cause irregular or heavy bleeding and increase the risk of uterine cancer. A hysterectomy can prevent cancer from developing by removing the abnormal tissue.
Abnormal bleeding. Some women experience excessive or prolonged bleeding during their periods or between periods. This can be due to hormonal imbalances, polyps, fibroids, or other causes. A hysterectomy can stop the bleeding and improve your quality of life.
Uterine prolapse. This is a condition where the uterus slips down from its normal position and presses on the bladder or rectum. Uterine prolapse can cause urinary or bowel problems, pelvic pressure, or sexual dysfunction. A hysterectomy can correct the prolapse by removing the uterus and supporting tissues.
Delivery complications. Sometimes, a hysterectomy may be necessary during or after childbirth to save your life or prevent severe bleeding. For example, if you have placenta accreta (a condition where the placenta grows too deeply into the uterine wall), you may need a hysterectomy to remove it.
Gender affirming surgery. Some transgender men may choose to have a hysterectomy as part of their transition process. A hysterectomy can help them align their body with their gender identity and reduce dysphoria.
There are different types of hysterectomy depending on how much of your reproductive organs are removed:
Total hysterectomy. This is the most common type of hysterectomy. It involves removing the entire uterus and cervix.
Subtotal (supracervical) hysterectomy. This type of hysterectomy removes only the upper part of the uterus and leaves the cervix intact.
Radical hysterectomy. This type of hysterectomy removes the entire uterus, cervix, ovaries, fallopian tubes, and surrounding tissues (such as lymph nodes). It is usually done for cancer treatment.
Salpingo-oophorectomy. This is a procedure that removes one or both ovaries and fallopian tubes along with or without the uterus.
There are also different ways to perform a hysterectomy depending on how your surgeon accesses your uterus:
Abdominal hysterectomy. This is done through an incision in your lower abdomen. It allows your surgeon to see your entire pelvic area and remove large tumors or masses.
Vaginal hysterectomy. This is done through an incision in your vagina. It avoids any scars on your abdomen and has a shorter recovery time than abdominal hysterectomy.
Laparoscopic hysterectomy. This is done through several small incisions in your abdomen. Your surgeon uses a thin tube with a camera and instruments (called a laparoscope) to remove your uterus through the incisions.
Robotic hysterectomy. This is a type of laparoscopic hysterectomy that uses a robotic system to assist your surgeon. It may offer more precision and flexibility than conventional laparoscopy.
It is important to discuss the pros and cons of each option with your doctor before choosing the type of hysterectomy you will have.
A hysterectomy can have both positive and negative effects on your health and well-being. Some of the possible outcomes are:
Relief of symptoms. A hysterectomy can often improve or eliminate the symptoms that caused you to have the surgery, such as pain, bleeding, or pressure. This can enhance your physical and emotional health and allow you to enjoy your daily activities more.
Loss of fertility. A hysterectomy means that you will no longer have periods and will not be able to get pregnant. This can be a difficult adjustment for some women, especially if they wanted to have children in the future. You may experience grief, anger, or depression after losing your fertility. You may also need to explore other options for family planning, such as adoption or surrogacy.
Menopause. If you have your ovaries removed during a hysterectomy, you will enter menopause immediately after the surgery. This means that you will stop producing estrogen and progesterone, which are hormones that regulate your menstrual cycle and affect many aspects of your health. You may experience symptoms such as hot flashes, night sweats, mood swings, vaginal dryness, or osteoporosis (bone loss). You may also have an increased risk of heart disease or stroke. You may need to take hormone replacement therapy (HRT) or other medications to manage these symptoms and reduce these risks.
Sexual function. A hysterectomy can affect your sexual function in different ways. Some women report an improvement in their sex life after a hysterectomy because they no longer have pain or bleeding that interfered with their intimacy. Other women report a decrease in their sex drive or arousal after a hysterectomy because of hormonal changes or psychological factors. Some women also experience changes in their orgasmic response or sensation after a hysterectomy because of nerve damage or loss of uterine contractions. You may need to communicate with your partner and seek counseling or medical help to cope with these changes.
Quality of life. A hysterectomy can have a significant impact on your quality of life, depending on how you view your uterus and its role in your identity, femininity, sexuality, or motherhood. Some women feel relieved or empowered after a hysterectomy because they are free from their symptoms or worries. Other women feel sad or incomplete after a hysterectomy because they lose a part of themselves or their potential. You may need to seek support from your family, friends, or professionals to deal with these feelings.
It is not always possible to treat your uterine problems with a hysterectomy. Other treatments may be more effective or less invasive. For example, you may be able to treat fibroids with medication, uterine artery embolization (UAE), or focused ultrasound surgery (FUS). Regular Pap tests and HPV vaccinations may prevent cervical cancer.
Before deciding to have a hysterectomy, it is important to discuss all of your options and alternatives with your doctor. Ask your doctor about the risks, benefits, and complications of each option and weigh them carefully against your values and goals.
Hysterectomy is a major decision that affects many aspects of your life. It is not a one-size-fits-all procedure and requires careful consideration and informed consent.
