Each year in the United States, over 500,000 women have hysterectomies. One-third of all women in the U.S. will have hysterectomies before age sixty, most while they are still in their forties.

Hysterectomy is a controversial subject, because many hysterectomies are probably unnecessary. Some health experts suggest that a third or more of all hysterectomies should not have been performed. Necessary or not, most women have strong feelings about this surgery. If your doctor has recommended a hysterectomy for you, it is important to understand exactly what this means.

What is a hysterectomy?

Hysterectomy is surgery that removes the uterus (womb). With the uterus removed, you will not have any more periods, and you cannot become pregnant.

Here are the four basic kinds of hysterectomy:

Total hysterectomy: The phrase “total hysterectomy” can be confusing, as many people think it includes removal of the ovaries, leading to “instant menopause”. This is not the the case. In a total hysterctomy, the uterus and cervix are removed. The fallopian tubes and ovaries are left intact. The ovaries will continue to produce hormones, possibly for as long as they would have without the hysterectomy.

Total hysterectomy with oophorectomy: (bilateral oophorectomy, bilateral salpingo-oophorectomy) Total hysterectomy plus removal of the ovaries (and usually the fallopian tubes). There are some variations on this which may include leaving one ovary or part of an ovary. For women over age 45, many doctors recommend removal of the ovaries as part of any hysterectomy, even when the ovaries are still healthy. The doctor may feel that since the woman is near menopause anyway, this is not a great loss, and it will protect her against ovarian cancer. (Note, however, that ovarian cancer is not common in women who do not have a family history of ovarian cancer.) Removal of the ovaries results in instant menopause. Hormone replacement therapy (HRT) may be recommended, and the doctor will usually start your HRT while you are still in the hospital, possibly even placing a hormone patch while you are still unconscious.

Supracervical (subtotal, partial) hysterectomy: The body of the uterus is removed, but the cervix is left in place. In the past, the cervix was always left in place, because surgeons did not have safe techniques for removing it. In the 1950s, new techniques (and the desire to prevent cervical cancer) led to removal of the cervix being the typical method. However, supracervical hysterectomies are still performed in some cases. Because you still have a cervix, you will need to continue regular getting Pap tests.

Radical hysterectomy: The uterus, ovaries, fallopian tubes, upper portion of the vagina, and the pelvic lymph nodes are all removed. This kind of hysterectomy normally is done only if there is a serious disease, such as cancer, that warrants it. If your doctor is recommending a radical hysterectomy, find out why! And get a second opinion.

Do I really need this?

Hysterectomy is usually “optional”, but may be the only effective treatment for a condition that is causing pain or other complications. Unfortunately, some doctors may not be aware of the effectiveness of alternative treatments, or they may simply prefer hysterectomy because it is simpler. On the other hand, sometimes hysterectomy is the only (or the best) way to solve the problem.

Most authorities now agree:

Hysterectomies are necessary for: Uterine, ovarian or invasive cervical cancers, or for the management of other cancers

Hysterectomy can be an appropriate treatment for: Large or rapidly-growing fibroids, severe endometriosis, serious damage to the uterus from infection or childbirth, severe bleeding that cannot be controlled through other methods, chronic pain from pelvic adhesions, prolapse

It is usually not appropriate for: Precancerous conditions of the cervix, benign ovarian cysts, small or painless fibroids

It is unnecessary for: Sterilization, abortion, menstrual irregularities

If your doctor has recommended hysterectomy, make sure you understand exactly why. Find out exactly what type of hysterectomy is being proposed. Find out whether or not there are alternative treatments, and how they may apply to your case.

It is always wise to get a second opinion before undergoing major surgery. Some insurance companies may require that you do so. Your doctor or your insurer can provide you with an appropriate referral. Don’t be afraid to ask questions!

What are the alternatives?

Available alternatives depend on the condition that is being treated and your overall health. Some possible alternatives:

Do nothing. If your condition is not life-threatening and does not pose a significant threat to your health, you may choose to take a “wait and see” approach. You will need to decide whether you can tolerate the current symptoms, and discuss with your doctor the best way to continue monitoring your condition. Some conditions are likely to get worse if untreated, but others will stay the same. Some conditions, such as fibroid tumors, may improve after menopause.

Treat the problem with hormones or other medications. Hormones or drugs may be helpful in controlling some conditions. However, not everyone can safely take hormones. Hormones and other medications can have unpleasant side effects, and some are not appropriate for long-term use.

Use some other kind of surgery. It may be possible to remove certain kinds of tumors, such as fibroids, and repair the uterus. Sometimes other organs or tissue can be removed without removing the uterus.

Other treatments. Treatments such as D&C, endometrial ablation, insertion of mechanical devices, laser treatments, radiation therapy, and others may be helpful for some conditions.

What will it be like?

How is the surgery done?
What are the risks?
How should I prepare for surgery?
What is the recovery like?
How will this change my life?

For information about before, during and after a hysterectomy, see the following post about “Having a Hysterectomy”.

What else should I know?

Hystersisters is a nonprofit organization providing positive support for women before, during and after hysterectomy.
See our page of helpful links.

© 2005 Rosemary K. West

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