As a gynecologic surgeon, I’ve found that many of my patients are daunted by the idea of a hysterectomy (removal of the uterus). And that’s understandable, as it is a major surgery.
But I think some of the fear comes from outdated ideas about what a hysterectomy entails. The truth is this surgery has evolved greatly in the last few decades. Today’s hysterectomies are faster, safer, and less invasive than ever before.
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Here are seven things you may not know about hysterectomy.
1. You can go home the same day.
Not long ago, recovering from a hysterectomy meant spending several days in the hospital, followed by more bedrest at home. We still want you to take it easy, and it can take up to 4 weeks to fully recover. But modern hysterectomies are much more manageable than you may think.
Most hysterectomies can be done vaginally with no incisions on your skin, or abdominally with very small cuts in your skin (a technique called laparoscopy). Both techniques make the surgery easier on your body than traditional surgery. And many hospitals have new protocols to help patients recover as quickly as possible from surgery. This means you’ll be able to go home and feel better sooner, with fewer complications.
Exactly how long you stay in the hospital depends on your condition and how the surgery was done, but many people go home the very same day.
2. The fallopian tubes and cervix are often removed with the uterus. But the ovaries are often left in place.
At its core, a hysterectomy is a surgery to remove the uterus. People often use “hysterectomy” as a catch-all term, but there are actually three main types:
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Supracervical (partial) hysterectomy—The upper part of the uterus is removed, but the cervix is left in place. We may go this route when treating conditions that are not cancer, like fibroids or prolapse. This is also called subtotal hysterectomy.
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Total hysterectomy—The uterus and cervix are removed. This is the most common type of hysterectomy. A total hysterectomy may also be called a simple hysterectomy.
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Radical hysterectomy—The uterus and cervix are removed along with the surrounding tissue. This includes removing the upper portion of the vagina and the tissue surrounding the cervix. A radical hysterectomy may be recommended if cancer is diagnosed or suspected.
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It used to be quite common for doctors to take out the ovaries along with the uterus. But these days, we only remove them when medically needed. That’s because the ovaries make important hormones, so there are risks and side effects when they are removed (more on that below).
Another thing that has changed in the past few decades: We now often remove the fallopian tubes along with the uterus. This is because removing the fallopian tubes has been shown to decrease the risk of developing ovarian cancer. And the fallopian tubes don’t make important hormones like the ovaries do. So we can decrease this risk of ovarian cancer without putting patients through the complications of having their ovaries removed.
A few terms you may hear:
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Bilateral salpingectomy is the removal of the fallopian tubes. Bilateral means both sides.
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Bilateral salpingo-oophorectomy is the removal of both the tubes and ovaries.
3. Your periods may end, but you may still ovulate and have cramps each month.
After a supracervical (partial) hysterectomy, you may continue to have some monthly bleeding. But after a total hysterectomy, you will not get your period anymore. In either case, you will no longer be able to get pregnant.
Still, if your ovaries are still in place, they will continue to release eggs and make hormones on a regular cycle (assuming you had not reached menopause at the time of your surgery).
This means you may have common premenstrual syndrome (PMS) symptoms such as cramps and bloating. And you may reach menopause a little earlier than average.
4. If your ovaries are removed, menopausal symptoms start right away.
Speaking of menopause: If your ovaries are removed during a hysterectomy, you can expect to enter menopause right afterward, if you hadn’t already. You may experience classic symptoms like hot flashes, mood swings, and vaginal dryness.
Hormone therapy can help relieve the symptoms of menopause and perimenopause, as well as reduce your risk of bone loss. You may be able start hormone therapy right after your hysterectomy, depending on why your ovaries were removed. Talk with your doctor about whether this treatment is right for you. You can also discuss nonhormonal medication options as well.
5. Hysterectomy can affect your sex life—sometimes for the better.
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You shouldn’t have vaginal sex while you’re healing from your surgery. But in the long term, many women report that their sex lives do not change after a hysterectomy. Others say that their sex lives actually improve. This may be because removing the uterus can make pelvic pain and abnormal bleeding go away. So you may find your sex drive increases after pain or discomfort is gone.
Removing the ovaries is another story. Vaginal dryness and other symptoms that come after removing the ovaries can cause sexual problems. The good news is that hormonal medications, such as estrogen cream, can treat these symptoms and improve your sex life.
Talk with your ob-gyn before a hysterectomy to understand all possible effects on sexual function.
6. You may be done with cervical cancer screening.
This is a silver lining for many of my patients: If your cervix is removed and you have no history of cervical cancer or severe cervical cell changes, you can say goodbye to cervical cancer screening after your hysterectomy.
But if you still have your cervix, you should keep up with routine cervical cancer screening following the surgery. The same is true if you have a history of cervical cancer or severe cervical cell changes.
Either way, plan to keep up with your routine ob-gyn visits even after you have had a hysterectomy. You’ll want to still see your ob-gyn regularly to prevent and get help with other health concerns.
7. You may have mixed feelings about your hysterectomy, and that’s OK.
First, there’s the positive. A hysterectomy can bring much-needed relief from the bleeding, pain, and discomfort of conditions like uterine fibroids, adenomyosis, and endometriosis. If you undergo a hysterectomy to prevent gynecological cancer, it can be so reassuring to know you are no longer at risk. And for transgender patients, a hysterectomy can be an important part of affirming their gender identity.
At the same time, a hysterectomy represents an official end to your ability to carry a pregnancy. Some of my patients have feelings of intense loss or grief, even if they didn’t plan to have more children or any at all. You may sense that your identity has somehow shifted now that you no longer have a uterus.
It is normal to feel thankful, sad, and everything between when you have a hysterectomy. Give yourself time and space to work through these feelings. Talking with your ob-gyn and your loved ones may help.
Get the Facts
A hysterectomy can be life-changing, even lifesaving, for people who need it. I would hate for any misconceptions or outdated notions to hold anyone back.
If you’re thinking about a hysterectomy, read up as much as you can and turn to your ob-gyn with questions you may have. Hysterectomies have come a long way in the 21st century, and you may be surprised at what you learn.
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