Menopause Mondays: Hysterectomy FAQs Answered

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How are these for some startling stats: One third of all American women will eventually have their uterus removed. Half a million women in the U.S. have a hysterectomy each year, according to Lauren Streicher, MD, Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s Feinberg School of Medicine in Chicago, and author of the new book, The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices Before, During, and After Surgery.

“Hysterectomies affect not only a woman’s health, but also her sex life, relationships, and her family. And most women who undergo hysterectomy are not offered appropriate alternatives or a minimally invasive approach,” she says.

Here, Streicher helps answer women’s most common hysterectomy questions:

What is a hysterectomy?
A hysterectomy is a surgery that removes a woman’s uterus. In the procedure, either the whole uterus or just a portion of it is removed, and the fallopian tubes and ovaries may be removed as well.

Why is a hysterectomy performed?
A doctor may decide a hysterectomy is necessary for multiple reasons. The most common cause for a hysterectomy is fibroid tumors. A hysterectomy may also be performed in extreme cases of endometriosis, prolapse of the uterus, adenomyosis, chronic pelvic pain, and abnormal vaginal bleeding. About 15 percent of hysterectomies are performed because of cancer or pre-cancerous cells of the uterus, ovary, cervix, or endometrium, according to Streicher. The procedure removes the cancerous cells and prevents the cancer from spreading.

Doctor Is In

Do alternatives to a hysterectomy exist?
“While many hysterectomies are appropriate and beneficial, there are still too many women who have unnecessary surgery or who are not offered less invasive alternatives,” Streicher says. Alternatives treatments such as hysteroscopic myomectomy, uterine lining ablation, and uterine artery embolization do exist, and while they aren’t viable options in all cases, they should be discussed with your healthcare provider. “The more information a woman has prior to surgery, the better the choices she will make, and the better her long-term outcome will be,” she says.

How is a hysterectomy performed?
How your doctor performs a hysterectomy depends on both a woman’s health history and the reason for the surgery. A hysterectomy can be performed by removing the uterus through a five- to seven-inch incision in the abdomen, an incision in the vagina, laparoscopically through three to four small incisions in the abdomen, or robotically. In most cases, laparoscopic surgery has all the benefits of a robotic surgery, but with a much lower price tag, Streicher says.

Do I still need to have Pap tests after a hysterectomy?
A woman still needs regular Pap tests to screen for cervical cancer if she has a partial hysterectomy and does not have her cervix removed, or if her hysterectomy is for cancer. Either way, any woman who has a hysterectomy should still have regular pelvic exams and mammograms.

What are the physical effects of a hysterectomy?
After the procedure, a woman may no longer become pregnant. If she has not yet entered menopause at the time of surgery and her ovaries are left in place, they will continue to produce estrogen. However, she may enter menopause at an earlier age. If her ovaries are removed during the hysterectomy she will enter menopause and encounter symptoms caused by a lack of estrogen such as hot flashes, vaginal dryness, and sleep problems. She may also be at risk of developing osteoporosis at an earlier age, according to The American College of Obstetrics and Gynecologists.

What are the emotional effects of a hysterectomy?
“Very few women are thrilled about having to have a hysterectomy. Even though intellectually you know it’s the right thing to do and will benefit you in the long run, it’s a complex decision that is often psychologically difficult,” says Streicher. Some women feel depressed because they can no longer have children, and, if they have entered menopause after the surgery, hormonal changes can cause emotionally difficult symptoms. Still, she may feel relieved because the symptoms she was having are no longer present.

What are the sexual effects of a hysterectomy?
Most women experience increased sexual satisfaction after a hysterectomy, according to research from the University of California, San Francisco. For example, women who previously experienced discomfort or heavy bleeding during sexual intercourse may feel more sexual pleasure post-surgery because of the loss of symptoms, according to The American College of Obstetrics and Gynecologists. However, because the uterus has been removed, the uterine contractions that the woman may have felt during orgasm will no longer occur and can decrease sexual satisfaction for some women. A minority of women report developing sexual dysfunctions following a hysterectomy. When a woman no longer produces estrogen, her vagina often takes a trip to the desert… and I’m not talking Las Vegas!

Have more questions? Should you keep your cervix? Your ovaries? What are the possible complications? Is hormone therapy necessary following the procedure? These and other questions are addressed in Streicher’s new book, The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices Before, During, and After Surgery.

Remember: Suffering in silence is OUT!  Reaching out is IN!

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • “Very few women are thrilled about having to have a hysterectomy”. Yeah, that’s the understatement of the year! Yet so many of us find it to be the only alternative. I had a complete hysterectomy nearly 4 years ago. It change my life … for the better. A tough surgery to recoup from but not something a woman should put off if the symptoms are there. Great info here Ellen. Praises to you for sharing it!

    • Dear Tammy – We are all better women for having you a part of this community, for your openness and honesty. Thank you for your comment and for sharing your journey. Your optimism is contagious.

  • Exactly what tammy said except its been about 10 years for me

    • Shelley, You continue to inspire me and other women by not being afraid to share. I wish you both continued wellness and happiness.

  • Great information. I really didn’t know much on the topic before I read this.

  • Chrysa

    Very helpful information. Thanks for sharing.

  • You never cease to amaze me with all your information. Thanks so much.

  • Ellen, thanks very much for your Re-Tweet this morning. So thrilled you’re discovering hysterectomy on your site and in your blog.

    My journey to avoid a hysterectomy was quite a long and painful one, as it is for so many women. Thanks for raising awareness of this important topic.

  • Holly. Thank you for speaking candidly with us about your hysterectomy. It’s not an easy decision to make. It changes your life. I hope your comment compels other women to talk about their procedure, or have them talk about whether they are considering having one… Reaching out is IN. Suffering in silence is OUT. I appreciate you stopping by.