Should you have
a hysterectomy?
How to Decide
1
Contents
Considering a hysterectomy? ........................................................ 2
Your uterus and ovaries. How do they work? ............................ 3
Should you have a hysterectomy? How to decide. ................. 4
Why you may need a hysterectomy .............................................. 4
Common reasons for a hysterectomy .......................................... 5-9
Benefits and risks of a hysterectomy ........................................... 10
Physical and emotional eects of a hysterectomy ................... 11-14
Options other than surgery ............................................................. 15-16
Getting a second opinion ................................................................. 17
Types of hysterectomies ................................................................... 18-19
While you’re in the hospital ............................................................ 20
Recovery .............................................................................................. 20
Questions to ask your doctor ......................................................... 21-26
Most likely, you
have time to
think about what
you want to do.
”
2
Considering a hysterectomy?
A hysterectomy is an operation to remove the uterus (womb).
Most hysterectomies are not emergencies. You have time to
think about what you want to do.
This booklet covers
the benefits and risks –
as well as options other
than surgery. It is
designed to help you
talk with your doctor.
We hope it helps you
decide whether or not
to have a hysterectomy.
Questions?
Wondering why you may need a hysterectomy? Or, how long
you will be in the hospital? Questions like these are listed in the
back of this booklet. Take them to your next doctor visit and
write answers in the space provided.
Ask others
Don’t hesitate to ask others for more information. Your doctor,
nurse, hospital or clinic can tell you who is available. Many
communities have support groups for women who have had
hysterectomies. These groups can help, and they can help you
find someone to talk with, if you need support.
This publication does not contain all there is to know about
hysterectomies and other treatments. To learn more, visit
the American Congress of Obstetricians and Gynecologists
www.acog.org.
3
Your uterus and ovaries. How do they work?
Your uterus is below your belly
button, in your lower abdomen.
Your uterus:
• cradles and feeds an unborn child
from conception to birth,
• helps deliver a baby, and
• produces your monthly
menstrual flow, or period.
Ovaries are glands on each side
of your uterus. They produce
eggs which allow women to bear
children. They also produce
hormones or chemicals. They
regulate your period, your sexual
health and other parts of your health,
such as helping bones grow.
Your ovaries release an egg each month. If it is not joined
by male reproductive cells, your uterus sheds its lining by
bleeding. This is your period, or menstruation.
After a hysterectomy, a woman’s periods stop. She can
no longer have children. Her ovaries generally keep
making hormones. But, some women’s ovaries make
fewer hormones.
Some hysterectomies remove both
the uterus and ovaries. Without
ovaries, a woman has a much
smaller supply of key female
hormones. This can aect a
woman in various ways, which
we’ll discuss later.
Fallopian tubes
Ovaries
Vagina
Cervix
Uterus
Uterus
or Womb
4
Hysterectomy is one treatment for many diseases
and conditions.
A hysterectomy may save your life if:
• you have cancer of the uterus or ovaries, or
• your uterus is bleeding fast and it can’t be stopped.
In most other cases, a hysterectomy is done to improve a
woman’s life. But, it is not needed to save her life. This is called
an elective hysterectomy. It can relieve pain, discomfort, or
heavy bleeding.
There may be other ways of treating or dealing with these
problems. You should weigh all options and their side eects
with your doctor. Decide what is right for you.
Why you may need a hysterectomy
Your doctor
may suggest a
hysterectomy to:
• save your life,
• improve your life, or
• fix serious problems
that prevent
your body from
working normally.
Should you have a hysterectomy? How to decide
Fibroid
Fibroid
Fibroid
Fibroid
Fibroid
Ovary
Endometrium
5
Cancer of the uterus or ovaries
A hysterectomy removes organs (parts inside the body with
special purposes) that have cancer. Sometimes, it also removes
other organs that are near the uterus or ovaries. This is done to
stop cancer from spreading.
Fibroids (fie-broyds)
These are common
tumors of the uterus.
Tumors are an
overgrowth of cells,
material that makes
up our body parts.
Fibroid tumors
are called benign
(be-nine), because they
are not cancer. Fibroids
are the most common
reason why a woman
needs a hysterectomy.
One type of fibroid grows from
the wall of the uterus. These
myomas (my-OH-muhs) are
made of muscle and fibrous
tissue. Many women over 35
have fibroids, but they usually
do not have symptoms.
But, some women have fibroids that may cause symptoms.
A woman may have heavy bleeding, pelvic discomfort and pain.
Sometimes the fibroids put pressure on other organs. These
symptoms may need treatment. But, a hysterectomy is not
always suggested.
Common reasons for a hysterectomy
Fibroids are the
most common reason
why a woman needs
a hysterectomy.
”
6
Some new and promising
experimental drugs may shrink
tumors for a while. But, these
drugs may have serious side
eects. They are also generally
very costly. There is also a type
of abdominal surgery that can
remove tumors without
removing the uterus. This
is called a myomectomy
(my-oh-mect-oh-me). See page
15 for more information.
These treatments may be enough to solve the problem. Or,
they may oer relief for just a while. This way a woman can
postpone a hysterectomy. This is especially helpful if she still
wants to bear children. Some women choose to do nothing
because fibroids often shrink as a woman goes through menopause.
Endometriosis (en-doe-mee-tree-oh-sis)
(when uterus-like cells grow outside the uterus)
Another common reason why a woman may need a hysterectomy
is endometriosis. This is not cancer. It is a condition in which cells
that are like the lining of the uterus grow like islands outside the
uterus. The cells most often grow in the ovaries, fallopian tubes,
bladder, bowel and uterus. These cells may cause pain and
discomfort by bleeding during a woman’s period. Endometriosis
may also cause scarring, adhesions (sticking together of organs
and tissues) and infertility (cannot make a baby).
Symptoms can vary a lot. Some women choose to do nothing.
Others find relief from drug therapy, medicine for pain or a
dierent type of surgery. When these do not help, a hysterectomy
may need to be done.
Common reasons for a hysterectomy
7
Common reasons for a hysterectomy
Prolapse (fall or slip out of place)
As a woman ages, the muscles that keep her vagina or birth
canal in place weaken and sag. This is called prolapse. When
it occurs, her bladder and/or rectum may be pulled down with
her uterus. This happens to most women to some degree.
For the vast majority, the sagging is minor and does not
cause symptoms.
If prolapse gets worse, some women get a heavy or dragging
feeling in their pelvic area. They can then have problems
controlling their bladders and/or bowels. Sometimes, one of
the organs comes through the vaginal opening.
Some women get relief from many
of these symptoms. They use
special exercises to strengthen
their pelvic muscles. These
exercises are called Kegels.
Others take hormones or use a
plastic or metal ring that may help hold the uterus in place.
The ring is called a pessary (pes-uh-ree). None of these treats
the actual problem. In most serious cases, a doctor suggests
a hysterectomy to fix a supporting structure like the vagina.
A woman has to decide for herself if her discomfort is great
enough to have a hysterectomy.
Ovary
Fallopian
Tube
UTERUS
Urinary
Bladder
Urethra
Vagina
Rectum
Anus
CERVIX
Uterus
and Cervix
Special exercises
to strengthen
pelvic muscles are
called Kegels.
”
8
Common reasons for a hysterectomy
Cancer of the cervix (lower part of the uterus)
The lower part of the uterus is called the cervix. Changes in the
cervix are often found on routine Pap smears. They are called
precancerous changes. This means a woman has a chance of
getting cancer. The changes must be treated, but rarely with a
hysterectomy. When found early and treated eectively, most do
not become life-threatening cancer that is invasive (it spreads).
They can be treated on an outpatient basis, so you don’t stay in
the hospital overnight. Hysterectomy may be the best treatment
only if it’s invasive cancer of the cervix.
Precancer of the Uterus
When the lining of the uterus grows too much, it can cause a
precancerous change. This change causes irregular and/or
too much bleeding. It can usually be treated with hormones.
If the growth is severe, or it doesn’t get better after hormone
treatment, it may lead to cancer of the uterus. If this happens,
a doctor may suggest a hysterectomy.
Pelvic adhesions (scars in the abdomen’s lining)
The abdomen’s lining can get irritated by infection, injury or
endometriosis. When this happens, it may cause scarring.
Scars that cause some organs to stick to one another are
called adhesions. Symptoms may include severe pain, infertility
(cannot make a baby), and bowel and bladder (the organ that
collects urine) problems. Some women are helped by pain relief
medicine or less severe surgery, such as laser therapy. In
very serious cases, a hysterectomy may be needed. But, a
hysterectomy can cause adhesions, too.
9
Common reasons for a hysterectomy
Very heavy bleeding
The amount and length of a woman’s period varies from woman
to woman. This is normal. Every woman may have a dierent
type of period each month, too. Very heavy or frequent bleeding
may be caused by many things. The most common causes are
fibroids and hormonal changes.
It is very important to get an accurate diagnosis before you
decide how to have very heavy bleeding treated. A doctor may
suggest drug therapy or minor surgery. Rarely, a woman’s uterus
may be bleeding uncontrollably. If this is true, a hysterectomy
can save her life.
Pelvic pain (pain in
the lower belly)
Many women have
pain in their lower
belly. This is called
pelvic pain. It is
common and can
have a number
of causes. These
include endometriosis,
fibroids, ovarian cysts,
infection or scar tissue.
Pain in the pelvic area may not be due to problems with a
woman’s uterus. This is why you should be sure to get an
accurate diagnosis before you consider a hysterectomy.
10
Benefits and risks of a hysterectomy
If you have cancer, a hysterectomy may save your life. It can
relieve bleeding or discomfort from fibroids, severe endometriosis
or prolapse (sagging) of the uterus. But, you may want to
look into options other than surgery for problems like these.
Symptoms like pelvic pain or unusual bleeding may not be
due to a problem with your uterus. Get an accurate diagnosis.
Knowing the true cause of your problem will help you decide if
a hysterectomy is right for you.
A hysterectomy is a major
operation. All major operations
have risks. The good news is
that a hysterectomy has one
of the lowest risks of any
major operation.
Some risks of a hysterectomy
• Hysterectomy patients may have a fever during recovery.
• Some women may have a mild bladder infection or wound
infection. If you get an infection, it can usually be treated with
antibiotics.
• It’s less common, but sometimes a woman is anemic and
needs a blood transfusion before surgery. Or, a woman may
need a transfusion during surgery due to blood loss.
• Complications from anesthesia (ann-eh-stee-shuh) may occur.
Anesthesia are drugs given before and during an operation so
you won’t feel the operation.
• Other serious complications may occur. They can happen
when anyone has major abdominal or pelvic surgery. They
include: blood clots, severe infection, adhesions, bleeding after
surgery, bowel obstruction or injury to the urinary tract. Rarely,
even death can occur.
Hysterectomy has one
of the lowest risks of
any major operation.
”
11
Physical and emotional eects of a hysterectomy
In addition to risks from surgery, there may be physical
and emotional eects that last a long time. You could feel
depressed and lose sexual pleasure. Your ovaries and uterus
could be removed before you enter menopause (change
of life). If so, you will have a higher risk of osteoporosis
(ah-stee-oh-poor-oh-sis) and heart disease. These will be
covered later, along with possible treatments.
You should know that a hysterectomy is not reversible. After
a hysterectomy, you will no longer be able to bear children.
You will no longer have a period. You need to think about
how these changes will aect you.
Talk about your concerns with
your doctor or a counselor and
your partner. You may want to
bring your partner to your doctor’s
oce to talk about concerns before deciding whether to
have the operation.
Removal of tubes and ovaries
Should your ovaries be removed along with your uterus?
If your doctor says you have cancer of the uterus, your ovaries
should be removed. The hormones they release may make your
cancer grow. They also may have to be removed if you have
severe endometriosis. The ovaries produce hormones that
cause this condition.
Usually, the fallopian tubes and ovaries are removed at the
same time. That’s because they are next to each other.
The tubes connect the ovaries and the uterus. Sometimes a
woman needs a hysterectomy due to a problem other than
uterine cancer or endometriosis. When this is true, doctors
don’t always agree about the benefits of removing ovaries
and tubes.
A hysterectomy is
not reversible.
”
12
Physical and emotional eects of a hysterectomy
As women age, their ovaries are
less active. That’s why some
doctors believe healthy ovaries
should be removed as part of a
hysterectomy for older women. It
is done to lower the risk of ovarian
cancer. This is because ovarian
cancer is very hard to detect at an
early stage. It is also often resistant
to the best medical treatments.
Other doctors disagree because this cancer is not common.
Also, removing ovaries does not always protect a woman from
ovarian cancer. A woman without ovaries can still get ovarian
cancer. This is because the cells that cause ovarian cancer
can already be in a woman’s body even after her ovaries are
removed. But, this is rare.
In addition, ovaries make several hormones which keep a woman
healthy. They protect a woman from serious diseases like heart
disease and osteoporosis (ah-stee-oh-poor-oh-sis means when
bones get weak and break easily). They also help a woman enjoy sex.
As women age, their ovaries
slowly make fewer hormones.
When a woman enters
menopause and her periods
stop, the ovaries make much
less estrogen. This means less
protection from heart disease
and osteoporosis. For a while
after menopause, the ovaries
keep producing androgen. This hormone is key to a woman’s desire
for sex. Normally, androgen may also create more facial hair.
Removing ovaries causes menopause to occur more abruptly.
Fallopian tubes
OVARIES
13
Physical and emotional eects of a hysterectomy
Menopause symptoms
may include:
• hot flashes,
• night sweats,
• insomnia,
• fatigue,
• depression, and
• vaginal dryness.
Hormone replacement therapy (HRT) often helps after
menopause or ovary removal. HRT cannot fully take the place
of the ovaries’ hormones. But, it will reduce the risks of heart
disease and osteoporosis. It will also reduce symptoms like
hot flashes and vaginal dryness. HRT may also add to sexual
pleasure. But, some women cannot use HRT. This may include
some women with liver disease. And, it may include women
who have had tumors that depend on hormones, such as
breast cancer.
Sexuality
Everyone reacts dierently. Reactions are both emotional and
physical. We still have a lot to learn about how a hysterectomy
aects sexual function. After this operation, some women say
they enjoy sex more. This is true, especially if they had a lot of
bleeding and pain beforehand. Some women feel more relaxed.
They no longer worry about getting pregnant.
Some women enjoy sex less. There may be many reasons
for this. The reasons are not fully understood. Some women
enjoy sex more when their uterus contracts and they feel
pressure against the cervix (the lower part of the uterus).
Others may enjoy or want sex less, especially after their
ovaries are removed. This is because they have a smaller
14
Physical and emotional eects of a hysterectomy
amount of certain hormones. Loss of hormones can also
cause vaginal dryness and make sex uncomfortable. Hormone
replacement therapy may relieve some of these symptoms.
A vaginal gel or lubricant can reduce vaginal dryness.
Some women enjoy sex less only until they and their partners
adjust. It may be hard to predict how a hysterectomy will
aect your feelings. Sexual feelings vary a lot from one person
to another.
Emotional Eects of a hysterectomy
After a hysterectomy, some women have a strong emotional
reaction, or they feel down. Most feel better after a few weeks.
But, some women feel depressed for a long time. Others
feel relieved.
Not being able to bear children can cause emotional problems
for some women. Some women feel changed or that they have
suered a loss. It often helps to talk things over with your doctor,
partner, a friend or a counselor. Before and after your operation,
it may help to talk with a friend or another woman who has had
a hysterectomy.
It may help to talk with a
friend or another woman who
has had a hysterectomy.
”
15
Options other than surgery
Each option has its own benefits and risks.
Myomectomy is surgery to remove fibroids. The uterus is
not removed.
• General anesthesia is used, like a hysterectomy.
• It is a major operation, like a hysterectomy.
• It is more dicult than a hysterectomy.
• There may be a higher risk of bleeding and infection.
• Tumors may remain or come back. This means you may
need more surgery in the future. Sometimes it means you
may need a hysterectomy.
Laparoscopy:
Your doctor may be able to see and treat your condition
using a slender camera to look inside your abdomen and guide
the surgical tools during the operation. One or more tiny cuts
(incisions) would be made in your abdomen and special tools
would be used to remove the organs. This is called laparoscopy
(lap-uh-row-skah-pee). The operation often takes place on one
day. General anesthesia (ann-eh-stee-shuh) is used. (anesthesia:
drugs given before and during an operation so you won’t feel
the operation)
If you have problems with your uterus, your doctor could
remove it through a cut in your abdomen. This is an abdominal
hysterectomy. Or, your uterus could be removed through your
vagina. To help with the operation, tiny cuts would also be
made in your abdomen. This is called an LAVH. It stands for
laparoscopically-assisted vaginal hysterectomy.
16
Options other than surgery
Women who have their uterus removed through their vagina,
often have less pain than those who have it removed via
their abdomen. They also get out of the hospital faster and
recover faster.
Each drug therapy has side eects. You should review these
with your doctor. Some treatments are more experimental.
Their benefits and risks may not be as well understood. You
need to carefully review with your doctor what is known about
any therapy you choose.
You might be able to
choose a myomectomy
or laser or drug treatments
as your first treatment.
And, you may keep the option of having a hysterectomy later.
Or, you may choose to simply bear your symptoms for a while
before you decide. Bleeding and discomfort from endometriosis
or fibroids may lessen as you enter menopause.
Carefully review with your
doctor what is known about
any therapy you choose.
”
17
Getting a second opinion
If you are considering a hysterectomy, you may wish to get a
second doctor’s opinion. He or she will review your medical
history, examine you and advise you. He or she may or may not
agree with your primary doctor about your treatment. This is a
chance for you to talk about your condition with another expert.
Before any major surgery,
many health insurance plans
require and pay for a second
opinion. You may not know
another doctor to ask for a
second opinion. In this case,
contact your insurance com-
pany or your county medical
society. The society can be
found through an Internet
search. Or, you can look
in your phone book’s
white pages under
“Medical Society of the
County of XYZ.” These sources will give you the names of
doctors in your area. It is best to ask for a doctor who is
board-certified in obstetrics and gynecology.
You make the final decision about which doctor is best suited
to your needs and situation. Think about how comfortable you
are with what the doctor says as well as where the surgery will
take place. Also consider what your health insurance will cover,
and how much you may be billed by the doctors and hospital
involved in your care.
Before you decide to have a hysterectomy, it is important to talk
about your risks and benefits with your doctor. Each doctor you
talk to may have a dierent opinion about when this operation
is needed.
18
Types of hysterectomies
All hysterectomies are major operations that remove at least
the uterus. Some hysterectomies remove other organs, too.
It is important to talk with your doctor about the kind of
hysterectomy you need.
Total hysterectomy
Both ovaries and fallopian tubes are removed, along with the
uterus and cervix (lower part of the uterus). Some people call
this a “complete hysterectomy.”
Vaginal hysterectomy
A hysterectomy can sometimes be done through the vagina
(vaginal hysterectomy). At other times, a cut (incision) in the
lower belly is best. This is called an abdominal hysterectomy.
If you have large fibroid tumors, it will be hard to safely remove
the uterus through the vagina.
When a vaginal hysterectomy can be safely done, it:
• generally involves fewer complications,
• has a shorter recovery period, and
• leaves no visible scar.
Subtotal hysterectomy
In this operation:
• only the upper part of the uterus is removed,
• the cervix (lower part of the uterus) is not removed,
• tubes and ovaries may or may not be removed, and
• it is always done through the abdomen.
Radical hysterectomy
This is done only when a woman has a serious disease such as
cancer. It is always done through the abdomen.
This procedure removes the entire uterus and usually both
tubes and ovaries, and the pelvic lymph nodes (small glands).
Other organs, or parts of other systems, are sometimes also
removed because cancer is hard to predict.
19
Types of hysterectomies
20
While you’re in the hospital
Recovery
Women are prepared for surgery in dierent ways depending on
which hospital is chosen.
Many hospitals do these things before operating:
• Blood and urine samples are taken.
• Sometimes, enemas are given.
• The abdominal and pelvic areas may be shaved.
After the operation, the hospital stay is usually less than a week.
How long you stay depends on the type of hysterectomy. It also
depends on whether or not you have any complications.
A hysterectomy is a big operation. This means you will be
uncomfortable and have pain afterwards. But, there is medicine
that will help you feel more comfortable. By the second or third
day, most patients are up walking. Usually, patients can return
to normal activity in four to eight weeks. Each patient is dierent.
Some patients will recover faster or slower than others.
You can usually have sex in six to eight weeks.
During recovery, you may need to rest often at first. Plan ahead
and ask friends, neighbors, or relatives to help you when you
get home. It will probably take a while to regain your energy.
Most women find that special exercises help them recover faster
and feel better. Talk with your doctor about what will be done
before your surgery and how your recovery will go. Be sure to
discuss which exercises will help you.
21
Questions to ask your doctor
You may want to ask these questions at your next doctor visit.
Write answers in the space provided. Check them o as your
questions are answered.
Why do I need a hysterectomy?
What organ or organs will be removed?
Why?
Will I keep my ovaries?
If not, why?
Will my cervix be removed?
22
Questions to ask your doctor
If so, why?
Do I have to get a hysterectomy?
Are there other choices?
What are the advantages, risks, benefits of each?
What are the physical eects of a hysterectomy?
Are they permanent?
What will happen to my figure, my weight, and my breasts?
How will it aect my sex life?
Will I experience menopause?
Can menopause symptoms be treated?
What are the risks and benefits of treatments?
Will I have a vaginal hysterectomy? Or abdominal?
23
Questions to ask your doctor
Why?
What can I expect in the hospital?
What will be done before the operation?
How long will I stay?
What kind of anesthesia will I have?
What is my risk of infection?
24
Questions to ask your doctor
What will happen if I need a transfusion?
How long will I use a urinary catheter?
(a thin tube put in your body to remove urine)
What kind of care will I need after the operation?
How should I prepare for coming home
from the hospital?
How soon can I go back to work?
25
Questions to ask your doctor
26
Questions to ask your doctor
When can I be physically active?
1421 04/17
Departmen
t
of Health