A hysterectomy is a major procedure — and sometimes even a lifesaving one — but despite the frequency in which hysterectomies are performed in the United States, many myths abound.
A hysterectomy, the surgical removal of the uterus, may help women with various health issues. About 600,000 U.S. women get hysterectomies each year, according to the Cleveland Clinic.
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Before undergoing one, obstetricians and gynecologists advise people to have open conversations with their doctors about their various options, noting there is still public confusion over what the procedure is and how it affects people's lives.
There can be a gap in understanding the different types of hysterectomies, said Dr. Monique Farrow, director of Penn Medicine's Penn Center for Integrated Fibroid Care. Many people mistakenly believe a partial hysterectomy is the removal of the uterus, and a total hysterectomy includes removing the ovaries. Medically speaking, there is no partial hysterectomy, and a total hysterectomy is the removal of the uterus and cervix.
"It has become challenging with nomenclature when talking to patients," Farrow said.
For women at high risk of cancer, doctors also may recommend the removal of the fallopian tubes and ovaries, but these are separate surgical procedures.
New data suggests the end portion of the fallopian tubes could be a site of cancer, said Dr. Crystal Brogan, an obstetrician-gynecologist at Main Line Health.
Conditions that may require a hysterectomy
Reasons for a hysterectomy include:
• Abnormal vaginal bleeding and menstrual pain
• Uterine prolapse – when the uterus slips out of place and falls into the vagina
• Fibroids – noncancerous growths
• Cervical, ovarian or uterine cancer
• Conditions involving the lining of the uterus, including hyperplasia – when the lining of the uterus is too thick — and adenomyosis – when tissue grows into the uterine wall, causing the uterus to double or triple in size.
• Severe pelvic inflammatory disease
• Serious complications from childbirth
• Part of gender-affirming care
Types of hysterectomies, risk factors and recovery timelines
A total hysterectomy is the removal of the uterus and cervix, but it does not involve the removal of the ovaries. Therefore, it will not send women immediately into menopause — a common myth.
A supracervical hysterectomy is the removal of the upper part of the uterus, but it leaves the cervix in place. Sometimes, doctors recommend also having a salpingectomy — removal of the fallopian tubes — and an oophorectomy — removal of the ovaries — at the same time. Since the cervix remains, women still need to get regular pap smears to screen for cancer, Brogan said.
A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes and ovaries. Due to the loss of the ovaries, menopause begins immediately.
A radical hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and some surrounding tissue and lymph nodes. This procedure is usually recommended for people with cancer. Sometimes it is recommended for people at high risk of certain types of cancer.
Depending on the reason for a hysterectomy, health care providers first may suggest an alternative treatment. That may include taking birth control pills and other medications to manage painful periods or abnormal bleeding, or having surgery to remove the lining of the uterus.
Doctors also may recommend a procedure to shrink or remove uterine fibroids or, in the case of uterine prolapse, suggest exercises that strengthen the muscles of the uterus or the use of a pessary to support the uterus.
"There are a variety of procedures for fibroids, not just hysterectomies," Brogan said. "A myomectomy is a procedure where the fibroids are removed, but the uterus remains intact and there are newer techniques like uterine artery embolization and radiofrequency ablation, which shrink fibroids by either cutting off their blood flow or applying heat."
There also are different surgical approaches that doctors can take during hysterectomies. Typically, the uterus is removed through the vagina or the abdomen, depending on the size of the uterus and other factors. The surgery also can be performed with the help of a laparoscope – a thin tube with a video camera that is inserted into the lower abdomen — or a robotic arm controlled by the surgeon, said Dr. Anna Zelivianskaia, an obstetrician-gynecologist at Temple Health.
"A vaginal technique can't be used when uterus is too big," she said. "It is about the size of large grapefruit, but with the presence of fibroids or pathologies, it could grow above the belly button. We are trying to limit abdominal surgery."
Another newer technique is vNOTES, which combines the benefits of the laparoscopic and vaginal approaches, Brogan added.
As with any surgery, there are risk factors with a hysterectomy. One is the falling down of the bladder.
"It is related to risk factors like obesity, prior pregnancy, or birth, increasing age. Many women have these risk factors, so (it's) difficult to parse out," Farrow said.
Recovery from a hysterectomy usually takes four to six weeks, depending on the type of surgery.
Zelivianskaia said there is a more extensive recovery with abdomen surgery. When a minimally invasive approach is used, patients may be able to go home on the same day. One-third of patients don't need opioids prescribed. Everybody's pain journey is different, she said.
Common myths about hysterectomies debunked
Here are some of the myths and concerns that obstetrician-gynecologists hear from their patients about hysterectomies.
1. A hysterectomy automatically prompts menopause.
The biggest question Brogan gets asked is whether a hysterectomy will cause menopause. The answer? Only if the ovaries are taken out, which is a separate procedure that sometimes happens at the same time.
"It is important to understand that a hysterectomy doesn't automatically mean menopause, and it is important to talk to your doctor about the best option for you," Brogan said. "Be open and talk through why one route might be better than other."
The removal of the uterus means women can not get pregnant and no longer will get their menstrual periods, which are caused by the shedding of the lining of the uterus. But if the ovaries are still intact, they will still have monthly cycles and experience premenstrual symptoms, because the ovaries are still producing hormones and releasing eggs during ovulation.
Zelivianskaia said some patients don't want a total hysterectomy, because they fear going into early menopause, but a total hysterectomy is just the removal of the uterus and cervix.
2. A hysterectomy will affect your sex life.
Patients often ask about the impact a hysterectomy will have on their sex lives, experts said.
"There are many places on a woman's body that can stimulate an orgasm," Brogan said. "Sex may feel a little different because of anatomy, but you can still achieve orgasm."
Added Farrow: "It is the taking out of the ovaries that affects hormones and leads to menopausal symptoms like vaginal dryness and decreased sex drive. The experience of sex may be different, but if you had been in pain prior to surgery, it might actually be better."
What if the cervix is also removed? Zelivianskaia said studies show it won't affect the ability to orgasm.
3. A hysterectomy can cure endometriosis.
A hysterectomy may help reduce the symptoms of endometriosis – when tissue that normally lines the uterus grows outside of it. But it is not a cure, and there is a specific s
urgery to remove the implants caused by endometriosis.
Endometriosis can cause extreme pain, irregular periods and lead to infertility. The first line of treatment is usually hormone therapy, or a medical procedure to remove the tissue.
"Endometriosis is a complex disease which can spread to ovaries, bowels, anywhere," Zelivianskaia said. "A hysterectomy in and of itself won't cure it. Surgical management should be led by surgeons advanced (and) trained in treating endometriosis."
4. Many women regret having hysterectomies.
"It doesn't happen a lot, but there can be some procedural regret for some patients," Farrow said. "Generally, procedural regret is low except for patients under 30."
For many benign, noncancerous gynecological conditions, there are lots of alternative treatments, Farrow added. She said she encourages patients to seek a second opinion if they are told they need hysterectomies. Patients who have hysterectomies tend to be happy with the results, because they had tried other treatments that failed or had side effects.
"As a doctor, I have to be sensitive to my patients," Zelivianskaia said. "Some struggle with (the) decision and it is perfectly understandable. My role is to guide you in making best decision for your health, but ultimately the woman is in charge."