Hysterectomy has changed. Here’s what women need to know about the surgery and its effects.
A patient saw me recently for a several-year history of very heavy periods and fibroids. Now she had developed anemia despite trying several medications to control her bleeding. We began to discuss surgical options including hysterectomy. She stopped me there and said, “Dr. Curlin, I can’t do that. I don’t want to have hot flashes, my hormones out of balance and no sex drive.” I asked her if she thought a hysterectomy meant removal of her ovaries and the beginning of menopause. She nodded her head and said, “Yes!”
This scenario has occurred multiple times in a similar way in my office over the last two years. I have come to realize that many women believe that having a hysterectomy always includes removal of the ovaries and the onset of menopause with negative side effects they have heard or read about from other women. I think it is important for women to have answers to the following questions so they can make well-informed decisions.
Question: What is a hysterectomy?
Answer: A hysterectomy is the removal of all or part of the uterus. It does not include the removal of the ovaries. A woman’s hormonal function from her ovaries remains the same after hysterectomy.
Q: Why do so many people associate menopause with hysterectomy?
A: For many years, surgeons recommended removal of the ovaries when the uterus was removed, especially for women over age 45. They were trying to decrease the risk of future ovarian cancer. However, in the database of the Nurses’ Health Study, a landmark study, we learned that removal of normal ovaries was a risk to women as they died younger than women who retained their ovaries. This occurred due to health problems associated with early menopause such as heart disease. The younger a woman was when she had her ovaries removed the greater the risk of an earlier death.
Q: Is there anything else that can be done at the time of the hysterectomy to help prevent future ovarian cancer?
A: The American College of Obstetricians and Gynecologists now recommends the routine removal of fallopian tubes (salpingectomy) at the time of the hysterectomy as this may decrease the risk of future ovarian cancer. When the fallopian tubes are removed, normal ovaries can remain in place allowing a woman to keep her usual hormonal function until the natural time her ovaries stop functioning.
Q: What is the age that most women will experience natural menopause or decreased hormone production from their ovaries?
A: The average age in the United States is around 50 to 51 years old.
Q: Does having a hysterectomy mean that I will need a large incision on my abdomen similar to a cesarean section scar?
A: The majority of the time we can avoid a large incision and use a minimally invasive technique instead. This can be done vaginally or laparoscopically. This helps decrease the risk of wound complications and improve the recovery time.
Q: How would you advise women who are suffering from problems that a hysterectomy may solve?
A: If medication options have not worked or someone is unable to try medications due to other medical problems, hysterectomy can often solve the problem (abnormal bleeding, fibroids, endometriosis) once and for all. The hysterectomy can usually be performed using a minimally invasive technique that allows quicker recovery and decreased risk of wound complications. The majority of the time we recommend that the ovaries remain in place.
Make sure you have your questions answered regarding hysterectomy. It may be the right choice for you.
This post was written by Howard L. Curlin, M.D. He is an assistant professor of Obstetrics and Gynecology at Vanderbilt University Medical Center, focusing on fibroids, endometriosis and adenomyosis treatment.
To see a gynecologic specialist to discuss problems you may be having, contact the Vanderbilt Center for Women’s Health at 615-343-5700 to make an appointment.