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What's a hysterectomy and how does it affect your hormones?

6 min read

A hysterectomy is a surgical procedure to remove a person's uterus (also known as the womb). Once you have the procedure, you lose your ability to menstruate or become pregnant.

Hysterectomy is actually a very common gynecological procedure. Understanding the why, how, and what comes next all helps to mitigate some of the uncertainty around the topic.

For example, did you know...

  • There are 3 different types of hysterectomy procedures to remove a person’s uterus. Sometimes surgery includes an oophorectomy (ovary removal) and/or a salpingectomy, (removal of the fallopian tubes)
  • Ovaries produce estrogen, progesterone, and testosterone. If ovaries are removed as during a hysterectomy, that can impact the levels of these reproductive hormones. (Removing the uterus itself won’t impact your hormone levels, because the uterus doesn’t make or store hormones.)
  • The sudden loss of estrogen following ovary removal can trigger symptoms of early menopause like hot flashes, vaginal dryness, trouble sleeping, mood changes, and painful intercourse.
  • Hormone replacement therapy (HRT) — medications designed to replace the estrogen that your body stops making after menopause — can help decrease your risk of certain health conditions after a hysterectomy with ovary removal.

Hysterectomy 101

Nearly 500,000 women get hysterectomies each year in the U.S., making it the second most common surgery among women (cesarean delivery is the first), according to the U.S. Department of Health and Human Services.

Hysterectomies are performed to treat or prevent health conditions, such as:

  • Heavy or unusual vaginal bleeding
  • Fibroids: (Often) noncancerous growths that develop in the wall of the uterus.
  • Endometriosis: An often painful disorder in which tissue similar to the lining of the uterus is present outside of the uterus (usually on the ovaries or fallopian tubes).
  • Uterine prolapse: When the muscles and tissue in your pelvis weaken and your uterus drops into or out of your vagina (this can happen after vaginal deliveries or menopause).
  • Cancer of the uterus, ovaries, cervix, or fallopian tubes

Dr. Jane van Dis, an OB-GYN and Modern Fertility medical advisor, says that women who undergo hysterectomy often do so because they’re experiencing pain, bleeding, pressure, or cramping that’s severe enough to interfere with their quality of life. She explains that following hysterectomies, women often report “significant improvements in urinary symptoms, fatigue, pelvic pain, psychological symptoms, and sexual functioning.”

Are there different types of hysterectomy?

Yup, there are 3 different types of hysterectomies. If you find yourself needing the procedure, you can talk to your healthcare provider about which is right for you.

  • A total hysterectomy removes both the uterus and cervix. It’s the most common type.
  • A supracervical hysterectomy removes the uterus but leaves the cervix intact. This is also known as a “partial” or “subtotal hysterectomy.”
  • As the name suggests, the radical hysterectomy procedure is the most thorough — removing the uterus, cervix, upper part of the vagina, and supporting tissues. This is usually performed to treat gynecological cancers when other treatments haven't been successful.

Sometimes, people will have one or both of their ovaries removed during a hysterectomy; ovary removal is called an oophorectomy.

As for how exactly the procedure is performed, there are various methods depending on your reason for the procedure and your health history.

  • Vaginal hysterectomy: Removing the uterus through the vagina is the first choice for many healthcare professionals because there are generally fewer complications and a shorter recovery time. But it isn't always possible for people who have a very large uterus or have adhesions from previous surgery.
  • Abdominal hysterectomy: Here, the uterus is removed through an incision in the lower abdomen; this is typically made horizontally along your bikini line or through a vertical incision tracing from belly button to bikini line. It's associated with a greater risk of complications (infection, bleeding, blood clots, and nerve and tissue damage) and usually requires a longer hospital stay.
  • Laparoscopic hysterectomy: After a few small incisions in your abdomen, a surgeon will insert a thin metal camera in order to view the pelvic organs and remove the uterus in small pieces. It's a minimally invasive procedure and comes with a quicker recovery period.
  • Robotic surgery: This is similar to a laparoscopic hysterectomy but is performed with the help of a robotic machine controlled by the surgeon.

What happens to your hormones after a hysterectomy?

Hormones are involved in basically everything our bodies do, and they’re constantly changing and evolving to keep up with what’s happening at any given moment. This process is controlled by the endocrine system: the series of glands that create and secrete hormones, releasing them into the bloodstream so they can reach other tissues and organs throughout the body.

Your endocrine system continuously tracks the amount of hormones in your blood to ensure that there's the right balance to keep your body healthy. Afterall, hormones affect pretty much everything — from growth and development to mood and emotions to sexual function and fertility.

For the purpose of this piece, we’re mostly interested in the hormones estrogen and progesterone, which are produced by the ovaries and control menstrual cycles and menopause.

  • Estrogen enables the development and maintenance of things like breast growth, menstruation, and pregnancy.
  • Progesterone plays an important role in the menstrual cycle and helps the uterus maintain early pregnancies.

Okay, good to know — but what does this have to do with a hysterectomy?

If your healthcare team deems it necessary to remove both of your ovaries during the hysterectomy, your body will experience a quick drop in hormones which will lead to something called early menopause. The sudden loss of estrogen can trigger those notorious hot flashes, as well as several other symptoms:

  • Vaginal dryness
  • Trouble sleeping (insomnia)
  • Mood changes
  • Painful intercourse
  • Lost libido

The ovaries also produce hormones that help prevent various health complications such as osteoporosis, heart disease, and aging skin (due to dehydration and loss of collagen). Unfortunately, there's growing evidence to suggest that unnecessary ovary removal may be linked to increased risk for heart disease and stroke and other age-related diseases.

What’s more, results from the Mayo Clinic Cohort Study of Oophorectomy and Aging found that people who have both ovaries removed before natural menopause may be more likely to experience cognitive impairment; however, more research is needed to prove causation.

What other symptoms can you experience after a hysterectomy?

The most obvious symptom of a hysterectomy is actually lack thereof: no more menstrual cycle! For many people, a hysterectomy symbolizes an improved quality of life (no more pain or side effects); however, others might experience grief over the loss of fertility or a disinterest in sex.

Dr. van Dis shares that for women whose menstruation or fibroids were interfering signifcantly with their quality of life, they may experience “great joy” after recovering from a hysterectomy. She elaborates, “They may feel free to have more sex, if sex was painful. They may decide to perform exercise(s) that before caused bladder leakage or pain.” In short, she says, “The majority of women who have hysterectomy experience marked improvement in their quality of life.”

How can you treat symptoms after a hysterectomy?

The hysterectomy procedure is relatively quick (between one and three hours) but recovery requires much more time and depends on the type of the procedure. Abdominal hysterectomy can take six to eight weeks for a full recovery, while vaginal or laparoscopic hysterectomy tends to be shorter.

As we mentioned earlier, hysterectomies that involve ovary removal will cause your body to begin the process of early menopause. If you’ve had one or both ovaries removed, discuss your options about hormone replacement therapy with your healthcare provider.

The most common way to treat symptoms is hormone replacement therapy (HRT); this is a medication that contains female hormones to replace the estrogen that your body stops making after menopause. It can help with those calling cards of menopause, as well as prevent bone loss and fractures.

The bottom line

A hysterectomy is a safe and effective way to help people with ovaries treat endometriosis, uterine prolapse, cancer, or other gynecological conditions that affect their quality of life. However (and this is a *big* however), undergoing the procedure means that you’ll no longer menstruate or be able to get pregnant.

When paired with an ophorectomy (removal of ovaries), a hysterectomy can also lead to early menopause. For this, there’s hormone replacement therapy (HRT) to help ward off hot flashes, vaginal discomfort, and bone loss.

With three types of hysterectomy surgeries and various methods of operating, there's no one-size-fits-all approach, so speak with your healthcare provider to see what might work best for you.

This article was medically reviewed by Dr. Jane van Dis, MD, FACOG. Dr. van Dis is a practicing OB-GYN, Assistant Professor of Obstetrics & Gynecology at the University of Rochester, CEO of Equity Quotient, co-founder of OB Best Practice, and co-founder of TIME'S UP Healthcare.

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Alexandria Bachert

Alex is a freelance health and science writer, public health professional, and new mama based in New Jersey. She enjoys food tours, making lists, and strolls with her mini bernedoodle.

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