Should you have a hysterectomy?

Some surgeries save lives. For most women, however, seeking a hysterectomy isn’t about extending their life — but reclaiming it.

One of the most common surgeries in women, hysterectomy is performed about 600,000 times each year in the United States. Roughly one in three American women will have the surgery by age 60.

The procedure removes the uterus (and often the cervix as well). Depending on why it’s done, a hysterectomy can also involve removing the fallopian tubes and ovaries.

The reasons women proceed with a hysterectomy are many and nuanced, but the tipping point is often the degree to which symptoms interfere with everyday life — work, sleep, exercise, relationships, or just feeling like yourself, says Dr. Louise King, a surgeon in the Division of Minimally Invasive Gynecologic Surgery at Harvard-affiliated Brigham and Women’s Hospital.

“When I meet patients opting for a hysterectomy, basically their entire life is being dominated by this one organ — they’re bleeding all the time, in the bathroom every half-hour, or in chronic pain,” Dr. King says. “They will describe it post-surgically as life-saving, even though technically it’s not. But they feel they get their life back, so in that sense it’s incredibly important.”

Why people consider a hysterectomy

The lengthy list of conditions making hysterectomy a reasonable treatment option include

• abnormal uterine bleeding
• chronic pelvic pain
• fibroids (noncancerous growths in the uterus)
• endometriosis (growth of endometrial tissue outside the uterus)
• uterine prolapse (movement of the uterus downward into the vagina)
• adenomyosis (growth of endometrial tissue into the muscular wall of the uterus)
• gender dysphoria
• desire for permanent sterilization
• gynecologic cancers or precancers.

What do most of these issues have in common? They cause heavy or prolonged bleeding, severe pelvic pressure or pain, frequent urination, and other symptoms affecting daily comfort. “Most of the women who see me have been coping with these problems for between four and 10 years,” Dr. King says.

Alternatives to hysterectomy

Even with persistent symptoms, though, hysterectomy isn’t always the answer. Many women can first consider hysterectomy alternatives that aim to ease symptoms, options such as

• medications
• birth control pills
• hormonal intrauterine devices (IUDs)
• uterine artery embolization (for fibroids)
• fibroid-removal surgery
• endometrial ablation, destruction of the uterine lining to ease or eliminate heavy bleeding
• pelvic floor physical therapy (for some prolapse symptoms).

Some of these approaches address excessive bleeding, while others tackle “bulk” — a feeling of pressure in the pelvis, Dr. King explains. Many health insurers require trying hysterectomy alternatives before approving the surgery, she notes.

But it’s not always easy to decide when trying less-invasive options makes sense. “There’s no real line,” Dr. King says. “It’s very much a decision-making process that should be completely individualized to each patient.”

Risks, side effects, and recovery

Hysterectomy recovery usually takes two to six weeks but depends largely on the technique used to perform the surgery. The most common approach is laparoscopic hysterectomy, a procedure involving several small incisions that can minimize pain and bleeding. Open surgery is the second most common, requiring a larger incision in the abdomen and generally involving a longer recovery of up to eight weeks. Vaginal hysterectomy — the least common approach — creates no visible scar and enables a quicker recovery.

As with any surgery, hysterectomy poses risks such as infection or bleeding. Younger women may also face an increased risk of pelvic floor prolapse later in life, Dr. King says, while other women experience more constipation over the long term.

On the plus side, many women say they enjoy sex more after their hysterectomy, especially if they experienced severe pelvic pain beforehand. “Almost every single person I’ve done a hysterectomy on over the past 17 years has felt less pain and better sexual satisfaction,” she says.

Questions to ask your doctor before deciding Before deciding whether to undergo a hysterectomy, Dr. Louise King, a surgeon in the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital, recommends that women ask their doctor these questions: What are all of my options, and what are the risks and benefits of each for me? What type of hysterectomy might be recommended for me and why? What happens if I wait? Additionally, Dr. King urges women to inquire about a surgeon’s expertise, including how long they’ve been practicing, if they perform a large  number of hysterectomies, their complication rates, and what type of specialized training they’ve had. “It’s important to do that kind of quality check,” she says.

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