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From the early onset of menopause to loss of sex drive, there are a lot of horror stories online about the side effects of hysterectomies — but is any of it true?
Despite hysterectomies being the second most common surgery performed on women and people with a uterus (after C-sections), there are many misconceptions and myths about the procedure.
“Social media can help us understand what’s important to patients and what questions they have, and it provides them with digestible information,” says Aparna Ramanathan, MD, MPH, a gynecologist and gynecologic surgeon at UW Medical Center – Roosevelt specializing in minimally invasive procedures. “But in general, social media can increase anxiety and other mental health impacts. It’s important for patients who are getting info from social to also have conversations with their doctor.”
Along with outright myths, the confusion around hysterectomies occurs because the procedure is used to treat multiple conditions. Recovery looks different based on why you are receiving a hysterectomy — and the information from Dr. Google might not apply to you.
To help calm fears, Ramanathan addresses common concerns and debunks myths (yes, including the ones that felt too awkward to ask your OB-GYN about).
What is a hysterectomy?
“A hysterectomy is the surgical removal of the uterus, and in terms of safety, it’s a safe procedure and one of the most commonly performed surgeries in the US, with about 600,000 performed per year,” says Ramanathan.
Some of the most typical reasons for a hysterectomy include abnormal uterine bleeding, chronic pelvic pain, fibroids, endometriosis, pelvic organ prolapse and adenomyosis (abnormal tissue growth on the uterine wall).
A hysterectomy can also be an important part of gender-affirming care for trans men and nonbinary people. It can also treat gynecological cancers, like cervical and uterine cancer.
During a typical hysterectomy, a surgeon removes your uterus in a minimally invasive fashion (via small incisions in the vagina or abdomen). Sometimes larger incisions may be needed with a laparotomy, an incision in your abdomen. As your uterus is removed during the surgery, you are not able to have children after the procedure with your own uterus. It is possible to have children through surrogacy even if you don’t have a uterus.
It is common to remove the cervix and Fallopian tubes during the same procedure. Less often, removal of the ovaries may be needed, or prolapsed pelvic organs may be fixed.
If only small incisions are made during the surgery, you might even be able to go home that same day, after you’ve fully woken up from anesthesia.
If you’re considering the procedure, Ramanathan recommends talking to your doctor about any concerns and building a close relationship with your treatment team. Being informed can also help you feel more comfortable — and that includes knowing what hysterectomy myths to stop believing.
Myth 1: A hysterectomy causes menopause
While a hysterectomy permanently stops you from having a period, in most cases it does not cause menopause.
To understand why, it helps to know which parts of your reproductive system are involved in these processes. Your period occurs when you shed your uterine lining; menopause occurs when your ovaries produce less estrogen.
Because hysterectomies involve the removal of your uterus, you will no longer have a period after surgery. But since a routine hysterectomy does not include the removal of your ovaries, your hormone levels will remain more or less the same and you won’t go into menopause.
While it’s less common, some studies show women who’ve had a hysterectomy may go into menopause a little sooner than those who haven’t. That said, Ramanathan notes these studies have limitations and do not prove that a hysterectomy causes menopause.
It’s different if your ovaries are removed during surgery. If both are removed, you will enter menopause, because your ovaries produce hormones that control your menstrual cycle. If just one ovary is removed, you are less likely to enter menopause much earlier than you would have anyway.
Myth 2: A hysterectomy decreases libido and orgasm
Another common worry about hysterectomies is how it will affect your sex life. While research on whether or not this is true is lacking (ahem, like a lot of research on women’s health), the current understanding among doctors is that in most cases your sex drive is safe.
“In general, hysterectomy does not impact sexual function that much,” Ramanathan says. “It doesn’t impact your ability to lubricate, as the glands responsible for that operate separate from your uterus. However, since some patients orgasm from stimulation of the cervix, it is possible that removing the cervix could impact the quality of your sex life.”
This may not be a problem if your cervix isn’t removed, but if it’s something you’re concerned about, you should definitely ask your doctor about it.
Also, just because sex drive isn’t affected for most people doesn’t mean you should hop into bed post-op; the top of your vagina needs to heal first.
Recovery lasts, on average, eight to 12 weeks, but you’ll want to talk to your doctor about when it is safe to start having sex again. Once you’ve allowed your body time to heal, you’re in the clear.
Myth 3: A hysterectomy causes incontinence (urine leakage)
Like sexual function, Ramanathan says there just isn’t good data to support that hysterectomies cause incontinence.
“Your uterus and bladder are really close together in your body, so sometimes people might notice a weakening of their pelvic floor muscles when their uterus is removed, not because of the surgery itself, but because they already had muscle weakening that was masked by their uterus providing pressure against their bladder,” says Ramanathan.
If you are experiencing leakage immediately after the procedure though, you should reach out to your doctor, as this can be a sign of a complication from surgery called a fistula.
More often, any leakage is caused by other factors apart from having a hysterectomy.
Basically, hysterectomies don’t cause incontinence, but a lot of other things (including menopause) can. So, if you find yourself leaking urine, know you aren’t alone and that there are effective treatments to help.
Myth 4: Hysterectomies cause weight gain
Having a hysterectomy doesn’t cause people to gain weight; however, some people do gain weight during the recovery period because they aren’t moving as much as they would otherwise, Ramanathan says.
First things first: It’s OK if you gain a bit of weight during recovery. It’s important to let yourself rest and heal during this time.
If you’re concerned about weight gain, you can talk to your doctor about ways to incorporate movement into your routine while you recover from surgery.
Additionally, you may notice weight changes depending on whether your ovaries are removed or not.
“The evidence is mixed regarding whether a decline in hormone levels increases weight gain when the ovaries are removed, but even in patients who did gain weight, the average amount gained was small,” says Ramanathan. “But if someone is preserving their ovaries, then their risk of weight gain is going to be much lower.”
Myth 5: Hysterectomies make you age faster
A hysterectomy won’t affect how you physically age, but it can be emotionally challenging for some people to have their uterus, cervix or ovaries removed. No longer having a period can affect how some folks feel about their age and identity, as can hormonal changes if your ovaries are removed.
“Historically, the psychological impact of having a hysterectomy has not been given the attention it deserves,” says Ramanathan. “I recognize that we as a medical profession have much more work to do learning about the total impacts of hysterectomy.”
Talk with your doctor and surgeon if you have concerns about having a hysterectomy. Feelings of loss or sadness are normal. Your care team will work with you to find the best solution for your physical and mental health. This includes finding ways to preserve fertility prior to surgery if that’s important to you.
If you have strong feelings about keeping your uterus, talk to your surgeon about options for uterine preservation — meaning treatment options other than a hysterectomy. This may not always be available, but it’s worth bringing up with your doctor.
Having a hysterectomy is a personal health decision. It’s a safe and effective way to treat several conditions — and it’s also something you should feel empowered to decide for yourself without myths and misconceptions getting in the way.
This article was originally published on April 6, 2022. It has been reviewed and updated with new info. McKenna Princing contributed to this article.
