After menopause, it’s common to wonder whether the uterus, ovaries or other reproductive organs can cause health problems – and whether removing them might ease concerns.
In some cases, a hysterectomy can relieve certain symptoms or lower cancer risk. But for many healthy people, the surgery isn’t necessary.
Talking with your doctor can help you weigh the benefits, risks and alternatives based on your individual health history and what matters most to you.
What is a hysterectomy?
A hysterectomy is a surgery that removes the uterus and, sometimes, the cervix. It can also involve removal of the ovaries and fallopian tubes.
If you plan to have a hysterectomy, it’s important to understand the scope of what’s being removed and how it could affect your health.
Hysterectomies can be performed through the abdomen, laparoscopically (using small incisions and a scope), robotically or vaginally.
How the uterus and ovaries change after menopause
- The lining thins and may cause minor bleeding.
- Fibroids and other growths may shrink.
- Endometriosis pain and complications improve.
- The ovaries become less active and stop releasing eggs.
- Ovarian cysts usually resolve.
Some postmenopausal bleeding is normal in most cases, but it can also signal a serious condition, such as cancer or an abnormal growth called an endometrial hyperplasia. Always visit your doctor if you notice bleeding.
Why you might consider a hysterectomy after menopause
Having a hysterectomy can help decrease pain, bleeding or incontinence and may indirectly improve sleep, mental health or sexual health.
The procedure also can reduce the likelihood of cancer in patients with certain risk factors; however, surgery isn’t typically recommended solely for prevention in a healthy person.
People might choose a hysterectomy if they have:
- Persistent or concerning bleeding.
- Painful conditions, such as endometriosis or adenomyosis.
- Fibroids, polyps, cysts or other benign growths that cause symptoms.
- Abnormal formations, such as a septum/wall or double uterus.
- Pelvic organ prolapse or related bladder/bowel symptoms.
- A mass on the uterus or ovaries that is concerning for cancer.
- Concerning genetic or family history – such as a breast cancer gene (BRCA) mutation, which increases risk for ovarian cancer, or a history of Lynch syndrome, which increases risk for uterine and ovarian cancer.
- A desire to remove the uterus as gender-affirming care.
Downsides and risks of having a hysterectomy
Before having a hysterectomy, consider:
- Hysterectomy is major surgery with needed recovery time.
- Keeping ovaries until age 61 may provide some health benefits, including a reduced risk of bone conditions, heart disease and dementia.
- While pelvic organ prolapse can improve with hysterectomy, in rare instances some people may develop prolapse years later, potentially causing bladder or bowel issues or affecting sexual health.
How hysterectomy affects hormones and overall health
The need for hormone therapy will depend on someone’s symptoms, menopause status and whether ovaries are removed.
Because the uterus doesn’t release hormones, removing the uterus alone won’t have an impact.
For people who haven’t been through menopause, removing both ovaries can trigger this phase.
Removing ovaries before menopause or before age 61 also may increase risks related to bone, heart, bladder or sexual health, as well as colon cancer, stroke and dementia.
If you’re considering a hysterectomy
Ask your doctor:
- Which cancer risks apply to you.
- What organs are being removed and what recovery will look like.
- How the surgery may affect your mental, physical and sexual health, including bladder and bowel health.
Staying healthy with or without a hysterectomy
Stay healthy throughout menopause by:
- Exercising.
- Eating a nutritious diet.
- Maintaining a weight that’s healthy for you.
- Practicing stress-reduction techniques.
- Always maintaining recommended gynecological visits and screenings.
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