Sonograms, CT scans, biopsies … some women are sent for tests involving their female organs so often that they start to wonder if they should just get a hysterectomy even though they don’t need one. While only you and your doctor can determine what’s best in your case, it’s vital to understand what a hysterectomy is — and isn’t (you might be surprised) — before making a big decision.
What Is a Hysterectomy?
Before deciding how to proceed, it’s best to demystify what a hysterectomy really involves.
Essentially a standard hysterectomy is a surgical procedure to take out one organ. That’s it.
- A hysterectomy involves removal of the uterus. It doesn’t remove the ovaries. It doesn’t always involve removal of the cervix. It doesn't address pelvic floor defects.
- A uterus is simply a sac that’s there to carry a fetus.
- A hysterectomy does not lead to menopause, although it will end the chance to get pregnant.
- Removing the uterus does not affect your hormones, although some patients experience menopausal symptoms for a short time because the blood flow is diverted.
Doctors often remove the uterus to help with issues such as chronic pain, irregular bleeding, challenges involving the uterine lining or for access to the pelvic floor to enable reconstruction.
Removing the ovaries is another procedure. That’s called an oophorectomy, and it is performed for women with ovarian cysts that cause pain, or who have or are at high risk for ovarian cancer, including those who have certain genetic syndromes.
Since ovaries allow us to have estrogen, progesterone and testosterone, removing the ovaries will cause menopause to start in women who haven’t already been through it. That’s why the ovaries are often left intact even for women in their early 70s; they continue to provide baseline testosterone for many years post-menopause, and that’s important for bone, heart and skin health. The medical community continues to research what the ovaries do for us later in life.
These are the stages of hysterectomy-related surgeries. A variety of techniques, some minimally invasive, can be used for each option.
- Suprecervical hysterectomy —Removing the uterus, and nothing more.
- Total hysterectomy — The uterus and cervix are removed.
- Hysterectomy with oophorectomy — The uterus, ovaries and maybe fallopian tubes are removed
- Radical hysterectomy — In critical cases, the uterus, cervix, ovaries, top of the vagina and possibly pelvic lymph nodes are removed.
What if You’re at High Risk for Cancer?
In some cases, women are sent for testing of the female organs beyond the standard pap smear. That often takes the form of a transvaginal sonogram, which used to diagnose endometrial cancer. It’s most common in women who have had cancer of the breast, uterine lining or ovaries — or whose family members have been diagnosed with one or more of these.
If you are at high risk for a female cancer because of a personal or family history, it’s best to consult with a genetic counselor and a gynecologist-oncologist to parse out what your risk is and figure out how to proceed.
There is no good screening tool to find ovarian cancer at an early stage, but gynecologist-oncologists have the most cutting-edge information and knowledge about what to do when there is a family history of any female-specific cancers.
But hysterectomies are about the uterus. Many women with no family history are found to have fibroids growing in their uteruses. Fibroids are just muscular growths of the uterus. About 99 percent of fibroids are not malignant, so there is no need to do a biopsy to rule out cancer unless your “stripe,” referring to the thickness of the uterine’s lining (the endometrium), is 4 millimeters thick or more.
Fibroids might be removed if they cause pain, heavy bleeding, or bladder or rectal issues. Doctors will look at the size and location before deciding whether to remove the fibroid with a procedure called a myomectomy, which can be done as an outpatient. Discuss the pros and cons with your doctor. Removing a fibroid can lead to more bleeding, and it can create a crater in the uterus that needs to be sutured.
Most uterine biopsies are actually endometrial biopsies of the thin lining of the uterus, called the endometrium. An ultrasound can be used to measure the thickness of the lining and uterine the and the size of a fibroid. Sometimes other procedures are used instead, such as these:
- D&C (dilation and curettage), which removes uterine tissue
- Hysteroscopy, a procedure to see inside the uterus and cervix using a thin illuminated tube.
What You Need To Know
It’s crucial to understand that a standard hysterectomy involves removing the uterus alone, not necessarily any other organs, and does not trigger menopause.
Women who question whether to request a hysterectomy for reasons unrelated to the uterus need deeper information to make a good decision. Issues with the cervix, ovaries or fallopian tubes will not be helped or harmed by having your uterus removed.
Research all you can before meeting with your doctor. Then have a candid conversation about your concerns and the solutions you’re considering. Arrive with a short, specific list of top-priority questions. Spell out what your goals are, and ask about the options for best achieving those goals.
The medical community today has so many methods to treat various female disorders that you may well not need a hysterectomy. Many minimally invasive options are available to bring you to optimum help.
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