Hysterectomy side effects: what removing your uterus can change

A hysterectomy cannot be undone

Many women in their 30s and 40s are told to remove the uterus for fibroids, adenomyosis or heavy bleeding, even for fibroids that could be treated without any operation. Before you agree, know what you are giving up.

Hysterectomy means removing the uterus. Sometimes the cervix, tubes or ovaries are removed too. It ends periods and any chance of pregnancy, permanently. It is still one of the most common operations offered to women for fibroids, adenomyosis and heavy bleeding, conditions that are not cancer.

For some women it is the right choice, and many are happy afterwards. But the uterus is not just a place where babies grow. The operation can change how the body ages, and those changes are rarely explained in the clinic. This page explains them in plain words, so you can decide knowing the full picture.

The operation itself

Hysterectomy is major surgery under general or spinal anaesthesia. Like any operation, it can cause bleeding, infection, injury to the bladder or bowel, and blood clots in the legs or lungs. Recovery usually takes several weeks, with no heavy lifting and time off work.

With uterine fibroid embolization, most women go home the next day or sooner, against about 5 days in hospital after surgery, and they get back to work faster ^[11].

Menopause can come earlier, even if your ovaries are kept

Many women are told that if the ovaries are left in, nothing changes. That is not quite true. The uterus and ovaries share some of their blood supply, and removing the uterus can make the ovaries slow down early.

Within 5 years of hysterectomy, about 1 in 5 women had already reached menopause. Without the operation, it was about 1 in 14 ^[1]. Early menopause means hot flushes, weaker bones and a higher heart risk, years sooner.

If the ovaries are removed too, menopause starts the day of the operation. In Indian hospitals, ovaries are often removed even when there is nothing wrong with them ^[8]. If you are told your ovaries will be removed, ask why.

Heart, blood pressure and weight

Women who have a hysterectomy, especially before 50, are more likely to develop heart disease, high blood pressure, high cholesterol and weight gain later in life. This has been seen again and again in large studies ^{[2, 3, 4]}.

The younger you are at the operation, the bigger the risk. Women who had a hysterectomy at 35 or younger had more than double the risk of heart disease ^[2]. Stroke risk was also higher, even when the ovaries were left in ^[4].

In women with fibroids, removing only the fibroids and keeping the uterus was not linked to more heart disease. Removing the uterus was ^[5].

Bones, joints, muscles and ageing

Hysterectomy can affect your whole body, not just the pelvis.

Weaker bones. In the years after hysterectomy, women were more likely to develop osteoporosis, where bones become thin and weak. The risk was higher, and lasted longer, when the ovaries were removed too ^[16].

Joint pain and arthritis. Even with the ovaries kept, women who had a hysterectomy were more likely to develop arthritis, rheumatoid arthritis and carpal tunnel syndrome, which causes numb, tingling and painful hands ^[17].

Muscle loss and weakness. Hysterectomy was linked to a higher risk of sarcopenia, the loss of muscle and strength that makes everyday work harder as you age. The risk was about double when the ovaries were removed too ^[18].

Faster ageing. In tests that measure how old the body really is, women who had a hysterectomy showed signs of ageing faster than their years ^[19].

Bladder leakage and the pelvic floor

The uterus helps support the bladder and the floor of the pelvis. After a hysterectomy, women were more than twice as likely to need another operation later for leaking urine, the kind that happens when you cough, sneeze or lift something. This was true however the hysterectomy was done ^[6].

Sex can get worse after hysterectomy

Removing the uterus can make your sex life worse. Many women are not told this before the operation.

When the cervix is removed along with the uterus, the vagina becomes about a third shorter, and women reported that sex got worse. Nerves and sensitive tissue at the top of the vagina can be damaged ^[13].

If the ovaries are removed too, the level of testosterone, the hormone that drives sexual desire, falls ^[14]. And because menopause can come early, dryness, painful sex and low desire can start sooner.

Whatever you may hear, the operation does not make sex better ^[12].

Mood and mental health

Women who have a hysterectomy are more likely to develop depression and anxiety in the years afterwards, even when the ovaries are kept. The younger the woman at the operation, the higher the risk of depression ^[7].

Thyroid problems

Women who had a hysterectomy in their 40s and 50s were more likely to develop thyroid lumps (nodules), a swollen thyroid (goitre) and thyroid cancer in the years afterwards, whether or not the ovaries were removed ^[20].

Hysterectomy in India: often too young, often without enough explanation

In India, hysterectomy is often done on women who are still having periods, and about 1 in 4 are under 40. The most common reasons are fibroids and heavy bleeding, conditions that can usually be treated without removing the uterus. Doctors reviewing these operations have called for more women to be offered treatments that keep the uterus ^[8].

Women who had a hysterectomy before 35 often said nobody had explained the other options to them, and many regretted the decision ^[9].

What these studies can and cannot tell you

Not every woman who has a hysterectomy will have these problems. But the risks are real enough that you deserve to know them before you agree, especially if you are young ^[10].

Keep your uterus: embolization first

Interventional radiology treats the most common reasons women are offered a hysterectomy without removing anything. A thin tube is passed through a pinhole in the wrist or groin, and the problem is treated from inside the blood vessels, guided by live imaging:

• Fibroids: uterine fibroid embolization cuts off the blood supply to all the fibroids at once, so they shrink. No cut, no stitches, and the uterus stays.
• Adenomyosis and bulky uterus: uterine artery embolization treats the whole affected wall, with a Mirena added later if symptoms return. About 3 in 4 women get clearly better, with less bleeding, pain and swelling ^[15].
• Pelvic pain from swollen pelvic veins: ovarian vein embolization closes the faulty veins.
• Heavy bleeding while the cause is found: a Mirena coil or medicines, on a doctor's advice.
• Surgery that keeps the uterus also exists: myomectomy cuts the fibroids out. It is still an operation, with an incision and a longer recovery.

Why see an interventional radiologist before you decide

Most women offered a hysterectomy have only been seen by a surgeon. An interventional radiologist looks at the same scans and asks a different question: can this be treated without removing the uterus? With embolization:

• Your uterus, and with it your body's normal hormone balance, stays in place
• There is no abdominal cut, only a pinhole that needs no stitches
• It is done under local anaesthesia and sedation, not general anaesthesia
• Most women go home the same day at Clinic Seven, against about 5 days in hospital after surgery in the REST trial ^[11]
• Most women are back to normal life in about a week, instead of several weeks
• No hormone tablets are needed to keep the problem under control

When hysterectomy is still the right answer

Hysterectomy is the right operation for some women: for cancer or suspected cancer, for some types of prolapse, or when uterus-sparing treatments have already failed. We will tell you plainly if it is the best route for you. What matters is that it is your informed choice, not the only option you were shown. Our guide on alternatives to hysterectomy compares the options side by side.

Questions to ask before you agree to a hysterectomy

Take these to your appointment:

• What exactly is the diagnosis, and has it been confirmed on an MRI?
• Which treatments that keep the uterus are possible for me, and why are they not suitable?
• Do my ovaries need to be removed? If so, why?
• Will it be open surgery or keyhole surgery, and how long is recovery?
• How will this affect menopause, my bladder and my heart in the long run?
• Can I get a second opinion from an interventional radiologist before I decide?

Get a second opinion before you consent

If you have been advised a hysterectomy for fibroids, adenomyosis or heavy bleeding, a second opinion costs little and can save your uterus. Dr. Nagateja Bonala reviews scans and reports at Clinic Seven, Kukatpally, Hyderabad. You can also send your reports for a second opinion on WhatsApp before you visit.