Hysterectomy - considerations

Hysterectomy

If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to have your cervix or ovaries removed.

These decisions are usually made based on:

• your medical history


• your doctors recommendations


• your personal feelings

Its important that youre aware of the different types of hysterectomy and their implications.

If you have cancer of the cervix, ovarian cancer or womb (uterus) cancer, you may be advised to have your cervix removed to stop the cancer spreading.

Even if you do not have cancer, removing the cervix takes away any risk of developing cervical cancer in the future.

Many women are concerned that removing the cervix will lead to a loss in sexual function, but theres no evidence to support this.

Some women are reluctant to have their cervix removed because they want to retain as much of their reproductive system as possible.

If you feel this way, ask your surgeon whether there are any risks associated with keeping your cervix.

If you have your cervix removed, youll no longer need to have cervical screening tests.

If you do not have your cervix removed, youll need to continue having regular cervical screening.

The National Institute for Health and Care Excellence (NICE) recommends that a womans ovaries should only be removed if theres a significant risk of associated disease, such as ovarian cancer.

If you have a family history of ovarian or breast cancer, removing your ovaries may be recommended to prevent you getting cancer in the future.

Your surgeon can discuss the pros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed.

If you have already gone through the menopause or youre close to it, removing your ovaries may be recommended regardless of the reason for having a hysterectomy.

This is to protect against the possibility of ovarian cancer developing.

Some surgeons feel its best to leave healthy ovaries in place if the risk of ovarian cancer is small – for example, if theres no family history of the condition.

This is because the ovaries produce several female hormones that can help protect against health problems such as weak bones (osteoporosis). They also play a part in feelings of sexual desire and pleasure.

If youd prefer to keep your ovaries, make sure you have made this clear to your surgeon before your operation.

You may still be asked to give consent to treatment for having your ovaries removed if an abnormality is found during the operation.

Think carefully about this and discuss any fears or concerns you have with your surgeon.

If you have a total or radical hysterectomy that removes your ovaries, youll experience the menopause immediately after your operation, regardless of your age. This is known as a surgical menopause.

If a hysterectomy leaves 1 or both of your ovaries intact, theres a chance that youll experience the menopause within 5 years of having the operation.

Although your hormone levels decrease after the menopause, your ovaries continue producing testosterone for up to 20 years.

Testosterone is a hormone that plays an important part in stimulating sexual desire and sexual pleasure.

Your ovaries also continue to produce small amounts of the hormone oestrogen after the menopause.

Its a lack of oestrogen that causes menopausal symptoms such as:

• hot flushes


• depression


• vaginal dryness


• sleep problems (insomnia)


• fatigue


• night sweats

Hormone replacement therapy (HRT) is usually used to help with menopausal symptoms that occur after a hysterectomy.

You may be offered HRT after having your ovaries removed. This replaces some of the hormones your ovaries used to produce and relieves any menopausal symptoms you may have.

Its unlikely that the HRT youre offered will exactly match the hormones your ovaries previously produced.

The amount of hormones a woman produces can vary greatly, and you may need to try different doses and brands of HRT before you find one that feels suitable.

Not everyone is suitable for HRT. For example, its not recommended for women who have had a hormone-dependent type of breast cancer or liver disease.

Its important to let your surgeon know about any such health problems you have had.

If youre able to have HRT and both of your ovaries have been removed, its important to continue with the treatment until you reach the normal age for the menopause (51 is the average age).

Find out more about HRT

If your cervix is removed during a hysterectomy, youll no longer need to have cervical screening.

If your cervix is left in place, youll need to continue to go for regular cervical screening tests.