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Hysterectomy: When do you need one?

A middle-aged white woman with a slight smile and her arms crossed in front of her chest.

May 17, 2021— Many women will have a hysterectomy at some point in their lives. In fact, it's the second-most common surgery for U.S. women. But other, less-invasive treatments may be an option instead. Read on to find out more.

Why hysterectomy?

A hysterectomy is surgery to remove the uterus and possibly the ovaries. According to the American College of Obstetricians and Gynecologists (ACOG), it is often done for these reasons:

  • Fibroids—abnormal growths in the uterus—that are causing symptoms.
  • Endometriosis, a condition in which uterine tissue grows outside the uterus.
  • Abnormal uterine bleeding.
  • Chronic pelvic pain.
  • Cancer or precancer of the uterus, ovary, cervix or endometrium.
  • Uterine prolapse, when the uterus slips down into the vagina.

Some of these disorders can cause pain and other symptoms, such as heavy menstrual bleeding. If a hysterectomy is recommended for you, it may improve your symptoms and it may be the best choice to treat your condition.

Hysterectomy is a major surgery, though. It can take weeks to recover. And changes can also be associated with a hysterectomy. For instance, a woman can't become pregnant after a hysterectomy. If your ovaries also need to be removed during the surgery, it may trigger menopause symptoms, like hot flashes and vaginal dryness. These symptoms can often be managed.

What are the alternatives?

In some cases, there might be other options you can try first instead of a hysterectomy, such as:

Medicines. Medications can help women with endometriosis pain and heavy menstrual bleeding.

Watchful waiting. You might want to postpone a hysterectomy if you have bothersome fibroids and are close to menopause. Fibroids tend to shrink after menopause. You might also want to wait to have the surgery if you want to get pregnant.

Kegel exercises. These can strengthen the pelvic floor muscles and may help with uterine prolapse.

Other surgeries or procedures. Several types of procedures can help treat uterine problems without removing the uterus. For instance:

  • Dilation and curettage removes the lining of the uterus to help stop heavy bleeding.
  • Endometrial ablation uses freezing, heat or microwave energy to destroy the lining of the uterus and treat heavy bleeding.
  • Myomectomy removes fibroids.
  • Myolysis and uterine artery embolization both shrink fibroids.

Not all of these procedures will preserve your ability to get pregnant. But some will. That's one of many factors you may want to discuss with your doctor if you are exploring any of these options. Be sure to discuss all of the pros and cons of these treatments too.

Learn more in our guide to hysterectomy.

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