Hysterectomy - Things to consider before having a 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 doctor's recommendations and your personal feelings. It is important that you are aware of the different types of hysterectomy and their implications.

Removal of the cervix (total or radical hysterectomy)

If you have cancer of the cervix (the neck of the womb), ovaries or womb, you may be advised to have your cervix removed to prevent the cancer spreading.

Even if you do not have cancer, removing the cervix means that there is no 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 there is 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, you will no longer need to have cervical screening tests. If you do not have your cervix removed, you will need to continue having regular screening for cervical cancer (cervical smears).

Removal of the ovaries (salpingo-oophorectomy)

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

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

Your surgeon will be able to 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 you are 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 that it is best to leave healthy ovaries in place if the risk of ovarian cancer is small – for example, if there is no family history of the condition.

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

If you would 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 (permission) for your ovaries to be removed if an abnormality is found during the operation.

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

Surgical menopause

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

If a hysterectomy leaves one or both of your ovaries intact, there is a chance that you will experience the menopause within five 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. It is a lack of oestrogen that causes menopausal symptoms such as hot flushes, depression, vaginal dryness, insomnia (sleep problems), fatigue and night sweats.

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

Hormone replacement therapy (HRT)

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

It is unlikely that the HRT you are offered will exactly match the hormones that 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, it is not recommended for women who have had a hormone-dependent type of breast cancer or liver disease. It's important to let your surgeon know about any such conditions that you've had.

If you are able to have HRT and both of your ovaries have been removed, it's important that you continue with the treatment until you reach the normal age for the menopause (52 is the average age).

Read more about hormone replacement therapy.