The most common reason for a hysterectomy, the removal of the uterus, is to address chronic sources of pain and bleeding that can disrupt daily life — including fibroids, endometriosis, menstrual disorders and pelvic organ prolapse. A rising reason is a patient’s desire to align anatomy with lived gender.
Despite being called “elective” by doctors, the procedure can be life-changing, and in some cases, even lifesaving. But hysterectomies are typically not emergency surgeries — meaning patients have time to ask questions and weigh all their options. To make sure you know exactly what you’re agreeing to, here are five questions to ask your doctor.
Can you go over the reproductive organs and explain which ones you will be removing?
Dr. Karen Tang, who is a gynecological surgeon and the author of the book “It’s Not Hysteria,” about reproductive health, begins her consultations by sketching the reproductive system out on a whiteboard.
Then, she explains which organs she plans to remove and why. When she and a patient go over a surgical consent form, she translates any technical terms into lay language. For instance, “total laparoscopic hysterectomy with bilateral salpingectomy” becomes “removal of the uterus, cervix, and fallopian tubes, leaving the ovaries behind.”
If a visual helps you understand, bring in a diagram yourself and ask your doctor to refer to it. If your consent form does not include plain language, have your doctor define unfamiliar terms or write nonmedical definitions on the form. Your surgeon should be able to explain why each organ is to be removed, and the risks and benefits of each option.
If the words “partial” or “total” come up, ask your doctor to slow down and explain exactly what they mean. In general, surgeons should avoid these terms, because they are used inconsistently, Dr. Tang said.
How will this procedure affect my experience of menopause?
While menopause is often used as shorthand for no longer having a period, it is more accurately defined as the time that ovulation ceases — meaning the ovaries are no longer producing eggs or large spurts of hormones every month.
Therefore, removing the uterus on its own does not bring about menopause. “A lot of times women are so relieved to hear that’s not the case,” Dr. Tang said. But if the ovaries are removed, menopause happens instantly, and it is often more severe if not addressed with hormone therapy.
Still, even if only the uterus is removed, there can be consequences to the menstrual cycle. This is thought to be because the procedure severs a key blood vessel between the uterus and ovaries.
Dr. Tang warns patients that they may get temporary menopauselike symptoms, like hot flashes and night sweats. Research also finds that patients who have only the uterus removed tend to enter menopause a few years earlier than usual, which brings its own risks.
What are the pros and cons of keeping my cervix?
The cervix is not a separate organ from the uterus; it’s the doughnut-like neck that separates the uterus from the vagina. In total hysterectomies, it is removed along with the rest of the uterus to remove the risk of cervical cancer.
For some patients, this is a perk: Without a cervix, you no longer need a regular Pap smear. If you are getting a hysterectomy to address a menstrual disorder, removing the cervix also means getting rid of a potential source of bleeding or “miniperiods.”
But there may be cons. While a hysterectomy generally does not prevent orgasm, it can affect the quality and sensation of it. Uterine contractions are part and parcel of some orgasms, and some women enjoy stimulation of the cervix during sex.
Since the research is inconclusive about whether removing the cervix affects sexual sensation for most women, the bottom line, said Dr. Cheryl Iglesia, a urogynecologist in Washington, D.C., is that those who know their cervix is key to sexual sensation should discuss the procedure with their surgeon.
Many patients actually have improved sex lives after a hysterectomy, because the operation resolves a major cause of pain, bleeding, or both. For transgender or nonbinary patients, the procedure can also help alleviate gender dysphoria, leading to better sex.
What route will you be using, and how will it affect my recovery?
In the past, a hysterectomy was often an open surgery that required cutting through several layers of muscle and fat, like a C-section. The operation left a large horizontal scar, and required months of recovery.
Most hysterectomies today are done using minimally invasive methods, with minor scarring and shorter recovery times. The route you and your doctor choose generally depends on a combination of your anatomy, the surgeon’s skill, the hospital’s resources and the condition the hysterectomy is addressing.
The most common approaches are vaginal hysterectomy (the uterus and cervix are removed through the vagina, leaving no outer scars), laparoscopic hysterectomy (the surgeon uses tiny surgical tools and a camera to remove organs through small incisions) or a combination of the two.
If a doctor is suggesting an open abdominal surgery, you should ask why.
What happens if I do nothing?
When it comes to addressing chronic pain and bleeding, alternatives to hysterectomies have mushroomed.
Besides birth control pills, there are IUDs, hormone-blocking medications, minimally invasive surgeries to scrape or cut away fibroids or lesions, strategies to cut off fibroids’ blood supply and ablation procedures to burn the lining of the uterus.
As a result, a hysterectomy is now considered a last resort rather than a first-line solution. “The default is toward removing less in general,” Dr. Tang said. Talk with your doctor about whether you have tried all possible alternatives before moving to uterine removal.
The post Five Questions to Ask Your Doctor When Weighing a Hysterectomy appeared first on New York Times.
