12 Reasons Not to Have a Hysterectomy

(updated June 9, 2022)

When the nurse practitioner gave me my diagnosis of adenomyosis (over the phone), in the same breath, she told me I would probably have to have a hysterectomy. My story is not new. Thousands of women in our Facebook Group have been told the same thing. This is because conventional medicine has, so far, not figured out how to cure adenomyosis, so their only solution is to remove the organ where the debilitating symptoms occur. A friend of mine with a perfectly healthy uterus was even told to get a hysterectomy simply because there was a history of uterine cancer in her family! The rush to push this irreversible, often unnecessary surgery, is astounding, especially when there are so many reasons not to have a hysterectomy.

I totally get the desire to end your prolonged suffering with endo and/or adeno, but hysterectomy is not the way to do it. Because endometriosis and adenomyosis should be considered the same disease, nothing has actually been cured—endo can still show up in the body outside the uterus, even after hysterectomy.¹ So it makes even less sense that hysterectomy is often prescribed for endometriosis, too. Still, many doctors try to coax their patients into it, telling you the procedure is safe, and stating as evidence that it’s the second most common surgical procedure in women. Indeed it is safe—you won’t die from it. But that doesn’t mean it has no long-term effects. Unfortunately, most doctors won’t discuss those with you.

In fact, “hysterectomy has been associated with a high rate of short- and long-term complications,”² and one study showed that within a year, nearly half of hysterectomy patients experienced at least one complication, including menopausal symptoms, bleeding, kidney disease, urinary tract and other infections, the splitting open of the vaginal cuff, “venous thromboembolism … nerve injury, repair to ureter, repair to bowel, or other complications (accidental cuts, puncture, perforations, or hemorrhage during medical care and surgical procedures).”³ And because the cardinal ligaments are severed during surgery, as well as those that are attached to the bladder and around the vagina, leading to “insufficient suspension of the vaginal apex,” hysterectomy can cause “several long-term effects on pelvic organ” or pelvic floor function⁴ (Reasons 9–12).

Some of these “complications” (such a euphemism, right?), may be the after-effects of having a major organ removed. But don’t forget, your surgeon is only human, and apt to make mistakes, too. Take it from this 1977 paper, “the surgeon who has never committed an error has never done an appreciable amount of surgery.”⁵ The authors actually open their paper with:

“Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening.”

Caveat emptor. (Or in this case, patient, beware.)

By the way, these new-fangled robots now often used to assist in surgeries, may not be of any help in reducing surgical errors.⁶

Here are twelve common side effects of hysterectomy for you to consider, so you can make an informed choice before considering whether or not this irreversible surgery is right for you.

1. You won’t be able to have children of your own

This goes without saying. But for some young women it’s still something that needs to be seriously considered. Some women in our Facebook Group have been told by doctors and even family, that they can always just get a surrogate mother. Or adopt. Not that either of those two choices are bad choices. But it is natural, in fact biologically innate, to dream of having a baby of your own, one day. No one should be trying to convince you otherwise. If that’s what you want, then say no to hysterectomy, and find natural ways to reverse your adenomyosis and/or endometriosis.

On the other hand, even if you already have children—like I had, when I was diagnosed—you still have reasons to avoid hysterectomy.

2. You increase your risk of lung cancer, heart disease and more

Hysterectomy, when removing the ovaries as well (oophorectomy), induces early menopause. And induced menopause (especially before age 45)⁷, versus natural menopause, increases the risk of coronary heart disease, stroke, lung cancer, decreased bone density and hip fracture, pulmonary embolus, dry eye syndrome, and “death from all causes.”^{8 9}

Dr. Jen Gunter, gynecologist and author of The Menopause Manifesto, equates this hyster-oophor-ectomy with the shorter life span of American women, compared to their Austrailan and German counterparts. “In the early 2000s, 54% of pre-menopausal American women having a hysterectomy for non-cancerous reasons had their ovaries removed versus 30% of Australian women and 12% of German women. That’s atrocious and unacceptable,” she says. “Women in Australia and Germany have a longer life expectancy than American women, so keeping their ovaries isn’t exactly holding them back. In fact it is almost certainly helping.“ ¹⁰

3. You increase your risk of neurological or mental disease

At the same time, women who undergo hysterectomy at a young age (with both ovaries removed) are also at an increased risk of developing neurological and mental diseases. These include Lou Gehrig’s disease (ALS), multiple sclerosis, Parkinson’s and dementia.¹¹ Patients treated with estrogen post-hysterectomy do not fare any better. Bove et al., also found that “surgical menopause” increases the risk of Alzheimer’s.¹²

While Reasons 2 and 3 may only be related to hysterectomy plus oophorectomy, even if you retain your ovaries, there are still more reasons not to have a hysterectomy.

4. You increase your risk of depression

Harnod et al. also found that hysterectomy increases a patient’s risk of depression.⁹ Even more so for women who undergo oophorectomy and/or hormone therapy, as well. The depression could be caused by anything from changes in sense of self and new gynecological symptoms to disruption of hormonal balance.

5. You could develop adhesions

Sixty to 90% of women who have undergone “major gynaecological surgery will develop adhesions.”¹³ Adhesions are when abnormal attachments between tissues and organs form, usually from sticky bands of scar tissue due to trauma from surgery. Adhesions can lead to further serious health issues, such as infertility, chronic pelvic pain, and small-bowel obstruction, which in some cases can turn fatal.

6. You could develop fistula disease

According to Forsgren and Altman, “pelvic surgery, and hysterectomy in particular are widely considered major causes of genital fistula disease.”⁴ In case you don’t know what that is—I didn’t, until I began researching for this post—Mayo Clinic defines it as “an abnormal opening that connects your vagina to another organ, such as your bladder, colon or rectum.” Or, “a hole in your vagina that allows stool or urine to pass through” it.

In addition to the obvious issues of incontinence—involuntary urination or defecation—WebMD says, “your genital area may get infected or sore, and you can have pain during intercourse.” The risk of developing a fistula is even greater for women with diverticulitis who have undergone hysterectomy, and the same may be “biologically plausible” for women with inflammatory bowel disease, but “the association has not been explored.”⁴

7. You could be left with chronic pain

Chronic post-surgical pain “is now considered possible after almost all types of surgery,”¹⁴ due to tissue damage as well as inflammatory responses. Abu-Alnadi et al. found that 42.7% of women who had a hysterectomy had chronic myofascial—muscle-associated—pain.¹⁵ That incidence was greatest among women who had chronic pelvic pain prior to surgery. So unfortunately, hysterectomy did not solve their pre-operation pain issues.

Other studies have shown that 16-50% of women experienced chronic pain,^{16 17 18} 4 to 6 months after surgery. The large discrepancy in percentages is due to how long after surgery patients were surveyed, as well as study design—assessing pain criteria is not an exact science. These percentages may even be higher, if you factor in those who were taking opioids for their pain management. (See Reason 8).

Less talked about, until recently, is the chronic pain caused by damage to nerves.¹⁹ Beyaz et al. call these “neuropathic symptoms” in 96.8% of hysterectomy patients, a “silent epidemic.”¹⁴

Cleveland Clinic describes neuropathic pain as “shooting, burning, stabbing, or electric shock-like pain; tingling, numbness, or a ‘pins and needles’ feeling.” Sometimes this can be evoked “by normally non-painful stimuli such as cold, gentle brushing against the skin, pressure, etc.” And because of this pain, you may have “trouble sleeping, and emotional problems.”

Incidentally, some researchers are trying to say the percentage of women who do experience post-operative pain (since not everyone does), are “pain catastrophizing.”^{20 18} That is, these women are exaggerating their pain. What do you think?

8. You could be left dependent on opioids

With all that pain, it’s understandable that the use of pain relievers would be prevalent after hysterectomy. And indeed, As-Sanie et al. found that gynecologists prescribed “twice the amount of opioids” after hysterectomy “than the average patient uses.”²¹

Worse, Wong et al. found that “surgeons prescribed 4 times the amount of opioids than was needed for patients undergoing laparoscopic hysterectomy.”²²

It follows then, that Surrey et al. would find, “the prevalence of opioid use” after hysterectomy “rose sharply from 17.7% at 6 months post procedure to 33.1% at 1 year.”³

9. You could develop urinary incontinence

As already mentioned under Reason 6, if you develop a fistula, you could develop incontinence. But even without fistula disease, urinary incontinence was found in 38%²³ to 53.4%²⁴ of hysterectomized women, and even as high as 60% in patients over 60.²⁵ It didn’t matter what type of hysterectomy they had.

Sadly, Forsgren and Altman found that urinary incontinence was one of the top reasons for the “elderly to be institutionalized.”

10. One of your pelvic organs could prolapse

Because the pelvic muscles and tissues are damaged or weakened in hysterectomy, it “is associated with an increased risk for subsequent pelvic organ prolapse” (especially if you’ve had more than child).^{26 27}

What is pelvic organ prolapse? Its when one of or more of your pelvic organs—bladder, rectum, urethra—drops or presses into, or even out of, the vagina. Not a pretty picture.

Just how high the risk is, is still up for debate. Most studies have not been long-term enough,¹⁹ so its incidence may be higher than doctors are telling us.

11. You could develop anal incontinence

Again, incontinence could happen with a fistula. But even without, “many women date the onset of bowel dysfunction to a hysterectomy,”⁴ and several studies support this.

In particular, “abdominal hysterectomy was associated with increased anal incontinence” at both the one-year and three-year follow-up,²⁸ while vaginal hysterectomy was associated with a “significant increase in incontinence” at three-years. Because studies have not followed up beyond three years, the incidence may be higher over time.

We don’t need a peer reviewed paper to tell us, as Forsgren and Altman say, “anal incontinence is a socially embarrassing and physically disabling condition.”

12. Your sex life might suffer

Many doctors will tell you that hysterectomy will make your love life better, because it will alleviate all your current problems. But if you’ve gotten this far in the post, you should have realized by now, hysterectomy may not, in fact, alleviate all of your problems.

You might also hear doctors tell you that, at the very least, hysterectomy will not disrupt your sex life. One poor lady in a study by Komisaruk et al. was even told by her surgeon, “the cervix has very few nerve endings and is of no sexual benefit.”²⁹ But as Dimond and Montagna point out, “Despite previous reports to the contrary, the human vagina and cervix are profusely innervated.”³⁰ That means, they are supplied with an abundance of nerves. But you probably don’t need me to tell you that.

Anyway, it is now well documented that hysterectomy has been associated with “persistent or recurrent reduction of sexual desire, arousal,” and “orgasm, along with the presence of pain.” This is because “the uterus is part of female sexuality both at an anatomical and an emotional” level.²

Baessler et al. found that 67% of patients had dyspareunia—pain during sex.³¹ Meanwhile, Wang and Ying found that 56-68% of hysterectomy patients reported decreased satisfaction with their sexual life,” including decreased libido, and orgasm dysfunction. Up to 70% reported “reduced frequency of sexual activity,” and as much as 86% reported pain during sex.³²

Some have theorized that whatever decrease in sexuality a woman might feel is purely psychogenic—ie., all in your head. Indeed, our thoughts and emotions do have an effect on whether or not we feel like having sex. But that doesn’t mean it isn’t something to consider, that it should just be blown off. As already mentioned, depression is a real risk of hysterectomy. If you aren’t feeling frisky, whatever the cause of depression might be, that isn’t your fault. As Martínez-Cayuelas et al. say, “The uterus is part of a women’s sexual identity, and any pathology that affects it can entail psychosexual problems, such as decreased libido and changes in genital sensitivity.”

But emotion and psychology are not the only reasons why women have decreased sexual function after hysterectomy. Hormonal changes can also cause low libido and decreased secretion. And since the arteries, blood vessels and nerves that supply the cervix and uterus are severed in hysterectomy, it can most certainly decrease blood supply and sensation to the pelvic floor. Hysterectomy can also cause a shortened vagina, another possible cause of pain during sex.²

Finally, this is probably obvious, but I’m going to say it anyway. Without a uterus, you will never be able to have a uterine orgasm again. If you’re one of the lucky women who has been able to have them, then you know how deep and intense that pleasure is. Of course, I know there are many ladies who are in such discomfort right now, they can’t even think about sex or orgasm. But don’t you want the chance to reclaim that pleasure, rather than say goodbye to if forever?

Other Reasons Not To Have a Hysterectomy?

So there you have twelve physical reasons, backed by scientific evidence, why not to have a hysterectomy. But what of the metaphysical, the spiritual? In our modern world, so many people try to convince you that science is the only thing that matters. (And science does matter, yes.) But in the course of healing from adenomyosis, I have learned a lot about my uterus. I’ve seen how intricately linked it is to emotion, to my gut feelings. I believe it’s where my women’s intuition comes from, my personal power. And because of its link to hormones (of all kinds), I also believe its linked to my joie de vivre. That’s reason enough for me not to want to give it up.

Whatever your reasons, the decision whether to have a hysterectomy is yours and yours alone, to make. Don’t let anyone else tell you how to feel about it.

###

References

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3. Surrey ES, Soliman AM, Yang H, Du EX, Su B. Treatment Patterns, Complications, and Health Care Utilization Among Endometriosis Patients Undergoing a Laparoscopy or a Hysterectomy: A Retrospective Claims Analysis. Adv Ther. 2017;34(11):2436-2451. doi:10.1007/s12325-017-0619-3[↩][↩]
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8. Parker WH, Broder MS, Chang E, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study. Obstet Gynecol. 2009;113(5):1027-1037. doi:10.1097/AOG.0b013e3181a11c64[↩]
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22. Wong M, Vogell A, Wright K, Isaacson K, Loring M, Morris S. Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator. Am J Obstet Gynecol. 2019;220(3):259.e1-259.e11. doi:10.1016/j.ajog.2018.10.022[↩]
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26. Altman D, Falconer C, Cnattingius S, Granath F. Pelvic organ prolapse surgery following hysterectomy on benign indications. Am J Obstet Gynecol. 2008;198(5):572.e1-572.e5726. doi:10.1016/j.ajog.2008.01.012[↩]
27. Forsgren C, Lundholm C, Johansson AL, Cnattingius S, Zetterström J, Altman D. Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery. Int Urogynecol J. 2012;23(1):43-48. doi:10.1007/s00192-011-1523-z[↩]
28. Forsgren C, Zetterström J, Lopez A, Nordenstam J, Anzen B, Altman D. Effects of hysterectomy on bowel function: a three-year, prospective cohort study. Dis Colon Rectum. 2007;50(8):1139-1145. doi:10.1007/s10350-007-0224-7[↩]
29. Komisaruk BR, Frangos E, Whipple B. Hysterectomy improves sexual response? Addressing a crucial omission in the literature. J Minim Invasive Gynecol. 2011;18(3):288-295. doi:10.1016/j.jmig.2011.01.012[↩]
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31. Baessler K, Windemut S, Chiantera V, Köhler C, Sehouli J. Sexual, bladder and bowel function following different minimally invasive techniques of radical hysterectomy in patients with early-stage cervical cancer. Clin Transl Oncol. 2021;23(11):2335-2343. doi:10.1007/s12094-021-02632-7[↩]
32. Wang Y, Ying X. Sexual function after total laparoscopic hysterectomy or transabdominal hysterectomy for benign uterine disorders: a retrospective cohort. Braz J Med Biol Res. 2020;53(3):e9058. Published 2020 Feb 14. doi:10.1590/1414-431X20199058[↩]