Hysterectomy and Hormone Imbalance

Over 600,000 women annually undergo a hysterectomy. Reasons for having a hysterectomy are uterine fibroids, endometriosis (condition in which cells of the uterus have migrated to pelvic organs where they should not be, causing painful inflammation and bleeding), and uterine prolapse (dropping of the uterus into the vagina). According to the National Women’s Health Information Center, one in three women in the United States has had a hysterectomy by age 60. Centers for Disease Control statistics show that the number of hysterectomies is actually starting to decline, especially in the 50-54 age group, and hysterectomy rates are higher in the South of the country and lowest in the Northeast, where rates continue to decline significantly. This decline is evidence that many hysterectomies may be unnecessary. Alternatives are being found to treat these conditions, as well as heavy periods or chronic pelvic pain, for which a hysterectomy is increasingly seen as a last resort. Also, a growing number of medical experts say that identifying imbalances of hormones like estrogen, which feed the growth of fibroids and endometriosis, can go a long way toward preventing the more common conditions that lead to a hysterectomy in the first place.

Recently published results from the Nurses’ Health Study show that women whose ovaries were removed at the time of a hysterectomy were significantly more likely to experience heart disease, stroke or death. Removal of the ovaries (“oophorectomy”) induces “surgical menopause,” suddenly placing a woman in a state of ovarian hormone deficiency that would normally have occurred over several years during a natural menopausal transition. Ovarian hormones, primarily estrogens and progesterone, play an important role in protecting the health of organs such as the heart, bones, brain and breasts. There are conditions where a hysterectomy is needed, and it then becomes important to discuss with your doctor the option of not removing the ovaries. However, it is also important to know that even if you do keep your ovaries, a hysterectomy can result in a decline in ovarian hormone production, and premature menopause is often seen.

A hysterectomy can also have emotional consequences, especially in women who have not yet had children or who are not sure they have completed their families. Many women can experience feelings of loss in these cases. For some it can also be experienced as a dramatic change in “femaleness,” so it is a topic that is very individual – just like overall hormone balance.

As mainstream medical thinking about the therapeutic value of the hysterectomy shifts toward prevention, the best approach may be to talk with your doctor about detecting and correcting hormone imbalances that can contribute to the development of conditions that put you at risk of requiring surgery.