Hysterectomy

What to Think About

Hysterectomy is performed more often in the United States than in any other country.¹⁰ Your doctor may suggest other treatments before recommending a hysterectomy. If you are considering a hysterectomy and would like more information about other treatments or surgeries, talk with your doctor. Ask about the risks and benefits of each option. Consider both the immediate and long-term risks and benefits of all treatments.

Hysterectomy is a necessary and effective treatment for cancer of the pelvic organs, a severe infection of the uterus, or uncontrollable bleeding.

Following hysterectomy, you will not be able to become pregnant. If you have plans for a future pregnancy, hysterectomy is not an appropriate treatment option for conditions such as uterine fibroids, endometriosis, or pelvic organ prolapse. Talk with your doctor about other treatments.

Hysterectomy is not used to prevent pregnancy. There are many methods of birth control that are safe and effective. If you are not sure which method is best for you, talk with your doctor about your options. For more information, see the topic Birth Control.

Estrogen replacement therapy (ERT)

Women who have early, sudden menopause after hysterectomy are usually advised to use estrogen replacement therapy (ERT) to protect against bone loss. The low estrogen levels of menopause cause bone thinning. Compared with women who are not taking hormone therapy, women taking ERT have fewer hip fractures (a sign of estrogen's bone-protecting effect).¹¹

ERT also helps with menopausal symptoms. Known ERT risks come from studies of women older than 50. It may be that the benefits outweigh the risks for younger women who take ERT until the age of natural menopause.¹² This question needs further research.

The Women's Health Initiative (WHI) studied estrogen-only therapy in older women and found that it increases the risks of blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism) and the risk of stroke during the first year of use.¹¹ ERT offered no protection against heart disease. It was linked to ovarian cancer in a small number of women.^{13, 14}

Some studies have found a possible link between ERT and breast cancer.¹⁵ In the WHI trial, women using ERT had no increase in breast cancer risk during the study's nearly 7 years of ERT treatment.¹¹ But the Million Women Study of British women ages 50 to 64 suggests that after 10 years of taking ERT, a small number of women develop breast cancer that is related to ERT.^{16, 17} (Many women in this age group also develop breast cancer without taking hormone therapy.)

For more information, see:

Should I use estrogen replacement therapy (ERT) after a hysterectomy or oophorectomy?

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Author:	Sandy Jocoy, RN	Last Updated: August 12, 2008
Medical Review:	Sarah Marshall, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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