Having your uterus removed. What are the pros and cons?

In this article, we’ll discuss all the pros and cons of having your uterus removed.

Why would a uterus be removed?

Heavy, painful, and/or irregular menstruations

There are various reasons why you would get your uterus removed. The most well known ones are menstrual complaints, such as very heavy, long-lasting, and/or irregular menstruations. Before it’s decided to undergo the surgery, many other treatments will usually have been attempted that didn’t work well enough. Pain during menstruation as a result of endometriosis, adenomyosis, or a fibroid can also be a reason to go under the knife.

Harmful afflictions

There are also certain harmful afflictions that could serve as a reason for getting your uterus removed, such as endometrial cancer (also known as endometrial carcinoma) or cervical cancer.

Prolapse

There are also people for whom the connective tissue to which the bladder, uterus, and/or rectum are attached has begun to ‘hang’:  it fails to be strong enough to provide the necessary support (for example due to vaginal births) to the pelvic floor. This puts you at risk of having a prolapse of the bladder, uterus, and/or rectum. That doesn’t sound very nice, and experiencing it certainly isn’t nice either.

For complaints such as a nagging or pressing feeling in the lower abdomen/vagina or a ‘ball feeling’, you’ll often first start with pelvic floor physical therapy, a pessary, or a less intensive surgical procedure. Should these treatments fail to help, or depending on the severity of the prolapse, it will be decided to have the uterus removed.

Different ways to have the uterus removed

There are various methods to remove a uterus. It could be done vaginally, through the belly with a keyhole surgery, or with a surgery where a larger incision is made in the belly. Which option is chosen truly depends on the individual and the surgeon.

What are the pros and cons of having your uterus removed?

Advantages

It’s simple, your problems will be gone! No more miserable menstruations where you feel like you’re losing liters of blood, agonizing cramps, or pain during sex. That thing is finally gone, and the rest of your life can begin!

Disadvantages

While you might be over the moon knowing that you’re finally getting the surgery, there are also quite a few disadvantages that come with the removal of a uterus.

There are always risks when you undergo a surgery, no matter how small of a surgery it is. You might lose a lot of blood, contract an infection or thrombosis, your urinary tract or intestines can be damaged (which can easily be treated, though it does have an effect on your recovery). You also often get adhesions in your abdomen after an operation. Most people don't notice much of this, but if you have to have another operation in your abdomen, it can be a lot more difficult for the doctor because this adhesion can get in the way.

Stating the obvious, but still! After having your uterus removed, you won’t be able to get pregnant again. Ever. It’s good to be aware of that. Your age and your current (family) situation are sure to have an impact on what treatment you decide is best for you. On the other hand, you might be removing something that you might associate with your ‘femininity’ or fertility. Have a good hard think about how important this is to you before you make such a choice, since these feelings are also very important!

Thankfully, most don’t notice a difference, but some state that their orgasms have changed after the surgery. During an orgasm, your uterus also contracts, and this can cause an intense feeling. This also won’t be possible anymore after the surgery.

During the operation (a part of) the bladder will often be detached a bit. Because of this, it can happen that you’ll struggle to pee after the surgery, find it more difficult to hold your pee, or accidentally leak a bit of pee. This is usually temporary, and will fix itself in time.

When the uterus is removed, blood vessels will also be tied off. This will somewhat change the blood flow to the ovaries. You can start perimenopause between 1 and 3 years earlier than usual after having had your uterus removed, though this exact number differs from person to person. It’s not the case that it will make your perimenopause more intense or longer.

Should you still get pap smears after your uterus has been removed?

That depends. In most cases, when the uterus is removed, the cervix will also be removed. The cervix is the bottom part of the uterus. It is the location where pap smears are done to check if you’re carrying the HPV virus and/or if you have cervical cancer. Whether or not you have a cervix doesn’t appear to have an effect on sex or peeing. Sometimes it’s decided during the operation to leave the cervix in place, because it doesn’t seem safe to remove it (for example if there’s a fibroid that’s blocking it, or if there’s a high likelihood that removing it will damage the ureter).

Will the oviducts and ovaries also be removed?

If you’re already under the knife to get your uterus removed, shouldn’t your oviducts and ovaries just be taken out too?

Research in Laura van Lieshout’s thesis “Overcoming the Silent Lady Killer” has shown that it is a safe option to have the oviducts removed during a gynecological abdomen surgery (for example a uterus surgery or a sterilization). This will prevent you from getting ovarian cancer in the future. If you don’t have a child-wish (anymore), the oviducts no longer have an important function. After all, ova no longer need to be transported from your ovary to your uterus to be fertilized and nestle in there.

Why would you remove the oviduct but not the ovary?

Research has shown that the early stages of ovarian cancer are found in the oviducts, but not in the ovary itself. So, by removing these, you get rid of the place where these early stages can begin to develop.

You don’t just remove an ovary without reason, since it’s an operation that brings along quite a bit of risk. If you’re not already in perimenopause, removing your ovary/ovaries will put you right into early-onset menopause, which has its own slew of consequences. Even after menopause, the ovaries sometimes continue to produce hormones (such as testosterone, which, amongst other things, has a great effect on your appetite for sex!), that can be good for your body and mind. Should there be a reason to have your ovary removed, your doctor will discuss this in detail with you. It’s also important to have a clear treatment plan - one that also includes the period after the surgery.

What to do?

Of course, this article is a relatively general one, which means that it might not be applicable to you personally. Still, it might help you to make a decision. Consider this information before you decide to undergo surgery, or choose to try other treatments first.