FAQs Hysterectomy

Should I keep my ovaries?

• If you are pre menopausal it is advisable to keep the ovaries so that you continue to produce the hormones necessary for your feeling of well being, libido and to prevent osteoporosis, hot sweats and flushes.
• If you are postmenopausal the ovaries continue to produce testosterone which is important for your feeling of wellbeing and libido if possible you should keep them.  However, if they are removed you can have HRT

When should I not keep my ovaries?

• If you have had previous problems with your ovaries
• If you have severe premenstrual tension
• If you want to reduce your risk of ovarian cancer
• If you have a family history of breast or ovarian cancer
• If you have a BRCA1 or BRCA2 genetic defect
• If you are having a hysterectomy for endometriosis (endometriosis is oestrogen dependent) and you want to reduce the risk of recurrence of endometriosis maximally

Should I keep my cervix?

• Some women feel that their cervix is important to them and if there is no medical reason to remove it (cancer) your surgeon can preserve it.
• If you keep your cervix it is important to continue having regular smears
• 5-10% of women who keep their ovaries and their cervix will have some bleeding from inside the cervix every month. This is usually very light and may eventually stop.

FAQ about Endometriosis and Hysterectomy

Do I have to have my ovaries out if there is endometiosis at the time of a hysterectomy

No. The endometriosis can be removed at the same time as a hysterectomy and the ovaries left alone. There is a cumulative risk of recurrence of the endometriosis over time with every cycle you have

Do I have to have a hysterectomy if I have endometriosis

No. You don’t have to have anything done unless you have symptoms. A hysterectomy will stop bleeding and pain from the womb itself but not from endometriosis outside the womb

I have adenomyosis ( endometriosis in the wall of the womb), do I have to have a hysterectomy

No. This can be treated with drugs but is usually not effective. The Mirena IUD can be very helpful in this situation. Rarely a localised form of adenomyosis can be cut out and improve symptoms of pain or infertility

Can I keep my cervix if I have endometriosis

If you have severe endometriosis, it is likely that this is involving the back of the cervix, the ligaments just behind the cervix and the top of the vagina. Leaving the cervix with the ovaries still present will significantly increase the risk of persistent or a recurrence of your symptoms

Can I  have key hole surgery if I have severe endometriosis (frozen pelvis)

Yes but it takes more time. The risks of surgery are the same as when the operation is done as an open procedure through a cut in the tummy. If you also have large fibroids then it becomes much more difficult to access the areas of endometriosis. Here the surgeon has to make a careful assessment of the risk of very prolonged operations over 3-4 hours versus the benefits. A shorter operation done ‘open’ in these circumstances may be wiser

Am I too young to have a hysterectomy

If you have completed your family and have significant symptoms affecting your day to day activities, then the younger you are the more likely you are to benefit from a hysterectomy as opposed to conservative measures

These are the personal views of Mr Oliver Chappatte, developed over 30 years of practicing Gynaecology