If you choose to have a hysterectomy, you may have to decide whether you wish to have your cervix or ovaries removed. These decisions are usually made based on your medical history, your doctor's recommendations and your personal feelings. It is important that you are aware of the different types of hysterectomy and the implications these may have for you.
Removal of the cervix (total/radical hysterectomy)
If you have cancer of the cervix, the ovaries or the womb, you may be advised to have your cervix removed to prevent the cancer from spreading.
Even if you do not have cancer, removing the cervix means that there is no risk of developing cervical cancer in the future.
Many women are concerned that removing the cervix will lead to a loss in sexual function, but there is no evidence that this is the case. Some women are reluctant to have their cervix removed because they want to retain as much of their reproductive system as possible. If you feel this way, you should talk to your surgeon about any possible risks of keeping your cervix.
If you do not have your cervix removed, you will need regular screening for cervical cancer (cervical smears).
Removal of the ovaries (salpingo-oophorectomy)
The National Institute for Health and Clinical Excellence (NICE) recommends that ovaries should only be removed when there is a significant risk of associated disease, such as ovarian cancer.
Your surgeon may recommend removal of the ovaries (oophorectomy) if you have a family history of ovarian or breast cancer, to prevent cancer occurring in the future. Your surgeon will be able to discuss the benefits and disadvantages of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will be removed also.
If you have already gone through, or are close to the menopause, some surgeons recommend removing the ovaries regardless of the reason for your hysterectomy. This is because it is a good way to protect against the possibility of ovarian cancer developing in the future.
Other surgeons feel it is best to leave healthy ovaries in place if the risk of ovarian cancer is small, for example if there is no family history. This is because the ovaries produce several hormones that are beneficial to women. They can help to protect against conditions such as osteoporosis and they also play a part in feelings of sexual desire and pleasure.
If you would prefer to keep your ovaries, make sure that you have discussed this with your surgeon and made it clear before your operation. You may still be asked to give consent for your ovaries to be removed if an abnormality is found during the operation. Think carefully about this and discuss any fears or concerns you have with your surgeon.
If you have a total or radical hysterectomy that removes your ovaries you will go through the menopause immediately following your operation, regardless of your age. This is known as a surgical menopause.
If a hysterectomy leaves one or both of your ovaries intact, there is a chance you will go through the menopause within five years of your operation.
Although your hormone levels drop after the menopause, your ovaries continue to produce testosterone for up to 20 years. Testosterone is an important part of the stimulus for sexual desire and sexual pleasure.
The ovaries also continue to produce small amounts of oestrogen after the menopause. It is a lack of oestrogen that causes menopausal symptoms such as hot flushes, depression, vaginal dryness, insomnia, fatigue and night sweats.
Hormone replacement therapy (HRT) is usually given to help with menopausal symptoms that occur after a hysterectomy.
Hormone replacement therapy (HRT)
If you have your ovaries removed you will usually be offered hormone replacement therapy (HRT). This is to replace some of the hormones that your ovaries used to produce and relieve any menopausal symptoms.
It is unlikely that the HRT you are offered will exactly match the hormones previously produced by your ovaries. It is not possible to tailor HRT exactly to an individual because people vary greatly in the amount of hormones they produce. The role of oestrogen and testosterone in men and women is still not fully understood.
Many women try different doses and brands of HRT before they find one that feels suitable for them.
Not everyone can take HRT. It is not recommended for women who have had a hormone-dependent type of breast cancer or liver disease. Make sure your surgeon is aware of any conditions you have suffered from in the past.
If there are no reasons why you should not take HRT and both of your ovaries are removed, it is important to take HRT until the normal age of the menopause (51 years of age).
See HRT for more information.