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Hysterectomy Myths: Hormones Unaffected by Uterus Removal

Your Uterus
The Uterus

Most of my patients are well-educated women who take interest in their health, but many of them are unaware of things that women should be informed of but rarely are -- like removing the uterus alone in a premenopausal or perimenopausal woman doesn't affect her hormones.

Quick anatomy review: the cervix sits at the top of the vagina and is the entrance of the uterus. The cervix is normally closed except during menstruation and childbirth. During a woman's reproductive years, the uterine lining builds up every month and the lining is shed (that lovely thing called a period) unless a woman is pregnant. The ovaries, and not the uterus, are what mainly produce hormones that result in the menstrual cycle, which is why removing the uterus alone (hysterectomy) does not result in hormonal changes. Hysterectomy does, however, result in no more menstrual bleeding (most of us say "yay" to that). Now, to make things a little more confusing, technically the definition of menopause is no period for 12 months which means hysterectomy does result in menopause in the sense that there are no more periods. BUT, if a woman is premenopausal or perimenopausal and doesn't have her ovaries removed (oophorectomy) then she will still experience her typical hormonal cycle symptoms, like mood swings, and eventually have symptoms of perimenopause and menopause such as hot flashes, difficulty sleeping, and everyone's favorite -- vaginal dryness. (Note: there are a lucky few who don't have symptoms of menopause but those are more the exception than the rule.)

Last little bits of trivia involve terminology. The term "subtotal" hysterectomy is used when a woman has a hysterectomy but her cervix if left behind, also called a supracervical hysterectomy (versus total hysterectomy if the uterus and cervix are removed). A total or supracervical hysterectomy alone will end a woman's periods if she is premenopausal, but it will not affect her hormones. If the uterus is removed with ovaries and tubes, the surgery would be called total or supracervical hysterectomy and salpingo-oophorectomy (salpingo referring to tubes). In this scenario, a premenopausal or perimenopausal woman would likely experience menopausal symptoms essentially overnight and is termed "surgical menopause."

That was a lot of info just to debunk a myth, and I'm sure you're wondering when a woman would want to keep her cervix and not. That will be in another blog...


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