When Lauri Casanas was 41 years old, she’d had just about enough of her heavy periods. “I would go through nine tampons and panty liners a day,” she says. “I’d wake up in the morning and my bed was soaked in blood.”
A few years earlier during a pregnancy, Lauri’s obstetrician had told her that she had a fibroid growing behind the placenta. Now, a second doctor discovered that the fibroid had swelled to the size of a grapefruit and she’d developed two other fibroids as well. The doctor gave her two options: remove the fibroids — which could likely grow back — or have a hysterectomy. She chose the hysterectomy.
“My husband and I have two kids, and he’d already had a vasectomy, so we knew we weren’t going to have any more children,” she says. “Meanwhile I was having anxiety at just the thought of another period.”
Every year, about 600,000 hysterectomies are performed in the U.S., most often among women between the ages of 40 and 44 — although sometimes younger women undergo the procedure, too. Actress and director Lena Dunham recently made headlines when she announced that she’d had a hysterectomy at age 31 to help relieve her endometriosis.
But for such a common surgery (among reproductive-age women, it’s the second most common procedure after childbirth), there are plenty of myths and misconceptions about hysterectomy, says Lauren Streicher, M.D., author of The Essential Guide to Hysterectomy. Here, she shares some much-needed truth.
Do women really still need hysterectomies?
Although rates of hysterectomy are much lower today than they were in the 1950s and ’60s, there are still plenty of reasons why a woman might have one, says Streicher. The most common reason — just like in Lauri’s case — is fibroids.
“If you’re 45 years old and you’ve got significant bleeding because of fibroids, then hysterectomy may be the best choice — especially if you’ve already had a less-invasive procedure to remove the fibroid but it grew back,” she says.
Some women also turn to hysterectomy to treat severe endometriosis, although Streicher points out that the condition cannot be completely cured by removing the uterus — the ovaries must also be removed. And, of course, hysterectomy may be necessary to treat uterine (endometrial) cancers, or you may choose to have it performed as a prophylactic against cancer if you test positive for BRCA gene mutations.
Still, if you’re considering a hysterectomy, one of the best things you can do is get a second opinion to determine if it’s really your best bet, says Streicher. These days there are loads of treatment options for reproductive conditions, as well as many different kinds of hysterectomy procedures.
“Keep in mind that your regular doctor may not be comfortable performing the type of surgery that you may need, whether it’s a robotic hysterectomy or a laparoscopic procedure,” she says. “You may need to see a specialist rather than the same ob-gyn who delivered your kids.” A good place to start is aagl.org, the website for AAGL (formerly called the American Association of Gynecologic Laparoscopists).
What’s the deal with hysterectomy and menopause?
One of the biggest myths about hysterectomy, says Streicher, is that it’s a one-way ticket to postmenopausal life.
“In the middle of the night, if the hysterectomy fairy came and removed your uterus without you realizing it, what would you honestly notice?” she says. “You wouldn’t get your period. You wouldn’t be able to get pregnant. If you had big fibroids and they were pushing on your bladder, you won’t have to run to the bathroom every 10 seconds. That’s about it.”
The reason that a hysterectomy doesn’t send you roaring into menopause is because when it comes to the hormone game, your uterus is essentially sitting on the sidelines. After her hysterectomy, Lauri noticed that even without periods, she still experienced occasional PMS, thanks to her still-functioning ovaries.
So unless your ovaries are removed, too (a procedure known as an oophorectomy), then you likely have a few years left before hormone production begins to naturally shut down and common menopausal symptoms — hot flashes, Saharalike skin, vaginal dryness — flare up. Whether your menopause is due to surgery or occurs naturally, there are ways to manage your symptoms. A menopause expert can go over the hormonal and nonhormonal treatments available.
What about sex after surgery?
Despite what you may have heard, hysterectomy won’t likely spell doom for your sex life. In fact, depending on your reason for having the surgery, sex may become more enjoyable afterward. (After all, the pain of endometriosis or a bleeding fibroid isn’t exactly an aphrodisiac.)
According to Streicher, much of the concern around hysterectomy and sexual issues relates back to the menopause myth, since postmenopausal women sometimes deal with painful sex as a result of vaginal dryness. However, she does note that a small group of women may find that their orgasm doesn’t feel as strong.
“That’s because a subset of women can sense their uterus contracting during orgasm,” she says. “They might not even be aware that that’s what it is, but when the uterus is gone, they can’t feel those contractions anymore.”
Streicher also says that culturally, a hysterectomy can sometimes interfere with the way that patients see themselves — and the way their partners see them — as women.
“To some women, a hysterectomy is really losing their femininity,” she says. “There can be a lot of emotions tied up in that. Some patients don’t want their husbands to know, even if they’re done having kids.”
And just like the rest of your life, your sex life will be temporarily impacted by the surgery itself. Although a laparoscopic procedure can cut down on your recovery time, most women will need four to six weeks to fully heal. That’s especially true for your sex life if you’ve had your cervix removed as part of the surgery.
Streicher says that in her experience, most patients feel relief — not regret — after having the procedure, especially if they were well-informed about all of their options beforehand. For her part, Lauri Casanas says that even though the surgery was “tough to recover from,” she’s glad to be rid of her debilitating menstrual cycles once and for all.
Everyone needs a girlfriend!
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