Things to consider before having a hysterectomy

If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to have your cervix or ovaries removed.

These decisions are usually made based on:

• your medical history
• your doctor's recommendations
• your personal feelings

It's important that you're aware of the different types of hysterectomy and their implications.

Removal of the cervix (total or radical hysterectomy)

If you have Cervical cancer , ovarian cancer or womb (uterus) cancer ,you may be advised to have your cervix removed to stop the cancer spreading.

Even if you don't have cancer, removing the cervix means there's 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's no evidence to support this.

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, ask your surgeon whether there are anyrisks associated with keeping your cervix.

If you have your cervix removed, you'll no longer need to have cervical screening tests . If you don't have your cervix removed, you'll need to continue having regular screening for cervical cancer (cervical smears).

Removal of the ovaries (salpingo-oophorectomy)

The National Institute for Health and Care Excellence (NICE) recommends that a woman's ovaries should only be removed ifthere's a significant risk of associated disease, such as ovarian cancer.

If you have a family history of ovarian or breast cancer , removing your ovaries (an oophorectomy) may be recommended to prevent cancer occurring in the future.

Your surgeon can discuss thepros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed.

If you've already gone through the menopause or you're close to it, removing yourovaries may be recommended regardless of the reason for having ahysterectomy. This isto protect against the possibility of ovarian cancer developing.

Somesurgeons feel it's best to leave healthy ovaries in place if the risk of ovarian cancer is small for example, if there's no family history of the condition.

This is because the ovaries produce several female hormones that can help protect against conditions such as osteoporosis (weak and brittle bones) . They also play a part in feelings of sexual desire and pleasure.

If you would prefer to keep your ovaries, make sure you've made this clear toyour surgeon before your operation. You may still be asked to give consent to treatment in regards to having your ovaries removed if an abnormality is found during the operation.

Think carefully about this and discuss any fears or concerns that you have with your surgeon.

Surgical menopause

If you have a total or radical hysterectomy that removes your ovaries, you'llexperience the menopause immediatelyafter 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's a chance that you'll experience the menopause within five years of having theoperation.

Although your hormone levels decrease after the menopause, your ovaries continue producing testosterone for up to 20 years. Testosterone is a hormone that plays animportant part in stimulating sexual desire and sexual pleasure.

Yourovaries also continue to produce small amounts of the hormone oestrogen after the menopause. It's a lack of oestrogen that causes menopausal symptoms such as:

• hot flushes
• depression
• vaginal dryness
• insomnia (sleep problems)
• fatigue
• night sweats

Hormone replacement therapy(HRT) is usually used to help with menopausal symptoms that occur after a hysterectomy.

Hormone replacement therapy (HRT)

You may be offered HRT after having your ovaries removed.This replaces some of the hormones your ovaries used to produce and relieves any menopausal symptoms you may have.

It's unlikely that the HRT you're offered will exactly match the hormones your ovaries previously produced.

The amount of hormones a woman produces can vary greatly, and you may need to try different doses and brands of HRT before youfind one that feels suitable.

Not everyoneis suitable forHRT. For example, it's not recommended for women who have had a hormone-dependent type ofbreast cancer or liver disease. It's important to let your surgeon know about any such conditions that you'vehad.

Ifyou're able to haveHRT and both of your ovaries have been removed, it's important to continue with the treatmentuntil you reach the normal age forthe menopause (51is the averageage).

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