A hysterectomy — the surgical removal of the uterus — is one of the most common surgeries in the United States. Roughly 500,000 to 600,000 are performed every year, and an estimated 1 in 9 women will have one in her lifetime. Despite how common it is, a hysterectomy is still major surgery with a significant recovery period, permanent effects on fertility, and lifelong hormonal implications if the ovaries are also removed. Deciding whether it’s the right choice is a conversation to have carefully with a gynecologist, not a decision to make alone.
This guide breaks down the medically appropriate reasons to consider a hysterectomy, the reasons that usually don’t warrant one, and the questions people search for most when researching this decision.
Should I Have a Hysterectomy?
A hysterectomy is generally recommended for cancer or high cancer risk, uncontrollable bleeding, and gynecologic conditions — like fibroids, endometriosis, adenomyosis, or prolapse — that haven’t responded to less invasive treatments and are significantly affecting quality of life. It is not recommended solely for birth control, to stop periods, or for mild symptoms that other treatments haven’t yet been tried on.
How Common is Hysterectomy, Really?
- About 500,000–600,000 hysterectomies are performed annually in the U.S., making it the second most common surgery for women after C-section.
- As of 2021, 14.6% of U.S. women age 18 and older had had a hysterectomy, rising from 2.8% of women ages 18–44 to 41.8% of women 75 and older.
- Hysterectomy prevalence differs by race and ethnicity: 16.3% among Black non-Hispanic women, 15.6% among white non-Hispanic women, 12.5% among Hispanic women, and 6.1% among Asian non-Hispanic women.
- Uterine fibroids are the single leading indication, accounting for over one-third of all hysterectomies performed in the U.S.
- The share of hysterectomies done through minimally invasive approaches (laparoscopic, robotic, or vaginal) rather than open abdominal surgery has climbed steadily, which generally means shorter hospital stays and faster recovery.
Reasons To Have a Hysterectomy
1. Cancer
A cancer diagnosis remains the clearest, most urgent reason to consider a hysterectomy. Ovarian, uterine, endometrial, cervical, and vaginal cancers are all treated, in many cases, by removing the uterus to stop the spread or progression of malignant cells. This decision is made with a gynecologic oncologist, who will weigh the cancer’s type, stage, and your overall treatment plan.
2. A high-risk genetic mutation
Women who test positive for a BRCA1, BRCA2, or Lynch syndrome mutation face a significantly elevated lifetime risk of ovarian and uterine cancers. For some of these women, a hysterectomy is often a preventive (risk-reducing) option and is typically paired with removal of the ovaries and fallopian tubes. This is something that should be discussed with a genetic counselor and gynecologic oncologist because it’s different from treatment for existing disease.
3. Uncontrolled, life-threatening bleeding
A hemorrhage that can’t be stopped through other means, such as a severe complication during childbirth, postpartum hemorrhage, or a bleeding emergency from another procedure, can require an emergency hysterectomy to save a patient’s life. This is typically an urgent, in-the-moment decision made by a surgical team rather than a planned one.
4. Conditions that seriously impede quality of life
This is the largest gray area, and the one that requires the most individualized conversation with a gynecologist. It includes:
- Uterine fibroids — noncancerous growths that, when large or numerous, can cause heavy bleeding, pelvic pain, and pressure. Fibroids affect up to an estimated 70–80% of women by age 50, though most cases are mild or asymptomatic; only 20–50% of women with fibroids develop significant symptoms.
- Endometriosis and adenomyosis — conditions where uterine-lining tissue grows outside the uterus (endometriosis) or into the uterine wall (adenomyosis), causing chronic pain and heavy bleeding. The two conditions frequently co-occur with fibroids.
- Abnormal or heavy uterine bleeding that hasn’t responded to medication, an IUD, or less invasive procedures.
- Pelvic organ prolapse, where the uterus drops into or out of the vaginal canal, causing pressure, discomfort, or urinary issues.
In all of these cases, a hysterectomy is generally only after other treatments haven’t provided enough relief. Doctors often recommend first trying other options including medication, hormonal therapy, minimally invasive procedures like uterine fibroid embolization or endometrial ablation.
Reasons Not To Have a Hysterectomy
1. To avoid pregnancy
A hysterectomy is major, irreversible surgery — not a form of birth control. Options like the pill, IUDs, implants, and the vaginal ring are far less invasive and are the appropriate first step for anyone who doesn’t want to get pregnant. Permanent sterilization options like tubal ligation also carry far lower surgical risk than a hysterectomy.
2. To stop having a period
Wanting to be done with periods isn’t, by itself, a medical reason for a hysterectomy. If periods are heavy, irregular, or disruptive enough to affect daily life, that’s worth bringing to a doctor — but the first-line treatments are usually hormonal therapy, an IUD, or a less invasive procedure, not surgical removal of the uterus.
3. Fibroids without significant symptoms
Since most fibroids are asymptomatic or mildly symptomatic, the standard approach is to treat symptoms first with medication, a hormonal IUD, or a fertility-sparing procedure like myomectomy or fibroid embolization. Hysterectomy is generally reserved for fibroids causing severe symptoms that haven’t responded to those options.
4. Mild bladder or bowel issues
For minor pelvic organ prolapse or mild incontinence, a hysterectomy often won’t resolve the underlying issue. Pelvic floor physical therapy, Kegel exercises, pessaries, and other minimally invasive treatments are usually tried first, with surgery considered only if symptoms are more severe or those approaches fail.
Frequently asked questions
What is the most common reason for a hysterectomy?
Uterine fibroids are the leading indication, accounting for more than a third of hysterectomies performed in the U.S. each year.
Is a hysterectomy a major surgery?
Yes. It involves general or regional anesthesia, a hospital stay in some cases, and several weeks of recovery — typically 4–6 weeks for minimally invasive approaches and 6–8 weeks for open abdominal surgery. It also permanently ends fertility.
Can you still have a period after a hysterectomy?
No. Once the uterus is removed, menstruation stops permanently. If the ovaries are left in place, they continue producing hormones and you won’t go into surgical menopause; if the ovaries are also removed, menopause begins immediately regardless of age.
Is a hysterectomy reversible?
No. It’s considered a permanent procedure, which is why doctors typically recommend exhausting other treatment options first for non-cancer, non-emergency indications.
What are the alternatives to a hysterectomy for fibroids or heavy bleeding?
Depending on the diagnosis, alternatives can include hormonal IUDs, medication, endometrial ablation, uterine fibroid embolization, and myomectomy (surgical removal of fibroids that preserves the uterus).
Talk to a Specialist Before Deciding About a Hysterectomy
Because the right answer depends heavily on diagnosis, symptom severity, cancer risk, and personal goals around fertility, this is a decision best made with a gynecologist or gynecologic oncologist who knows your full medical history.
If you have questions about your health regarding a hysterectomy, contact Dr. Lynn Kowalski’s office at Nevada Surgery and Cancer Care in Las Vegas by calling 702-739-6467.
This article is for informational purposes only and is not a substitute for professional medical advice. Talk with your doctor about your specific symptoms and health history.