The most common reason women have a hysterectomy is uterine fibroids, but several other conditions can also lead to the surgery. These include endometriosis, adenomyosis, uterine prolapse, abnormal bleeding that doesn’t respond to other treatments, chronic pelvic pain, and gynecologic cancers. In nearly every case, hysterectomy is considered only after less invasive options have been tried first.
About 2.8% of women ages 18 to 44 have had a hysterectomy, but that number climbs sharply with age: 22.1% of women ages 45 to 64, and over 35% of women 65 and older. It remains one of the most common major surgeries performed on women.
Uterine Fibroids
Fibroids are noncancerous growths in or on the uterus, and they’re the single most common reason for hysterectomy. Many women have fibroids without knowing it, but when they cause problems, those problems can be significant: heavy or prolonged periods, pelvic pressure, frequent urination, constipation, low back pain, and pain during sex.
Hysterectomy is the only treatment that completely eliminates fibroids and prevents them from coming back. It’s typically offered to women whose symptoms are severe, who haven’t gotten relief from medications or less invasive procedures, and who don’t plan to become pregnant. The fact that a fibroid is growing, on its own, isn’t a reason for removal. Fibroids naturally grow and shrink over time, and the risk of a fibroid turning out to be cancerous is very low, roughly 1 in 400.
One alternative worth knowing about is uterine artery embolization, a procedure that cuts off blood flow to fibroids to shrink them. In the EMMY trial, which followed women for 10 years, about 69% of women who had successful embolization avoided needing a hysterectomy later. That’s a meaningful success rate, but it also means roughly a third of women eventually needed the surgery anyway.
Endometriosis and Adenomyosis
Endometriosis happens when tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, or pelvic lining. Adenomyosis is a related condition where that tissue grows into the muscular wall of the uterus itself. Both cause painful periods, chronic pelvic pain, and sometimes heavy bleeding.
For endometriosis, hysterectomy can remove areas of tissue that are causing pain, but it’s only considered after hormonal treatments, pain management, and less invasive surgeries have failed. It’s also not a guaranteed cure, since endometrial tissue outside the uterus may remain. For adenomyosis, hysterectomy is the only definitive cure, since the problematic tissue is embedded in the uterine wall. In both cases, the surgery is reserved for women who are done having children or unable to become pregnant.
Abnormal Uterine Bleeding
Some women experience bleeding so heavy or unpredictable that it disrupts daily life. Periods that soak through a pad or tampon every hour, bleeding that lasts more than a week, or spotting between periods can all fall into this category. The causes vary widely, from hormonal imbalances to polyps to structural problems in the uterus.
Doctors will almost always try medications first, typically hormonal treatments that regulate or lighten periods. If those don’t work, a procedure called endometrial ablation (which destroys the uterine lining) may be an option. Hysterectomy enters the picture when a woman hasn’t responded to medical management, when bleeding is severe enough to affect her health, or when the underlying cause can’t be treated any other way.
Uterine Prolapse
Uterine prolapse occurs when the muscles and ligaments of the pelvic floor weaken enough that the uterus drops down into or even out of the vaginal canal. This is more common after multiple vaginal deliveries, after menopause, or in women who have done heavy lifting over many years. Symptoms include a feeling of heaviness or pulling in the pelvis, tissue protruding from the vagina, urinary problems, and difficulty with bowel movements.
Pelvic floor exercises and a device called a pessary (which physically supports the uterus) can manage mild to moderate cases. When prolapse is severe or these approaches aren’t effective, hysterectomy combined with pelvic floor repair is a common surgical solution.
Gynecologic Cancers
Cancer is one situation where hysterectomy may be medically necessary rather than elective. Endometrial cancer (cancer of the uterine lining) almost always requires a full hysterectomy, removing both the uterus and cervix, because leaving any uterine tissue behind would be unsafe. Cervical cancer has traditionally required a more extensive radical hysterectomy, which also removes the upper portion of the vagina and surrounding tissue.
Recent research has shifted treatment for some early cervical cancers. The SHAPE trial found that a simpler hysterectomy may be sufficient for tumors that are small (2 cm or less), have not deeply invaded the cervical wall, and are at low risk of spreading. Ovarian cancer treatment sometimes involves hysterectomy as part of a broader surgery, though the specifics depend on how far the cancer has spread.
Types of Hysterectomy
The underlying condition determines how much tissue needs to be removed. A partial (supracervical) hysterectomy removes the upper portion of the uterus but leaves the cervix in place. This is most commonly used for fibroids and may be preferred when removing the cervix would increase the risk of complications like bladder injury or prolapse.
A total hysterectomy removes both the uterus and cervix. This is the standard approach for endometrial cancer and is also common for many noncancerous conditions. A radical hysterectomy goes further, removing the uterus, cervix, upper vagina, and surrounding tissue, and is typically reserved for cervical cancer.
Whether the ovaries are removed at the same time is a separate decision, and it matters significantly for long-term health.
Long-Term Health Effects
Even when the ovaries are left in place, hysterectomy carries some long-term health implications that are often underappreciated. Mayo Clinic research found that women who had a hysterectomy without ovary removal still had a 33% increased risk of coronary artery disease, an 18% increased risk of obesity, a 14% increase in cholesterol abnormalities, and a 13% increase in high blood pressure compared to women who kept their uterus.
The risks were especially pronounced for younger women. Those under 35 at the time of surgery had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease. The reasons aren’t entirely clear, but the uterus and ovaries share blood supply, and removing the uterus may subtly affect ovarian function even when the ovaries remain.
None of this means hysterectomy is the wrong choice when it’s genuinely needed. But it does underscore why the surgery is treated as a last resort for noncancerous conditions, and why doctors will typically exhaust other options first. Understanding the reasons behind the recommendation, and the alternatives that exist, helps you have a more informed conversation about whether it’s the right path for your situation.