Hysterectomies: Understanding Your Procedure

About 20 million American women have had a hysterectomy. Interestingly, studies show that any pelvic surgery, whether it involves removing ovaries or not, contributes to a slightly earlier age of perimenopause and menopause. Experts are not certain about why that is the case, but it may involve an insult to the blood vessels that feed the ovaries, leading to a decline in their ability to function.

In terms of what else to know, first it’s important to clarify what “type” of hysterectomy you have had—or whether you’ve had another kind of pelvic procedure. Here are the main types of hysterectomies and pelvic procedures common to women in midlife along with their technical, surgical name which is the one your medical chart should reflect:

Name of procedure (short-form)

Organ(s) removed

Organs left inside you

Total abdominal hysterectomy (TAH)

Uterus including cervix

Both right and left ovaries

Total abdominal hysterectomy (TAH-BSO)

Uterus including cervix and both ovaries

No reproductive organs remain

Total abdominal hysterectomy with unilateral salpingoophorectomy (TAH-R or L SO)

Uterus including cervix and: Right ovary (RSO), Left ovary (LSO)

One of your ovaries and it’s important to know which one

Total laparoscopic hysterectomy (TLH)

Uterus including cervix

Both right and left ovaries

Subtotal laparoscopic hysterectomy (SubTLH)

Uterus (not cervix)

Cervix remains (Pap tests needed)

Radical hysterectomy with bilateral salpingoophorectomy

Uterus including cervix and both ovaries and both fallopian tubes

No reproductive organs remain (usually for precancer or cancer diagnosis)

Other Pelvic Surgery

Salpingectomy (R or LSO)

One or both fallopian tubes

Ovaries, unless specified, are still inside you

Oophorectomy

One or both ovaries

Fallopian Tubes, unless specified, are still inside you

Bilateral salpingoophorectomy (BSO)

Both ovaries AND tubes

Uterus, unless specified, is still inside you

While this may seem complicated, getting clear on which organs were removed, which remain, and which need ongoing surveillance or screening is an important way to advocate for your own health. All to say that if you don’t know, call the office of the doctor who performed the procedure and get that information.

For example, if your cervix has not been removed as part of your hysterectomy, you’ll need to continue to have occasional pap smears to screen for cervical cancer. Similarly, if you still have your fallopian tubes and/or ovaries, you’ll need to continue having pelvic exams to evaluate for ovarian cysts, ovarian cancer or fallopian tube problems.

What to Expect with Hormone Therapy

Once you know what’s still inside you, it’s much easier to understand the implications for taking menopausal hormone therapy (mHT).

The big advantage for women who have had their uterus removed is that only estrogen is needed and not progesterone. Studies to date reveal that estrogen, taken alone, has the lowest risks and may actually have a lower risk for breast cancer than post-menopausal women who don’t take any hormones at all. Some women wonder about taking progesterone, regardless, but there is no evidence for benefit and even some studies that hint at the importance of keeping it simple and avoiding hormones that aren’t needed.

The bottom line

Women can expect to spend over 30 years post-menopausal. Menopause is not an end-of-life event, it is actually a mid-life event and menopausal women need to be at their best throughout these highly productive, life-positive years. Understanding your body, including any surgical procedures you’ve had, can ensure that you’re advocating for yourself in the right ways and setting yourself up for the best long-term health possible.

Further reading