The term hysterectomy means removal of the uterus. Hysterectomies are very common surgical procedures; one in three women will have one. There are many reasons why a woman may need to have her uterus removed. The most common reason is heavy bleeding due to fibroids, which are benign growths within the walls of the uterus. Other reasons that a woman may need a hysterectomy include endometriosis, infections, and cancer. Cancer accounts for about 10% of hysterectomies performed.
The uterus is removed either through 
an incision on the lower abdomen or through the vagina. The cervix, which is the lower tip of the uterus, is also removed. The ovaries are not attached to the uterus and they are left intact during a hysterectomy procedure. However, sometimes the ovaries are removed along with the uterus and this is advisable if there is cancer in any of the female organs, or if there is extensive endometriosis or an other condition that has severely damaged the ovaries.
Yet in many cases, if a woman is approaching the age of menopause, surgeons frequently suggest also removing the ovaries, even if they are healthy. The rationale behind this is that since a woman wouldn’t need her ovaries after menopause, removing them at the time of surgery would prevent her from getting ovarian cancer in the future. In some studies taking out the ovaries for this reason occurred in up to 38% of hysterectomy cases.
Let me explain why this is not a good idea.
Why taking out healthy ovaries is a bad plan
First of all, ovarian cancer is relatively rare, affecting only 1.2% of women. Compare this to how many women will develop breast cancer, which is 12%, or lung cancer which is 5%.
We certainly don’t promote removing a woman’s breasts or lungs simply to prevent these cancers!
And the downsides are considerable. During natural menopause, there is a gradual decrease in hormone production over a number of years. While this transition does cause a number of significant symptoms, taking the ovaries out surgically and inducing menopause overnight can be a much more dramatic event. The abrupt loss of hormones wreaks havoc on a woman’s body. All the typical menopause symptoms tend to be more severe, such as hot flashes, night sweats, mood changes, and sleep disturbance. Changes in the vagina, such as dryness, decreased elasticity, and thinning of the tissues develop rapidly, leading to pelvic discomfort, pain with intercourse, and an increased risk of vaginal and bladder infections. In addition, since the ovaries also produce testosterone, the loss of this hormone negatively affects libido and sexual function.
Hot flashes and other symptoms are very obvious aftereffects, but what many women don’t realize is that these symptoms are just the tip of the iceberg. Hundreds of studies now document that women who go through early surgical menopause face higher risks of multiple medical problems.
The long-term negative effects of removing the ovaries prematurely and how to prevent them
There is an accelerated rate of bone loss – some women can lose as much as 20% of their bone mass within 18 months of having their ovaries taken out. This increases the risk of osteoporosis and fractures.
Studies have demonstrated that women’s cholesterol levels rise and that fat gets deposited around the abdomen. These changes increase the risk of heart disease, strokes, and diabetes. The rate of heart disease is much higher in women who have lost their ovaries compared to women of the same age whose ovaries are not removed.
In addition it has been shown women who lose their ovaries prematurely have higher rates of dementia. One study found that these women had twice the risk as women who went through menopause at the normal time. There is even a decrease in life expectancy in women undergoing surgical menopause.
Fortunately hormone replacement with estrogen will ameliorate most of the symptoms and prevent many of the medical complications that I’ve described. The research on this is so strong that just about every menopause expert strongly advocates placing women on estrogen after her ovaries have been removed and this should be continued to the time when women normally go through menopause, which is about age 52. Whether or not to continue HRT beyond that time is a decision women will need to make, similar to women who go through natural menopause at the normal time.
Effects of hysterectomy without removing the ovaries
Women whose ovaries are not removed at the time of the hysterectomy will not go through the symptoms and medical problems discussed above, because the ovaries will continue to produce hormones just like they were doing prior to surgery. The main impact of a hysterectomy is that a woman will no longer have menstrual periods or be able to get pregnant. If the uterus had been causing pain or fullness in the lower abdomen, those symptoms would resolve. Otherwise the majority of women should not be aware of the fact the uterus is gone. The vagina does not feel different either to a woman or her partner and there should be no change in sexual function or orgasms (as long as hormone replacement is taken).
A woman who has had a hysterectomy will go through menopause eventually, but interestingly this may occur up to several years earlier than if she had not had the surgery. The reasons for this are unclear, but likely related to an alteration in the blood supply to the ovaries, which may cause them to stop functioning sooner.
The importance of being informed before surgery
Studies show that many women 
undergoing a hysterectomy are not fully informed about the benefits and risks of either leaving or removing the ovaries. As noted, in some cases there are clear-cut reasons for taking them out along with the uterus, but in many cases this is not justifiable.
If a doctor tells a woman that removing the ovaries will decrease her risk of ovarian cancer, she needs to understand that this benefit is very minimal compared to the other short-term and long-term effects of loosing her estrogen years before she normally would go through menopause. In addition, if her ovaries are removed, she also needs to be informed about the important role that estrogen replacement therapy plays in preventing some significant health risks.
Hello! I am 51 and schedule to have hysterectomy due to multiple large fibroids. My surgeon left it up to me to decide if I want my ovaries taken out too. My Mom was diagnosed of ovarian cancer when she was 47 metastasize to her bone and died at 51. My genetic test was showing VUS result. Will still benefit me if I keep my ovaries ? or should I have them both remove? Please let me know Thank you
Hello Diane thanks for your question. I cannot give direct medical advice, but here are some things to consider. In general, there is a consensus among menopause experts for women to keep their ovaries when they have a hysterectomy for benign disease, unless they are postmenopausal or close to menopause. This is because premature removal of the ovaries creates a number of years without estrogen, and this increases the risk of osteoporosis, heart disease, diabetes, and cognitive decline. However these impacts are proportional to the number of years that the ovaries are removed prior to the age of menopause. Since you are about the normal age of menopause, removing the ovaries likely will not put you at much greater risk in these areas. The other concern is your family history of ovarian cancer. Even though it may not appear genetic, there are genes that we don’t even know about that promote ovarian cancer, and when women have cancer fairly young, that raises the suspicion that genes are involved.
The other slight downside to removing the ovaries is that the testosterone level will be lower. Most women don’t have too much effect from this but some woman note a decrease in libido and a general decrease in energy.
The bottom line is that the younger a woman is, the more benefit she will have by keeping the ovaries. There is less benefit as women get closer to menopause. I hope this is helpful. Sandra
Greetings Dr. Rice,
In 2019, I was diagnosed with DCIS breast cancer in my right breast. I had a lumpectomy, followed by radiation, and prescribed Tamoxifen 20 mg for 5 years because the tumor removed tested positive for estrogen at 98%. I am currently 45 years old. I tested negative for genetics. Tamoxifen use has caused some issues with my uterus. I was thinking about talking to my gynecologist about a hysterectomy. I was opting for a full hysterectomy and keeping my ovaries but now reconsidering and probably should have them removed due to the estrogen positive tumor. What are your thoughts? Thank you for your time and expertise.
Hello Carol, I am very sorry to be so tardy in addressing your comment. I had shoulder surgery and not able to do much on the computer until now. Your situation is very complicated and I really can’t advise you what to do, but here are things to consider. Presumably you are premenopausal and likely will still be when you finish your tamoxifen at age 47 since the average age of menopause is 52. Currently the tamoxifen is blocking the estrogen being produced by the ovaries but when you go off the tamoxifen you will once again have estrogen in your system (although sometimes being on tamoxifen can make menopause occur earlier than normal).
That means that your ovaries will still make estrogen for up to five or more years. The down side of this is that this would put you at a slightly higher risk of having another breast cancer. Taking the ovaries out now would eliminate any future estrogen production from the ovaries and decrease your future risk.
The question is, would keeping the ovaries in and having a few more years of estrogen in your system be of any advantage? You may have less hot flashes and better sleep. Currently the tamoxifen is helping keep the bones strong like estrogen does, but when you stop the tamoxifen and don’t have estrogen, the bones will become weaker sooner and put you at an increased risk for osteoporosis down the line. So that should be monitored and fortunately today we do have other non-hormone treatment for osteoporosis.
Whether having no estrogen in your system after you are off the tamoxifen will increase the risk of heart disease and diabetes is unclear. There may be a slightly greater risk. Taking measures to maintain an ideal weight and monitoring and treating any elevations in blood sugar and cholesterol would be important.
The only other effect to consider in removing the ovaries now is that your testosterone level may be slightly lower. Most women don’t have too much effect from this but some woman note a decrease in libido and a general decrease in energy.
Unfortunately we don’t have a crystal ball to know what sort of health impacts may be of more significance in your situation. Odds are, the slight increase risk in breast cancer by keeping the ovaries in may outweigh the other benefits – mainly because of your current age and proximity to menopause. If you were much younger, say in your early 40’s, likely you would have more benefit by retaining the ovaries.
Again, I am sorry for the delay and hope my late response may be of some help. Sandra
Hi Dr. Sandra,
This is Shalini. I like your post. This is the first time I hear from an expert giving reasons why we do or don’t go for these surgeries without understanding the repercussion.
I appreciate your advice as last year in June of 2021 I was diagnosed with hormone positive Breast cancer in both my breast. I am now 44 years old. Long story short I had 6 months of aggressive Chemo (13 sessions from July to Nov) then had my double mastectomy on 12/15/21, had radiation for 5 weeks (Feb -March 2022). Now I am on Lupron injections(had two already) and should start Armidex (but I am holding off for another month) as side effects extreme fatigue, body aches, sleepless night, hot flashes…. are so much that I don’t want to introduce another variable of Armidex.
My doctors suggesting me for removal of ovaries, Fallopian tube & may or may not uterus. The call is mine but I don’t want to go for any more surgeries as for preventive method what will come next is my fear.
I never had painful periods or fibroids or so far any menses related issue, other than frequent urination.
Right now I am doing intermittent fasting to fix myself but I need some help that what should I choose to do as of my age for future quality of life.. I have along life ahead, I have 2 kids , 13(son), 11(daughter) and my husband is 49.
I don’t drink or smoke, I am vegetarian and pretty healthy life style overall.
Please advise, I am lost.
Regards,
Shalini
Hello Shalini, thank you for sharing your story. You have been through a lot. I cannot advise you what to do, but when a breast cancer patient is advised to consider removal of the ovaries, it is usually because it is suspected the patient has a genetic profile that puts them at risk for cancer of the ovary, and usually this is based on blood tests that test for certain gene profiles. My suggestion is that you consult with a genetic counselor. Hopefully your oncologist, surgeon or primary care doctor can recommend one to you. The counselor could explain any tests you have had, or advise you to have other ones and then he or she should be able to give you some numbers regarding your potential risk of another type of cancer. You then need to decide how much risk you are willing to take and compare that to the risk of a surgery. In general, the risks of a surgery are very, very low. As far as the other downsides, removal of the uterus and ovaries will obviously preclude any future pregnancies. Otherwise, removing the ovaries leads to no further hormone production (which includes estrogen, progesterone and testosterone). As it is, the chemotherapy that you have had may have already stopped the production of any hormones by the ovaries. I hope this is helpful. Sandra
After reading this article I am so thankful that I was under your care when I went through a complete hysterectomy at such a young age (37) and that you had me on estrogen replacement which I stayed on until just a few years ago. I’m 71 now and do struggle with high cholesterol and elevated sugar levels but so far have been able to control it with lots of exercise and diet. Thank you for your foresight in keeping me on estrogen replacement for those years in a attempt to ward off some of the health risks associated with having ovaries removed so young.
Hi Faye! How nice to hear from you and share your comment. I appreciate your ongoing support. Say Hello to Eric. Sandy
I hope this reaches you VERY soon. I am scheduled for a total hysterectomy including bilateral oophrectomy in one week. I am 52 – I’ll be 53 in less than months. Lab work confirms the presence of menopause. I stopped menstruation last October. Then started back up in May this year. The flow has been very heavy and the tenure between 6-9 days. TVS confirms an enlarged uterus and 19mm endometrium. The ovaries “were not seen”. I thought this was a good thing, assuming there were probably small and possibly atrophied. I am scared to lose my ovaries based on all the information I am reading, but more scared of ovarian cancer as the “silent killer”. I lost a dear friend many years ago to ovarian cancer. She had a hysterectomy for fibroids and they left one ovary. I know the percentage is low, but it happened to her and watching her pain and degradation adds to my fear. Additionally, recent generic testing put me at 26% risk for breast cancer. However, there was no correlation to the risk of developing female cancers on this genetic profile/risk assessment. I have a strong family history of breast cancer on my maternal side (mom, aunt and grandmother) I’m wondering if you have any thoughts on someone with my backstory having the ovaries removed – or will keeping one make any sense at this point?
Hi Susan, I am so sorry to be tardy in responding. I am recovering from surgery and Covid. I believe that at your age and in your situation, losing your ovaries at this point would not cause significant problems. It mainly is an issue for premenopausal women. You may experience a drop in testosterone, but most women in your age group don’t find this too troubling. I believe that women in your situation would benefit GREATLY from starting a transdermal estrogen for HRT after the ovaries are removed. Sandra