The Hidden Truth About Hysterectomy: What Every Woman Needs to Know Before Making This Life-Changing Decision

Dr. Salome Masghati, MD
Sep 21
6 min read

As a board-certified gynecologist with fellowship training in Minimally Invasive Gynecologic Surgery (MIGS), I've performed over 500 hysterectomies throughout my career. But what I'm about to share with you might surprise you—and it's information that could fundamentally change how you approach this decision.

After years of performing these surgeries and now focusing on optimizing women's health through an integrative approach, I've gained a unique perspective that most women never hear from their doctors. Today, I want to share the complete truth about hysterectomy, including recent research that has shocked the medical community.

The Shocking Discovery That Changes Everything

A groundbreaking study called the Multi-Ethnic Study of Atherosclerosis (MESA) recently revealed something that challenges everything we thought we knew about hysterectomy. The research found that women who had hysterectomy with ovarian preservation had a 32% higher risk of developing metabolic syndrome compared to women who never had surgery.¹

Let me repeat that: even when ovaries are kept, hysterectomy significantly increases your risk of heart disease, stroke, diabetes, and premature death.

This finding has profound implications for the millions of women who undergo hysterectomy each year, believing that keeping their ovaries will protect their health.

Why Preserved Ovaries Don't Work the Way We Thought

For decades, doctors and patients believed that preserving ovaries during hysterectomy would maintain normal hormone production. We were wrong.

Here's what actually happens:

Blood Supply Disruption: Your uterus and ovaries share blood vessels through what we call the "utero-ovarian anastomosis." During hysterectomy, even when ovaries are preserved, this removes 20-25% of the blood supply to your ovaries.²

Immediate Hormonal Changes: Studies show that ovarian function begins changing immediately after hysterectomy:

FSH and LH levels rise (your pituitary gland working harder to stimulate struggling ovaries)
AMH levels drop (indicating reduced ovarian reserve)
Estradiol and progesterone levels begin declining³

Accelerated Ovarian Aging: Research demonstrates that women who have hysterectomy are nearly twice as likely to experience ovarian failure and reach menopause 1-2 years earlier than they would naturally.⁴

The Critical Question: Do You Really Need Surgery?

Most hysterectomies performed today are elective, meaning they're not life-threatening emergencies. This gives you time to make an informed decision—but it also puts the responsibility squarely on your shoulders.

True Medical Emergencies (Rare)

Life-threatening bleeding that can't be controlled
Aggressive cancers requiring immediate treatment
Severe infections unresponsive to antibiotics

Most Common Reasons (Usually Have Alternatives)

Uterine fibroids: Affect up to 80% of women by age 50
Heavy menstrual bleeding: Often related to hormone imbalances
Endometriosis: Can frequently be managed without removing the uterus
Adenomyosis: May respond to hormone therapy

The Perimenopause Connection Many Doctors Miss

If you're in your 40s experiencing heavy, irregular bleeding, you might be dealing with perimenopause rather than a condition requiring surgery. Understanding this natural transition can save you from unnecessary surgery.

What's Really Happening

During perimenopause, two critical hormone disruptions occur:

The Missing Estradiol Peak: In normal cycles, there's a crucial estradiol peak around day 12 that stabilizes your uterine lining. Without this peak, the lining becomes unstable and prone to irregular bleeding.

Progesterone Deficiency: When you don't ovulate regularly, you don't produce progesterone. The problem isn't "estrogen dominance"—it's progesterone deficiency. Without progesterone to organize and stabilize the lining, it grows chaotically under estrogen stimulation.

Optimal Hormone Levels

Peak estradiol: 250-500 pg/mL (mid-cycle surge)
Luteal phase progesterone: Above 15 ng/mL

Many women find that bioidentical hormone replacement using physiologic restoration that reproduces natural hormone peaks can resolve bleeding issues without surgery.

Modern Causes of Abnormal Bleeding

Several factors affecting today's women contribute to abnormal bleeding:

Insulin resistance and obesity: Disrupts hormone balance and ovulation
COVID-19 and spike protein effects: Can affect ovarian function and cause cycle changes
Thyroid dysfunction: Often worsens during perimenopause
Chronic inflammation: From various sources affecting hormone signaling

Alternatives Worth Trying First

Before considering hysterectomy for benign conditions, explore these evidence-based alternatives:

Minimally Invasive Procedures

Uterine Fibroid Embolization (UFE): Blocks blood flow to fibroids
ACCESSA Procedure: Uses radiofrequency energy to target fibroids specifically
Endometrial ablation: Destroys uterine lining (though 1 in 5 women still need hysterectomy later)

Bioidentical Hormone Therapy

Rather than synthetic GnRH agonists that shut down all hormone production, consider bioidentical hormone therapy that works with your body's natural rhythms.

Targeted Nutrition Support

Iron optimization: Use heme iron or ferrous bisglycinate (avoid sulfate forms)
Anti-inflammatory support: Omega-3 fatty acids, curcumin
Hormone-supporting nutrients: Vitamin D with K2, magnesium, B-complex vitamins

The Hormone Replacement Truth After Hysterectomy

If you do have hysterectomy, hormone replacement becomes more complex than most doctors realize.

Even With Preserved Ovaries

You may still need hormone replacement because:

Ovarian function declines faster after surgery
Comprehensive hormone testing can begin as early as 2 weeks post-surgery
HRT can be started immediately if levels are deficient

The Progesterone Factor Most Doctors Ignore

Many women don't realize that progesterone remains beneficial even after hysterectomy. Progesterone receptors exist throughout your body, providing benefits for:

Bone density and fracture risk reduction
Better sleep quality and reduced anxiety
Brain health and cognitive function
Cardiovascular health
Balancing estrogen effects throughout the body

Bioidentical micronized progesterone is the preferred form for optimal absorption and fewer side effects.

Optimizing Your Recovery

If you do choose surgery, proper nutrition can dramatically impact your outcomes:

Pre-Surgery (7-10 days before)

Carbohydrate loading: 8g per kg body weight daily
High-quality protein: 1.2-2.0g per kg body weight daily
Glutathione support: 2-3 swishes daily to optimize cellular antioxidant status

Post-Surgery Support

Protein priority: Up to 2.5g per kg daily for healing
Anti-inflammatory nutrients: Vitamin C, zinc, omega-3s
Pelvic physical therapy: Should be routine for all post-hysterectomy patients

Making Your Decision

Creating a decision framework helps clarify what's right for you:

Quality of Life Assessment

Rate these areas (1-10):

Physical comfort and energy
Sleep quality
Work productivity
Relationship satisfaction
Sexual health
Emotional well-being

If multiple areas score below 5 and directly relate to your gynecologic condition, surgery may significantly improve your quality of life.

Values Clarification

Rank these in order of importance:

Preserving natural anatomy
Eliminating symptoms
Avoiding surgical risks
Maintaining fertility options
Optimizing long-term health
Improving quality of life now

Finding the Right Specialist

Not all gynecologists have the same expertise. Consider:

MIGS specialists: Fellowship-trained in minimally invasive techniques
NAPRO surgeons: Focus on fertility-preserving approaches
Gynecologic oncologists: Essential for cancer-related surgery
Urogynecologists: For concurrent pelvic floor issues

The Bottom Line

Hysterectomy can be life-changing in positive ways when it's truly needed. But the decision requires understanding:

Even preserving ovaries doesn't guarantee normal hormone function
Many bleeding problems are actually hormone imbalances that can be corrected
Multiple effective alternatives exist for most benign conditions
Proper hormone replacement after surgery is more complex than most realize
Your surgeon's expertise significantly impacts your outcome

As someone who has stood on both sides of this decision—as a surgeon performing these procedures and as a physician now focused on helping women optimize their health naturally—I encourage you to explore all your options thoroughly.

Remember: except in true emergencies, you have time to get second opinions, try alternatives, and make an informed decision that aligns with your values and goals.

Your health, your body, your choice—but make it an informed one.

Dr. Salomé Masghati is a board-certified obstetrician-gynecologist with fellowship training in Minimally Invasive Gynecologic Surgery. She now focuses on women's health optimization through integrative approaches. For personalized guidance on your specific situation, consider consulting with a qualified healthcare provider experienced in both surgical and non-surgical approaches to women's health.

References

Broni EK, Echouffo-Tcheugui JB, Palatnik A, et al. Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis. American Journal of Obstetrics & Gynecology. 2024;230(3):S1084-S1085.
Moorman PG, Myers ER, Schildkraut JM, et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics & Gynecology. 2011;118(6):1271-1279.
Laughlin-Tommaso SK, Khan Z, Weaver AL, et al. Cardiovascular risk factors and disease after hysterectomy with ovarian preservation. Menopause. 2018;25(5):483-492.
Parker WH, Feskanich D, Broder MS, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses' Health Study. Obstetrics & Gynecology. 2013;121(4):709-716.
Mytton J, Evison F, Chilton PJ, Lilford RJ. Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage. BMJ. 2017;356:j372.
Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstetrics & Gynecology. 2013;121(3):654-673.
American College of Obstetricians and Gynecologists. Practice Bulletin No. 89: Elective and Risk-Reducing Salpingo-Oophorectomy. Obstetrics & Gynecology. 2008;111(1):231-241.
Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. 2015;(8):CD003677.
The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992.
Edelman A, Boniface ER, Benhar E, et al. Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19) Vaccination. Obstetrics & Gynecology. 2022;139(4):481-489.