Hysterectomy - How it Can Influence your Long Term Health
- Jun 8
- 6 min read
If you have been offered a hysterectomy for heavy periods, chronic pelvic pain, fibroids, or any other gynaecological diagnosis, the focus of conversations with your doctor have probably been about symptom improvement.
But there is a growing body of research on the long term implications of this surgery that rarely makes it into the appointment where the decision is being made. This information is really important to know before you say yes to something irreversible, so you are able to make an informed decision about what is right for you.
The uterus does more than most women realise. And removing it has implications that extend well beyond the reproductive system.
What the Research Shows About Long Term Health
There is an established body of evidence on what hysterectomy does to long term health that is rarely discussed with women at their gynaecology appointments. Hysterectomy has impacts on:
The Cardiovascular System - A 2023 nationwide cohort study of over 135,000 women published in JAMA Network Open found that hysterectomy before age 50 was independently associated with an increased risk of cardiovascular disease, including stroke, even in women who kept their ovaries. This suggests the uterus itself may have a protective cardiovascular role that has nothing to do with oestrogen.
Ovarian Function - Even when the ovaries are conserved, surgery appears to accelerate their decline. Most women experience menopause two to four years earlier than they otherwise would have. Earlier menopause means earlier bone density loss, earlier cardiovascular changes, and earlier cognitive changes, all of which are manageable when anticipated, and harder to address when they come as a surprise.
Pelvic Health - Pelvic organ prolapse is another well-documented long term risk. The uterus and its supporting ligaments are part of the structural integrity of the pelvic floor. A 2023 national cohort study found that hysterectomy significantly increases the risk of prolapse surgery, with a Finnish ten-year follow-up finding that over 16% of women required prolapse reoperation after hysterectomy.
Bone Health - Bone density loss, sexual function changes, and the downstream effects of earlier menopause on cardiovascular and cognitive health round out a long term picture that is more complex than the surgery itself suggests.
Hysterectomy Does Not Cure Endometriosis
This is one of the most important things to understand, and one of the least clearly communicated. Endometriosis is not a disease of the uterus. It is a systemic condition where tissue similar to the uterine lining grows on the bowel, bladder, peritoneum, ovaries, and elsewhere in the body. Removing the uterus removes one location where tissue can grow and may be a useful strategy to manage the chronic pain often associated with the menstrual cycle where other options have failed. However it does not remove the lesions that already exist on other tissues, and it does not address the inflammatory, hormonal, and immune drivers that created them.
Research has found that approximately 21% of women with endometriosis continue to experience symptoms after hysterectomy. When ovaries are conserved and oestrogen production continues, existing lesions remain active and recurrence rates are significantly higher. For endometriosis, surgery manages a site of the disease. It is not a cure.
"What I see regularly in clinical practice is women offered hysterectomy for heavy periods without any investigation into what is driving them. Heavy bleeding has causes: oestrogen dominance, low progesterone, thyroid dysfunction, iron deficiency, fibroids driven by hormonal imbalance. These are identifiable and in many cases addressable. The goal is to find and treat the cause so the symptom resolves, rather than removing the organ that is expressing it." - Gemma Knaap, Naturopath | Southernwood Apothecary & Clinic.
What We Are Still Learning About the Uterus
For a long time, medicine operated on the assumption that once a woman has finished having children, the uterus is essentially redundant. However as we continue to learn more about women's health, that assumption is being challenged.
Research from Arizona State University found that rats who had their uterus removed but ovaries left intact developed measurable memory deficits within weeks of the procedure. The uterus appears to communicate with the brain via the autonomic nervous system independently of oestrogen. A research program is now underway to understand what this means for neurotransmitter function in women who have had hysterectomies. It's important to note that this research is primarily in animal models and has not yet been replicated in humans, however it raised intriguing questions about how much we are still learning about women's bodies.
What Else Is Worth Exploring First
For many gynaecological conditions, several effective and less invasive options exist and deserve to be part of the conversation before surgery is considered. Naturopathic approaches that identify and treat the hormonal, nutritional, and inflammatory drivers of symptoms can be remarkably effective. When the underlying cause is addressed, the problem often resolves itself.
If Surgery Is the Right Choice
For some women, hysterectomy is the right decision. Certain cancers, severe adenomyosis, and other conditions where every other option has genuinely been exhausted are all situations where it may be the most appropriate path.
When that is the case, knowing what to expect and having support in place can help to make sure that you reduce your risk of poor health in later years. Supporting bone density, cardiovascular health, and the earlier hormonal transition through diet, lifestyle, and targeted naturopathic care means the long term implications are managed proactively rather than discovered after the fact.
The Question Worth Asking
Before making this decision, it is worth asking whether the underlying cause of your symptoms has been properly investigated. Whether alternatives have been genuinely explored. And whether you have the full picture of what the research says about life after hysterectomy. You are allowed to ask for more time, more information, and more options. That is not being a difficult patient. That is informed consent.
If you want to help to understand what is driving your symptoms and what options exist before or alongside surgery, I'd love to help. Bookings can be made for both in person and Telehealth consultations by clicking here. 🌿
Frequently Asked Questions
Is hysterectomy a cure for endometriosis?
No. Endometriosis grows outside the uterus on the bowel, bladder, peritoneum, and other structures. Removing the uterus does not remove these lesions or address the underlying drivers of the disease. Research shows approximately 21% of women with endometriosis continue to experience symptoms after hysterectomy, with significantly higher recurrence rates when the ovaries are conserved.
Does hysterectomy affect brain function?
Emerging animal research from Arizona State University suggests the uterus communicates with the brain via the autonomic nervous system independently of oestrogen, and that its removal affects memory and neurotransmitter function. This research has not yet been fully replicated in large human studies, but it is published and peer-reviewed and raises important questions about the organ's systemic roles.
Does hysterectomy increase cardiovascular risk?
A 2023 nationwide cohort study of over 135,000 women published in JAMA Network Open found that hysterectomy before age 50 was independently associated with an increased risk of cardiovascular disease, including stroke, even in women who kept their ovaries. The association held after controlling for other cardiovascular risk factors.
What are the alternatives to hysterectomy for heavy periods?
Several effective and less invasive options exist for treating heavy periods. Naturopathic approaches that address the hormonal, nutritional, and inflammatory drivers of heavy bleeding are worth exploring before a permanent surgical decision is made.
Can a naturopath help with heavy periods or endometriosis?
Yes. A naturopath works to identify and address the underlying drivers of heavy periods and endometriosis, including oestrogen dominance, low progesterone, thyroid dysfunction, iron dysregulation, gut health, and chronic inflammation. This work complements medical management and is relevant both as an alternative to surgery where appropriate and as support before and after surgical care. Telehealth consultations are available across Australia.
About the Author
Gemma Knaap is a naturopath practicing in Albany, WA and via Telehealth across Australia, specialising in women's hormonal health, gut health, and reproductive wellbeing. She holds a Bachelor of Health Science in Naturopathy and is a Certified Natural Fertility Educator and Gut Microbiome Analyst. Gemma is based in Albany, Western Australia.
References
Koebele, S.V. et al. Hysterectomy uniquely impacts spatial memory in a rat model: A role for the nonpregnant uterus in cognitive processes. Endocrinology. https://www.nia.nih.gov/news/uterus-plays-role-brain-function-animal-study-shows
Bimonte-Nelson, H. (2024). ASU research finds link between removal of uterus and brain function. ASU News. https://news.asu.edu/20240528-health-and-medicine-asu-research-finds-link-between-removal-uterus-brain-function
Yuk, J.S. et al. (2023). Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women. JAMA Network Open, 6(6), e2317145. https://doi.org/10.1001/jamanetworkopen.2023.17145
Aagesen, A.H. et al. (2023). Hysterectomy on benign indication and risk of pelvic organ prolapse surgery. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.14561
PMC. (2023). Pelvic organ prolapse after hysterectomy: A 10-year national follow-up study. https://pmc.ncbi.nlm.nih.gov/articles/PMC10072247/
Hassan, M.A.M. et al. (2023). Long-term outcomes of hysterectomy: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2023.06.043
PMC. (2023). Osteoporosis and Fracture Risk Following Benign Hysterectomy Among Female Patients in Korea. https://pmc.ncbi.nlm.nih.gov/articles/PMC10716721/
Facts, Views and Vision in ObGyn. (2014). Recurrence of endometriosis after hysterectomy. https://pmc.ncbi.nlm.nih.gov/articles/PMC4286861/
Zimmerman, J. et al. (2023). Long-Term Follow Up of Sexual Function after Perimenopausal Hysterectomy. Journal of Clinical Medicine, 12(15), 4976. https://doi.org/10.3390/jcm12154976
Tags: hysterectomy, heavy periods, endometriosis, informed consent, naturopath, women's health, pelvic organ prolapse, alternatives to hysterectomy, hormonal health, telehealth, Albany WA
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