A hysterectomy is a surgery to remove a person's uterus. Sometimes, other organs from the reproductive system are removed during this surgery. These may include the:

  • cervix
  • fallopian tubes
  • ovaries
  • portions of the vagina

Each type of hysterectomy carries with it different possible side effects and complications.

Hysterectomies are a common surgical procedure in the United States. The Centers for Disease Control and Prevention (CDC) says 1 in 3 women will have a hysterectomy by age 60.

If a hysterectomy includes an oophorectomy, the removal of the ovaries, it could cause hormonal changes depending on whether the person is premenopausal or postmenopausal. These changes can include an increase in age-related issues, like bone loss, memory loss, and more.

What other age-related changes may occur in people who have this surgery? Is the risk higher with a specific type of hysterectomy? And does it matter if the person has the surgery before they reach menopause?

In this article, we'll explore what happens to the body after a hysterectomy, and how those changes can result in increased risks for age-related health issues.

The science

The majority of age-related health issues occur in people who have surgery to remove both ovaries, which is called an oophorectomy. A hysterectomy alone does not significantly impact hormones or aging. But, sometimes people have both a hysterectomy and an oophorectomy.

In women ages 45 to 64, 78 percent of hysterectomies also include ovary removal. Ovaries are the organs in the reproductive system that are responsible for producing estrogen. Research suggests that the sudden loss of estrogen is the culprit behind the increased risk of age-related health issues.

Let's break down the role estrogen plays and why it can be problematic when it's suddenly gone. The examples below are largely talking about people who have both a hysterectomy and an oophorectomy.

The effect on hormones

When a person has both a hysterectomy and their ovaries removed, their estrogen production is dramatically reduced. This hormone is responsible for a number of bodily functions. Chief among them is menstruation. When ovaries are removed, menstruation stops abruptly, and menopause begins if you are not yet postmenopausal.

For people who don't remove their ovaries during a hysterectomy, there is a risk for ovarian failure. In fact, people who do not have an oophorectomy at the time of their hysterectomy are twice as likely to experience ovarian failure compared to people who have their uteri. This, too, will lead to a decrease in estrogen, though likely more gradually.

Early menopause

Again, for people who have had both a hysterectomy and the ovaries removed, the sudden loss of ovaries will result in a steep drop-off in estrogen levels. In addition to physical changes, like hot flashes, mood swings, and vaginal dryness, low estrogen can have a number of hidden effects. In fact, 2010 research shows that people who have their ovaries removed and experience sudden menopause are more likely to experience cognitive impairment, including dementia and Parkinsonism.

Age at time of surgery

More than half of women who have a hysterectomy are younger than 44 years old. Women between ages 40 and 44 have the highest rates of hysterectomy. But research also says risks for age-related health issues, like low bone mineral density and arthritis, are more common in women who had a hysterectomy before age 45.

Other complications of estrogen loss

Estrogen also helps maintain bone strength. In people with a sudden loss of the hormone, low bone mineral density is a risk. This can lead to arthritis and osteoporosis. People who have their ovaries removed early in life should be monitored closely for signs of these conditions.

The loss of estrogen is also connected to the acceleration of tissue loss typically associated with aging. In addition to age-related health issues, a sudden loss of estrogen has been linked to increased risks of:

  • heart disease
  • stroke
  • depression
  • anxiety

Finally, estrogen plays a role in your appearance. The hormone helps the elastic fibers of your skin stay buoyant and vibrant. As estrogen declines, the skin may show signs of aging more easily.

Symptoms of low estrogen

If you have an oophorectomy, the signs of estrogen loss may be quick and sudden. For others, signs that the ovaries are failing may be more gradual. In both cases, the symptoms of low (or no) estrogen remain similar.

These symptoms of low estrogen include:

  • difficulty sleeping
  • hot flashes
  • night sweats
  • mood swings
  • depression
  • anxiety
  • irritability
  • bone density loss
  • bone fractures
  • racing heart
  • urinary incontinence
  • vaginal dryness
  • irregular periods or absence of periods (amenorrhea)
  • decreased sex drive
  • pain during sex

If you have both ovaries removed in addition to a hysterectomy, these symptoms will likely come on suddenly and be more severe. For people who have just one ovary removed, the signs may be more gradual or less severe. Your body is still producing estrogen, but it may take some time for your body to align itself with the new, lower levels of the hormone.

Lastly, if you have a hysterectomy without removing your ovaries, odds are you won't experience signs of low estrogen at first, but these symptoms may become more common. This is likely a sign that the ovaries are failing.

What you can do

If you are planning to have both ovaries removed during a hysterectomy, you may want to discuss hormone therapy with your medical professional. This treatment can help your body slowly adjust to the loss of estrogen so the signs and symptoms of menopause aren't so sudden and severe.

In turn, hormone therapy can help reduce your risk of age-related health issues common in people with a hysterectomy and ovary removal, including bone loss and osteoporosis.

Some people may be able to take hormone therapy short term. Others may need to remain on it until they reach the age of natural menopause, or 45 to 55. The average age of menopause is 51.

Likewise, your healthcare professional may recommend lifestyle adjustments that can help prevent health issues related to early menopause and estrogen loss. Exercise and an improved diet may be helpful.

How to talk with your doctor about a hysterectomy

Many people who have a hysterectomy do so to treat symptoms or pain caused by conditions like:

  • fibroids
  • endometriosis
  • uterine prolapse
  • chronic pelvic pain
  • heavy menstrual bleeding

Others may choose to have a hysterectomy to reduce their risk of certain types of ovarian and breast cancers.

If you are considering a hysterectomy and/or oophorectomy for any reason, it's important to have a candid conversation with your doctor. While the surgery may be common, it does come with risks and long-term issues you should consider.

Ask your doctor:

  • Are the risks of keeping my ovaries and/or uterus greater than the risks of removing them and developing age-related health issues?
  • Do I have specific risk factors that makes a hysterectomy more problematic?
  • Should I use hormone therapy after surgery? For how long?
  • How will this affect my fertility? Should I take steps to preserve eggs?

The bottom line

A hysterectomy with an oophorectomy can cause several age-related issues, including bone mineral loss, dementia, and Parkinsonism. What's more, the sudden loss of estrogen can lead to other health issues, like coronary heart disease, stroke, and depression.

A hysterectomy alone can also cause changes in your body. The loss of the uterus may speed up the decline of the ovaries, and ovary failure will bring about menopause. Women who have both ovaries removed before reaching natural menopause carry a long-term risk for age-related health issues.

Your doctor can help you understand the possible benefits and disadvantages of this type of surgery, especially in people who have not yet reached menopause. They can also help you prepare for the possible changes to your health and well-being that may occur after the surgery.