FTM Hysterectomy Pros and Cons: Should You Keep Or Remove Ovaries?

A hysterectomy is often performed to resolve:

• Uterine fibroids that cause pain or bleeding
• Uterine prolapse
• Ovarian cancer
• Endometriosis
• Abnormal vaginal bleeding
• Chronic pelvic pain
• Adenomyosis

Types of Hysterectomy

The surgeon will discuss the type of hysterectomy needed by the patient, depending on the condition. There are four types of hysterectomy:

Total Hysterectomy – removing the uterus and cervix, but leaving the ovaries.

Supracervical hysterectomy – Removing just the upper uterus

Risk Reducing Salpingo Oophorectomy – Removes the uterus, fallopian tubes and ovaries. The operation is typically performed on people with ovarian cancer or chronic pain due to recurring endometriosis

Benefits of Removing Both Ovaries

• Decreases the risk of subsequent gynecological tumors, especially in people with a strong family history of the BRCA mutation
• Reduces ovarian cancer risk
• Eliminates the development of ovarian cysts
• Reduction of estrogen production decreases gender dysphoria for some people
• Correction of high estrogen levels in people undergoing hormone therapy
• Some transgender patients can reduce the Testosterone dosage they take post-op

Disadvantages of Removing Both Ovaries

• Permanent loss of fertility
• Some may be required to take low-dose estrogen therapy in conjunction with hormone replacement therapy (HRT). This is to maintain hormonal balance
• People who are not on HRT may have an increased risk of osteoporosis

Benefits Of Retaining Ovaries

• Patients have the option for future fertility
• Studies on cis female populations who underwent oophorectomy found that it had negative health implications on the bone, heart, cognitive and sexual health. (Note that there are no studies on the long-term risks for transmasculine patients)
• People without HRT can still have natural hormone production
• Reduced risk of osteoporosis
• Prevention of vaginal dryness and discomfort

Disadvantages of Retaining Ovaries

• Premenopausal women who stop taking testosterone therapy may experience menstruation and ovulation
• Treating cysts and fibroids could become more difficult
• Undergoing oophorectomy after hysterectomy is technically more difficult as they usually fall and stick to the pelvic sidewalls. This means patients who want to have their ovaries removed are at a high risk of sustaining damage to their uterus and blood vessels.

Hysterectomy Risks

In general, a hysterectomy is a safe procedure. But like other major surgeries, it comes with the risk of complications.

Common risks associated with a hysterectomy include:

• Blood clots
• Infection
• Excessive bleeding
• Adverse reaction to general anesthesia
• Damage to surrounding tissues
• Earlier onset of menopausal symptoms

Patients who have any of these symptoms should seek medical attention:

• Fever or chills
• Heavy bleeding
• Unusual vaginal discharge
• Severe pain
• Discharge from incisions
• Redness around the incision site
• Problems urinating or having a bowel movement
• Chest pain

How To Prepare For A Hysterectomy

Much like any other surgery, patients are advised to be mentally and physically prepared for the procedure to help ensure success and speed up recovery. Here are some general tips:

Gather information. Before undergoing bilateral oophorectomy, prophylactic oophorectomy, and hysterectomy, it is best to be educated about how the procedure will go and what the recovery process looks like. This helps patients be comfortable with what to expect from the surgery.

Lose weight. Being overweight can pose a significantly increased risk for complications. Severe obesity can increase the time it takes a surgeon to perform the preventive surgery as well as blood loss during the procedure. Patients who may be overweight can discuss with their doctor the best ways to go about losing weight prior to the surgery.

Stop smoking. Smoking can also increase the risk of complications associated with general anesthesia and recovery.

Discuss your medical history with your surgeon. Talk to your doctor about your medical history, including your medication(if any) and any pre-existing conditions. Some medications and underlying medical conditions may make the surgery more complex.

Take some time off work during the recovery period. Fill out any paperwork needed for a medical leave before the surgery. Usually, patients need between two to six weeks to recover. During the recovery process, patients are advised against driving or lifting heavy objects.

Who Is A Good Candidate For Hysterectomy?

Criteria for hysterectomy and bilateral oophorectomy in transgender patients include:

• Persistent and well-documented gender dysphoria or gender identity disorder
• Capacity to make a fully informed decision
• At least 12 months of continuous hormone therapy

Hormone therapy is advised prior to the surgery to introduce reversible estrogen or testosterone suppression surgery.  

What To Expect During Recovery Period

After a hysterectomy, the patient may be asked to stay at the hospital for a brief period to recover. However, the duration of the entire recovery process depends on the type of hysterectomy performed.

Abdominal hysterectomy. Most patients are allowed to go home two to three days after the surgery. Complete recovery may take six to eight weeks. Patients may engage in sexual intercourse after six weeks.

Vaginal hysterectomy. A vaginal hysterectomy is less invasive than an abdominal hysterectomy. This means recovery time is significantly reduced, with some making a full recovery after two weeks. Many are sent home the same day or the next day following the operation. It is generally advised to abstain from any sexual activities for six weeks.

Laparoscopic supracervical hysterectomy (LSH). This procedure is the least invasive type of hysterectomy. Recovery period can be as short as six days to two weeks.

A hysterectomy is a surgical procedure performed to remove the uterus. Depending on the reason for the surgery, the procedure may also involve removing the surrounding organs and tissues.

Frequently Asked Questions

Can you engage in sexual intercourse after a hysterectomy?

Patients would have to wait at least six weeks before partaking in penetrative sex.

How much does a hysterectomy cost?

The cost of getting a hysterectomy varies widely between surgeons and procedures. Certain risk factors, such as coronary heart disease, can also make the procedure more complex, thus costing more.