Hysterectomy

Overview

What Is It?

A hysterectomy is a common surgical procedure that removes a woman's uterus. Hysterectomies are performed to treat various medical conditions including uterine fibroids, abnormal uterine bleeding, pelvic prolapse and several kinds of cancer.

A hysterectomy, or surgery to remove the uterus, is the second most common major surgery among women in the United States, second only to cesarean section. About one-third of American women will have a hysterectomy by the time they are 60.

Why Is a Hysterectomy Performed?

Several medical conditions can be treated or cured with a hysterectomy. Of the approximately 600,000 hysterectomies each year in the United States, about one-third are performed to treat uterine fibroids. Hysterectomies are also performed to treat endometriosis and to stop abnormal uterine bleeding, although alternative, less invasive treatments for these conditions now are available. Other reasons to have a hysterectomy include:

• endometrial hyperplasia with atypia, an overgrowth of the uterine lining in which uterine cells contain precancerous changes
• cancer of the uterus, ovaries, fallopian tubes or cervix
• pelvic prolapse, in which the ligaments that support pelvic structures like the uterus weaken and the organs drop
• uterine fibroids, when other, less invasive treatments have not provided relief. (Myomectomy, removal of just the fibroids, is a less invasive surgical option for fibroid removal.)
• colon or bladder cancer that has spread to the uterus
• uncontrollable bleeding after childbirth (rarely)

Pros and Cons of a Hysterectomy

For some women, a hysterectomy is the answer to years of suffering from uterine problems. For others, hysterectomy is a last resort to treat cancer or another life-threatening condition.

Unless you have a severe pelvic infection, cancer or uncontrollable bleeding, there is usually no reason to rush into the decision. Because most hysterectomies are elective procedures (as opposed to emergencies), there is usually plenty of time to explore all options.

Diagnosis

A hysterectomy may be recommended as treatment for a variety of gynecologic conditions. However, in most cases, a hysterectomy is the most invasive option and only one of various treatments that may be available to you. Like any major surgery or treatment, it should be considered carefully, and you should understand why it's being recommended and the risks and benefits associated with it.

There has been much concern in recent years that too many unnecessary hysterectomies are performed. To decide if a hysterectomy is the right procedure for you, consider getting a second opinion. Most insurance companies will cover the cost. You may want to ask your primary care doctor for a referral to another doctor. Seeking the advice of another health care professional could reveal options you may not have considered.

Below is a list of conditions that often are treated with a hysterectomy; benefits and risks of other treatment options are also included.

Abnormal Uterine Bleeding (AUB)

Many women with abnormal uterine bleeding (AUB) have a hysterectomy, but this approach may be more aggressive than necessary. Abnormal uterine bleeding, or menorrhagia, refers to menstrual periods that are abnormally heavy, prolonged or both or may refer to bleeding between periods. In general, AUB is diagnosed when abnormal bleeding interferes with daily activities and there is no evidence of a physical cause (like cancer or endometriosis).

Abnormal uterine bleeding is a common problem for women between ages 40 and 50 when hormone levels begin to change in the five to seven years before menopause—when menstrual periods end forever.

Here are several alternatives to hysterectomy as a treatment option for AUB:

• Endometrial ablation. This minimally invasive surgery uses electrical energy, heat, a balloon or freezing to destroy the endometrium, or uterine lining. It can minimize or stop heavy bleeding, but should only be considered in women who are certain they no longer wish to ever become pregnant.
  
  Success rates of endometrial ablation vary depending on the specific procedure used and the patient, but success rates for the following three to five years are generally quite high.
  
  Risks of endometrial ablation are rare. They include:
  • perforation of the uterus
  • injury to other pelvic organs
  • bleeding
  • infection
  • overloading of fluid into the bloodstream
  • accumulation of blood within the uterus because of scarring.
• Hormonal treatments. Abnormal uterine bleeding can also be treated with hormonal treatments, like oral contraceptives (estrogen and progestin) that help to balance your body's hormones. Natazia, which contains the synthetic estrogen estradiol valerate, is the first birth control pill FDA-approved for treatment of heavy menstrual bleeding that is not caused by a condition of the uterus. The combination estrogen-progesterone pill may help women who choose oral contraceptives for contraception and do not have risk factors that may make using hormonal birth control inadvisable.
• Progesterone IUD. Mirena, an intrauterine device that contains the progesterone levonorgestrel, helps decrease heavy bleeding for some women by slowly releasing progestin into the uterus for up to five years.

Uterine or Endometrial Cancer

Uterine (endometrial) cancer is the most common reproductive cancer in women. Hysterectomy, together with some form of cancer therapy, may be the only treatment choice you have. Your chances of curing this cancer are usually good if it's diagnosed in its early stages—when the cancer is confined to the uterus and hasn't spread to other organs.

The type of treatment recommended depends on when the cancer is diagnosed. Hysterectomy is the most common treatment. It generally involves removing the uterus and cervix. This type of hysterectomy is called a total hysterectomy. (Details about other types of hysterectomy can be found in the Treatment section of this topic.) The surgeon may also remove pelvic lymph nodes to determine if the cancer has spread beyond the uterus.

Surgery may be preceded or followed by radiation therapy and, in some cases, chemotherapy.

Ovarian Cancer

Ovarian cancer is the fifth-leading cause of cancer death among women. It is the leading cause of death from gynecologic cancer because less than 20 percent of cases are diagnosed before the cancer has spread beyond the ovaries. If diagnosed and treated at an early stage, however, the five-year survival rate is up to 94 percent.

The initial treatment for ovarian cancer is surgery to remove the ovaries. A hysterectomy is often performed, too, depending on how far the disease has spread and a woman's age.

Fibroids

About one-third of hysterectomies are performed every year in the United States to treat fibroid tumors. Noncancerous balls of muscular tissue, fibroids can grow inside the uterus, on the surface of the uterus or in the muscular wall of the uterus. They can range in size from less than an inch in diameter to the size of a grapefruit. They don't always produce symptoms.

However, even small fibroids that bulge into the uterine cavity can cause heavy menstrual bleeding. Plus, these fibroids may affect fertility by interfering with an embryo's ability to attach to the uterus. Large fibroids might cause frequent urges to urinate; they can also cause heaviness and discomfort in the pelvic region.

If fibroids aren't causing any problems, however, you don't need treatment. Plus, because fibroids tend to shrink after menopause, women in their late 40s or early 50s with fibroid-related symptoms may opt to wait to see if symptoms go away with menopause.

Although hysterectomy permanently removes fibroids (because a hysterectomy removes your uterus), there are other options for treating fibroids. These include:

• Hormone-suppressing drugs. Drugs called gonadotropin-releasing hormones (GnRH) agonists, such as leuprolide (Lupron), nafarelin nasal (Synarel) and goserelin (Zoladex) that are typically used to treat endometriosis, can also help shrink fibroids. Their effects, however, are usually temporary, and the fibroids may eventually grow back larger than before. GnRH agonists also produce side effects in some women, such as hot flashes, headaches, vaginal dryness, constipation and decreased sex drive.
• Myomectomy. This procedure is one of the best options for treating fibroids if you want to preserve your fertility. During an abdominal myomectomy, fibroids are cut out of the uterus and removed through an incision in the abdomen, and the uterine muscle wall is reconstructed with sutures.
  
  If fibroids are located in the uterine cavity, they may be removed through the vagina without an abdominal incision in a procedure called hysteroscopic myomectomy. The technique involves the use of an instrument called a hysteroscopic resectoscope and is primarily useful for women with bleeding or fertility-related problems.
  
  They may also be removed laparoscopically, using a small telescope called a laparoscope. During this procedure, a few small cuts are made in your abdomen or pelvis, which allow the laparoscope and other small instruments to be slipped inside, thus enabling the surgeon to remove the fibroids without having to make a large incision.
  
  The benefit of a myomectomy is that it preserves the uterus and cervix so pregnancy is still possible. Myomectomy is also an option for women who wish to preserve their uterus for any reason.
  
  Also, it may take longer to recover from an abdominal myomectomy than from a vaginal or laparoscopic hysterectomy. Although the goal of myomectomy is to preserve your uterus and your ability to have children, the procedure may cause scarring in the uterus that could require you to have a cesarean with your next pregnancy.
• Uterine artery embolization (UAE). In this minimally invasive procedure, a narrow, flexible tube called a catheter is passed through the femoral artery in the groin into the uterine artery. Once there, tiny plastic particles the size of grains of sand are slowly released into the blood vessels feeding the fibroid. The particles wedge in the vessels (but can't travel to other parts of the body), blocking blood flow to the tumor. Without a blood supply, the fibroids shrink.
  
  Fibroid embolization usually requires an overnight hospital stay. Most women return to normal activities within a week. Risks include moderate to severe pain and cramping in the first few hours after the procedure, and nausea, fever and infection. Rarely, a woman might enter menopause after embolization. A small percentage of women are readmitted to the hospital after the procedure for complications, some of whom require additional surgery.

Endometriosis

Endometriosis occurs when cells from the endometrium—or your uterine lining—grow outside the uterus and adhere to other parts inside your pelvis, such as the ovaries, bowel, fallopian tubes or bladder.

Hysterectomy is generally recommended for endometriosis only when the disease is severe.

Hormone-suppressing drugs used to treat fibroids are also considered effective for endometriosis since both conditions are affected by your body's production of estrogen. As with fibroids, benefits from these treatments may be temporary.

Aside from hysterectomy, surgical treatments for endometriosis include:

• Electrocautery techniques, in which stray endometrial tissue is burned away
• Excision, in which endometrial tissue is cut out
• Laser vaporization, which uses the laser to destroy the affected tissue

These procedures can usually be done laparoscopically and are often used when preserving fertility is important. Endometriosis frequently recurs, but the addition of postsurgical medical therapy, such as birth control pills or GnRH agonists, such as leuprolide (Lupron) or danazol (Danocrine), for six months may increase the pain-free interval.

The only definitive treatment for endometriosis is removing the ovaries to reduce your body's production of estrogen, which triggers the growth of endometrial tissue.

Pelvic Prolapse

Pelvic prolapse (a term that describes when the uterus drops into the vaginal canal) occurs when the ligaments that support the pelvic organs fail.

This weakening can occur with age, estrogen deficiency, obesity or after multiple births. Once this pelvic support weakens, pelvic organs, including the uterus, bladder and rectum, may sag, resulting in pressure, rectal discomfort and problems with bladder and bowel control.

Losing weight, stopping smoking and avoiding constipation by getting plenty of liquids and fiber in your diet can sometimes help. Additionally, you can strengthen your pelvic muscles with Kegel exercises. To do these exercises, tighten and relax the muscles used to stop the flow of urine. This strengthens the vaginal canal and pelvic floor muscles, helping control urine flow and enhancing orgasm.

You may also be fitted with a pessary, a device placed in the vagina that holds the organs in place.

Another treatment is short-term hormone therapy to make the vaginal tissue suppler. Estrogen prevents drying and thinning of the vaginal tissues. Supplemental estrogen can help strengthen vaginal tissues. However, because of the potential risks of estrogen therapy, such as increased risk of blood clots, breast cancer and gallbladder disease, the decision to use estrogen must be made only after you and your doctor have weighed all the pros and cons.

Surgery can be an option when organs have prolapsed. Surgery may involve creating a sling for the bladder or using specialized surgical tape to keep the bladder or uterus in place, or removing the uterus, via hysterectomy.

Dysplasia

Removing the uterus and cervix was once standard practice for a common precancerous condition called dysplasia, or cervical intraepithelial neoplasia (CIN). Today, cutting, burning or freezing the diseased portion of the cervix is generally recommended for CIN, and hysterectomy is rarely performed for this condition.

Treatment depends on the severity and location of dysplasia, your age, health status and whether you want to preserve your ability to have children.

Treatment

A hysterectomy is used to treat several conditions. If you decide to have a hysterectomy, you and your health care professional should discuss which type is most appropriate. There are three types:

• Total hysterectomy. During this procedure, your uterus and cervix are removed. Your ovaries and fallopian tubes may or may not be removed at the same time. If your ovaries are not removed, you will continue to have menstrual cycle-related hormonal changes, but you won't have any bleeding.
  
  If your ovaries and fallopian tubes are also removed, called a bilateral salpingo-oophorectomy, you won't have monthly hormonal changes. Removing only the uterus can reduce the blood supply to the ovaries, ultimately decreasing their function, however, this only occurs about 10 percent of the time.
  
  The decision about removing the ovaries depends on a few factors, including how close you are to menopause, your current estrogen levels and your risk for some other diseases and conditions. Premenopausal women may opt to keep their ovaries to provide a natural source of the hormones estrogen, progesterone and testosterone, which are important for maintaining sexual interest and function and preventing menopausal symptoms like hot flashes and decreased bone density. On the other hand, some premenopausal women with severe PMS, menstrual migraines or other hormone-related conditions may experience an improvement in their symptoms by removing their ovaries.
  
  As far as disease risk is concerned, a study published in the January 2013 issue of Menopause reported that removing both ovaries during a hysterectomy is associated with a decreased risk of ovarian cancer but an increased risk of osteoporosis, problems with cognition and sexual function, and coronary artery disease. As such, women should review their individual risk factors and the pros and cons before making the decision of whether or not to remove their ovaries during a hysterectomy.
  
  Ask your health care professional to explain this information to you so you can better understand your surgical options and the best plan for you.
• Subtotal, partial or supracervical hysterectomy. In this procedure, only the part of your uterus above the cervix is removed. There is a small risk that cancer could develop in the remaining part of the cervix, but routine Pap smears will detect pre-cancer in an easily treatable form. Nonetheless, there may be some benefits to leaving the cervix intact, including a reduced risk of vaginal prolapse (the vagina falling out), shorter recovery time and less postoperative pain. Some women note that leaving the cervix allows intercourse to remain pleasurable.
• Radical hysterectomy. This type of hysterectomy is performed in some cases of cancer. During this procedure, your uterus, cervix, supporting ligaments and tissues, the upper portion of the vagina and the pelvic lymph nodes are removed. Cancer specialists usually perform this type of hysterectomy.

In addition to discussing which organs should be removed during a hysterectomy, you and your health care professional should discuss how the surgery will be performed. The surgical technique you choose should depend on your individual diagnosis, personal preference and your surgeon's training. They include:

• Abdominal, or open, hysterectomy. This is the classic form of hysterectomy, involving an abdominal incision. This allows the surgeon to easily view the pelvic organs and provides more operating space than a vaginal hysterectomy. It is generally used for large fibroids or cancer.
  
  If you have this form of hysterectomy, expect a two- to three-day hospital stay and a six-week recuperation time. In most cases, your surgeon can make a "bikini line" incision that your bathing suit hides. Exceptions include cancer surgery or surgery to remove extremely large fibroids. Complete recovery from abdominal hysterectomy can take six to eight weeks, during which time you'll gradually feel your strength return and gradually be able to resume your normal activities.
• Vaginal hysterectomy. In this procedure, the surgeon removes the uterus and the cervix through an incision in the vagina, so there's no large external scar. This form of hysterectomy is ideal when there is uterine prolapse and minimal uterine enlargement.
  
  Vaginal hysterectomy can be performed in two ways: entirely through the vagina or using a laparoscope, a small, telescope-like device inserted into the abdomen through a small incision, enabling the surgeon to visualize the pelvic region, also called a laparoscopic-assisted vaginal hysterectomy. Laparoscopically assisted vaginal hysterectomy (LAVH) may be used if standard vaginal hysterectomy would be difficult or if the surgeon wishes to better visualize the ovaries or other pelvic organs during surgery. During this procedure, the uterus is removed through the vagina.
  
  Vaginal hysterectomy and abdominal hysterectomy each take between one and two hours and are performed under regional (epidural or spinal) or general anesthesia. One study found that women who had vaginal hysterectomies had significantly fewer complications than those having abdominal hysterectomies. Additionally, the women had shorter hospital stays and returned to their normal activities quicker than the women who had abdominal hysterectomies.
  
  Women with large ovarian cysts, a serious case of endometriosis or large fibroids may not be candidates for vaginal hysterectomy.
• Laparoscopic supracervical hysterectomy (LSH). This newer type of hysterectomy also uses laparoscopic techniques to remove the uterus but leaves the cervix intact; in the past, some studies suggested leaving the cervix might help reduce the complications associated with total hysterectomies, such as pelvic prolapse and urinary incontinence. However, the most recent research shows there is no compelling reason to leave the cervix if it can be easily removed along with the uterus. Hospital stay is usually no more than one night, and recovery takes about two weeks.
• Computer-assisted (robotic) surgery. Robotic-assisted laparoscopic hysterectomy is similar to a laparoscopic hysterectomy, but the surgeon conducts the operation from outside the body, using a robotic system of surgical tools. This equipment allows the surgeon to view the hysterectomy on a three-dimensional screen and use wrist movements to control the procedure. Hospital stay is usually one night or less, and full recovery can take up to two to four weeks. Robotic surgery is more expensive, takes longer and has more visible incisions than laparoscopic surgery.

Possible Complications

While discussing hysterectomy techniques with your health care provider, you should also talk about possible complications. Rarely, women who undergo a hysterectomy experience complications from surgery, most of which are minor or reversible. Possible complications include:

• fever and infection following surgery
• urinary tract infection or injury
• if your ovaries are removed, menopausal symptoms, such as hot flashes, night sweats and vaginal dryness,
• constipation
• depression or other emotional problems
• pain or discomfort during intercourse
• loss of sexual pleasure or interest in sex

More serious, but rarer, complications may include:

• hemorrhage requiring transfusion
• injury to the bowel, bladder or other internal organs during surgery, requiring repair
• bowel blockage
• life-threatening cardiopulmonary events such as a heart attack

If your ovaries are removed, you may experience a sudden drop in hormone levels, which may produce menopausal symptoms such as hot flashes, night sweats and dizziness. Postmenopausal estrogen therapy (ET), taken soon after surgery, may offset menopausal symptoms. Although the FDA now requires a warning on all estrogen products for use by postmenopausal women advising health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time, estrogen therapy may still be recommended after surgery to remove the ovaries.

Prevention

There likely isn't anything you can do or could have done to prevent the conditions for which you are considering a hysterectomy, but there is a lot you can do to prepare for this surgery. Fortunately, few hysterectomies are emergencies, so there usually is plenty of time to prepare.

First, be sure this treatment option is right for you.

A hysterectomy may be the only course of treatment for some conditions, such as cancer of the uterus, for example. But other treatment options may be available. Be sure you are comfortable with your health care professional's recommendation. If you want a second opinion, ask what you should do to get one.

These suggestions may help you prepare and recover from your surgery more easily:

• Plan the surgery two or three months ahead of time.
• Review the surgery and recovery needs with your physician. Be sure you understand why and how the surgery is being done. Ask questions if you're not sure.
• Be sure sure you know what to expect after surgery. How long will recovery take? What type of activities will you be able to do and not do?
• Review family and/or work schedules to determine what timing may work best.
• Ask for (and accept) help from friends and family with your routine; then, schedule it. This might include help with children's schedules, cooking, pets or household chores, for example.

Facts to Know

1. Many alternatives to hysterectomy now exist including hormonal therapy, the progesterone IUD, endometrial ablation, laparoscopic excision of endometriosis, myomectomy by hysteroscopy, laparoscopy or abdominal incision and uterine artery embolization.
2. About one-third of American women will have a hysterectomy by age 60. The United States has one of the highest hysterectomy rates in the world. Many of these procedures may be unnecessary. Hysterectomy rates are higher for African-American women.
3. A hysterectomy is often performed to stop abnormal uterine bleeding. It may also be recommended to treat fibroids that cause symptoms that aren't successfully managed by other treatment options.
4. A considerable number of hysterectomies are performed to correct symptoms of endometriosis. Endometriosis occurs when endometrial tissue, which forms the lining of the uterus, grows in other parts of the body, causing scar tissue and subsequent pain.
5. Some hysterectomies are performed to treat abnormal uterine bleeding (AUB), or menstrual bleeding excessive enough to disrupt a woman's life. Abnormal uterine bleeding may be caused by structural problems in the uterus (fibroids, for example), certain medical conditions or hormonal imbalances.
6. Some women elect to undergo hysterectomy to correct pelvic prolapse, which occurs when the ligaments that support a woman's pelvic organs weaken and lose their supportive ability.
7. Hysterectomies can be done several ways: A total or complete hysterectomy removes the uterus, including the cervix. A subtotal, partial or supracervical hysterectomy removes the uterus above the cervix. A radical hysterectomy, performed for certain cancers of the reproductive organs, removes the uterus, cervix, supporting ligaments and tissues, the upper portion of the vagina and the pelvic lymph nodes.
8. Developments in laparoscopic procedures have added two more surgical options. In laparoscopically assisted vaginal hysterectomy, a surgeon inserts a laparoscope (small telescope) through a woman's belly button to view the entire pelvis. Parts of the hysterectomy are performed through other small incisions in the abdomen, but most will be completed through the vagina. In a laparoscopic hysterectomy, the entire procedure is performed through laparoscopic incisions in the abdomen.
9. Depending on the type of hysterectomy you have, you may need to stay in the hospital for a few days. Although normal activities may be resumed gradually, a woman may not be fully recovered until four to six weeks or longer following surgery, depending on the surgical approach used.
10. Some women's health centers and hospitals offer support groups or social workers to emotionally support hysterectomy patients. Ask your health care professional for a referral.

Questions to Ask

The following Questions to Ask may help you talk with your surgeon or health care professional:

1. What kinds of problems are treated with a hysterectomy?
2. What are all the methods available to treat this problem?
3. Why are you recommending one medical or surgical approach over others to treat my condition?
4. What is the worst that can happen if I decide not to follow this recommendation?
5. If I need a hysterectomy, what surgical approach is most appropriate for me?
6. What changes should I anticipate following surgery?
7. What resources can you recommend to help me learn more about hysterectomy, as well as other treatment options?
8. How many times have you performed my procedure? How many complications have you had in cases like mine and what were they?
9. What's the success rate for this procedure, and how is success measured?
10. Can I talk to other patients who had this same procedure? (Although patient information is confidential, your health care professional may know women who have indicated an interest in helping others.)
11. If my ovaries are removed, would I be a candidate for postmenopausal hormone therapy? What are the risks and benefits of hormone therapy in my case?

Key Q&A

Lifestyle Tips

1. Determine your need for Pap tests
   If your cervix was removed along with your uterus for a noncancerous condition, and you do not have a history of cervical cancer or serious pre-cancer, you won't need a Pap test anymore, according to the American Cancer Society. If you've had a hysterectomy and your cervix was left intact, then routine Pap tests should be continued. Ask your health care professional for guidance.
2. Resume your sex life
   Your sex life may improve after your hysterectomy, especially if the surgery was performed because of pelvic pain or discomfort. A landmark two-year study conducted at the University of Maryland Medical Center in 1999 involving interviews with about 1,300 women who had hysterectomies found that the percentage of women who engaged in sexual relations increased significantly and rates of painful sex dropped. Researchers also found women had higher rates of sexual activity and more frequent orgasms following hysterectomy.
3. Pace your recovery
   Traditional hysterectomy through a large abdominal incision requires about four to six weeks for recovery, and recovery from vaginal hysterectomy takes about two to four weeks. Overall, recovery could be between two and eight weeks. With less invasive approaches, such as vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy (LAVH) and laparoscopic supracervical hysterectomy (LSH), recovery time is shorter. Potential, yet relatively uncommon, side effects of hysterectomy include incontinence, pelvic pain, pelvic prolapse, constipation and sexual dysfunction. Some hysterectomy patients feel fatigued for several weeks or months following surgery.
4. Seek help with depression
   Another potential side effect is depressive-like symptoms or other mental health problems, but there is no known physiological link between hysterectomy and psychological side effects. Depression may occur because the procedure ends a woman's ability to become pregnant, marking a life-stage transition that may be traumatic. Discuss your feelings and any fears about hysterectomy with your family and friends, and consider talking to a mental health professional if you experience emotional difficulties before or after surgery.

Organizations and Support

For information and support on Hysterectomy, please see the recommended organizations, books and Spanish-language resources listed below.

American Association of Gynecologic Laparoscopists (AAGL)
Website: https://www.aagl.org
Address: 6757 Katella Avenue
Cypress, CA 90630
Hotline: 1-800-554-AAGL (1-800-554-2245)
Phone: 714-503-6200

American College of Obstetricians and Gynecologists (ACOG)
Website: https://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org

American Society for Reproductive Medicine (ASRM)
Website: https://www.asrm.org
Address: 1209 Montgomery Highway
Birmingham, AL 35216
Phone: 205-978-5000
Email: asrm@asrm.org

Hysterectomy Educational Resources and Services (HERS) Foundation
Website: https://hersfoundation.org/
Address: 422 Bryn Mawr Avenue
Bala Cynwyd, PA 19004
Hotline: 1-888-750-HERS (1-888-750-4377)
Phone: 610-667-7757
Email: hersfdn@earthlink.net

National Family Planning and Reproductive Health Association (NFPRHA)
Website: https://www.nfprha.org
Address: 1627 K Street, NW, 12th Floor
Washington, DC 20006
Phone: 202-293-3114
Email: info@nfprha.org

National Uterine Fibroids Foundation
Website: https://www.nuff.org
Address: P.O. Box 9688
Colorado Springs, CO 80932
Hotline: 1-800-874-7247
Phone: 719-633-3454
Email: info@nuff.org

Books

A Gynecologist's Second Opinion
by William H. Parker, Rachel L. Parker

Coping With Endometriosis
by Robert H. Phillips, Glenda Motta

Dr. Susan Love's Menopause and Hormone Book
by Susan M. Love, Karen Lindsey

Health, Happiness & Hormones: One Woman's Journey Towards Health after a Hysterectomy
by Arlene Swaney

Hysterectomy: Before and After: A Comprehensive Guide to Preventing, Preparing for, and Maximizing Health
by Winnifred Berg Cutler

Just as Much a Woman: Your Personal Guide to Hysterectomy and Beyond
by Nancy Rosenfeld, Dianna W. Bolen

Official Patient's Sourcebook on Endometrial Cancer
by Icon Health Publications

The Woman's Guide to Hysterectomy: Expectations & Options
by Adelaide Haas, Susan L. Puretz

Yale Guide to Women's Reproductive Health: From Menarche to Menopause
by Mary Jane Minkin, Carol V. Wright

Spanish-language resources

Medline Plus: Hysterectomy
Website: https://www.nlm.nih.gov/medlineplus/spanish/hysterectomy.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov