It’s a Surgery That’s Often Viewed as a Tragedy. For Many, It’s Actually a Wonderful Choice.

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Lauren started asking doctors for a hysterectomy when she was 17. Her periods had long been intolerable, involving excessive bleeding and excruciating pain. Then, having sex was painful too.

Yet each time, doctors were alarmed that she would want to pursue a solution as extreme as removing her uterus. She was certain she never wanted children. You’ll change your mind, Lauren heard over and over. (I’ve changed the names of everyone in this piece to protect their privacy.) Finally, she got the procedure when she was 31. I spoke with her a year later. She still felt ecstatic about it. “It was the best thing I’ve ever done for my health,” she said. “Absolutely no regrets.”

A hysterectomy is commonly viewed as a disaster, as something that happens to you rather than something you choose yourself. A woman might have an emergency hysterectomy after being denied an abortion or during a war, or she may be coerced into it. The procedure is often described as a last resort, and one that may sever the patient from her sense of womanhood.

The truth is that 1 in 5 people born with a uterus will have it removed by the age of 65, and that many among them will still be in their “childbearing years.” Though the procedure has historically involved months of recovery and left patients with a cross-body scar, today it is much simpler and largely regarded by doctors as minimally invasive. Patients may have only four small marks on the abdomen after they heal. Patients can also keep their ovaries to avoid entering surgical menopause. For my book, Get It Out, I spoke to 100 people who have had or would like the procedure.

Hysterectomy, in addition to being a choice that can be made as part of gender-affirming care, is basically a catchall solution to any issue someone with female reproductive organs might be experiencing, like fibroids, polycystic ovary syndrome, premenstrual dysphoric disorder, uterine prolapse, or good old-fashioned mysterious “abnormal uterine bleeding.” There are dozens of things that can go wrong with these organs, yet very little doctors can do to permanently improve the situation beyond simply removing them—which is, unfortunately, often viewed as a terrible thing to do. For many of the people I spoke to, it wasn’t terrible. It was a great decision.

“I have this peace of mind now that I don’t have this organ in me that at any point might try to kill me,” Lauren told me. She was speaking figuratively, noting that her uterus used to make her days miserable with little warning. Removing it removed a huge burden.

It turned out that her “bad periods” were actually a symptom of endometriosis, a condition that afflicts 10 percent of people with uteruses and in which cells similar to the uterine lining grow outside the uterus. It can be diagnosed only with a surgery called a hysteroscopy. Despite doctors having known about endometriosis for over 100 years, there is no cure. Yet for people like Lauren—and, incidentally, the actress and director Lena Dunham—removing the organ, and/or ovaries and cervix, can bring substantial relief. Lauren could have kept living with her uterus; in fact, many doctors advised it. But her life improved without it.

A whopping 90 percent of hysterectomies are considered elective, meaning not immediately lifesaving, for example, because of cancer. Yet the reasons for allegedly elective hysterectomies, no matter how solid, are often met with resistance. Many patients are told by doctors that they will one day come to regret making the choice to remove their uterus and will be overcome with grief at the loss of their ability to get pregnant. Others are told they will feel as if they’ve lost symbolic parts of themselves they cannot gain back (never mind that you don’t really interact with your uterus on a day-to-day basis).

Another woman I spoke to, whom I’ll call Stacey, told me that when she was 21, her doctors actually recommended she get pregnant to cure her pain and bleeding, instead of receiving a hysterectomy. She recalls them reassuring her, “You can always give the baby up for adoption.” Though women with endometriosis may experience relief from those symptoms during pregnancy, it is hardly a practical—let alone desirable—form of symptom management. And while some women might opt against a hysterectomy so that they may bear children, or may have complex feelings about the choice to take getting pregnant off the table, others will opt for it without feeling as if they are giving anything up.

As I learned throughout my interviews, personal reactions following a hysterectomy vary widely, from grief to neutrality to delight. Often, these feelings weren’t specifically or solely connected to the hysterectomy itself; rather, they were related to cultural context that surround the procedure, and the reluctance of doctors to talk through it as a viable, and possibly desirable, option.

Faizah, for example, is a 31-year-old woman living in California, where she works as an administrative assistant at a nonprofit. Faizah had to fight for a hysterectomy for years. When she was 26, she started experiencing excessive bleeding during her periods. “I’m talking filling up a tampon and a pad every 30 minutes,” she told me. “It wasn’t a great way to live, as you can imagine.”

She went to doctor after doctor, but none of them seemed to grasp the severity of what she was going through, though they did attempt to regulate the bleeding by putting her on every type of available contraceptive—every variation of the pill, IUDs, and shots, she recalled. “I basically wasted four years of my life going on contraceptives.” Eventually, once she was “pretty much bleeding for nine months out of the year,” she told me, she became set on a hysterectomy. Why not address the problem at the source?

At one appointment with a surgeon who was reluctant to perform the procedure on her, she bled through her pants onto the doctor’s white chair. After that, he agreed to remove her uterus. “I honestly can’t recommend it enough,” she told me. “I had six years of just pain for what reason? I was not taken seriously, and if somebody had been like ‘A hysterectomy might be possible for you’ just earlier, like, the course of my life would have changed.” She also mentioned feeling more feminine and confident after surgery, since she wasn’t bleeding seemingly all the time. She felt regret over the whole situation—regret that she had not gotten her uterus out sooner.

To be sure, my book does not tell a straightforwardly joyful, pro-hysterectomy story, even as I reject the assumption that the procedure is always terrible. The more one learns about hysterectomy, the more complicated the tale becomes, both to the people who have (and who don’t succeed in having) the procedure and to the medical providers who perform (and who don’t perform) it. Tracing hysterectomy’s historical roots, for instance, led me to chilling stories of medical experimentation, forced sterilization, and eugenics. There are good reasons we associate hysterectomies with terrible loss. But there are bad ones too, namely the idea that all women must want to be fertile, and to preserve their fertility above their own well-being. Many do not.

Ironically, reducing the uterus, ovaries, and cervix to their babymaking capacity has led the medical field away from initiatives to properly diagnose and cure the various ailments that affect these organs. Uteruses are a part of women’s bodies that affect them; they are not simply for pregnancy. They should be studied as the core component of the body that the doctors reluctant to remove them claim they are. There should be more ways to provide relief to people who have heavy periods and pain, whether it’s from fibroids, PCOS, or endometriosis, diseases that doctors have known about for over 90 years. People should be able to choose a hysterectomy—and there should be more options in the first place. Many people who get their uteruses out are thrilled about it, in part because it can finally give them, after years of misdiagnosis and pushback, a sense of control.

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