Hysterectomy

Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.

This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make.

What is hysterectomy?

Hysterectomy is a surgery to remove the uterus and the cervix. A second part of the surgery, called a salpingo-oophorectomy (SO), can also be performed to remove one or both of the ovaries and both the fallopian tubes. There are a few types of surgery you can choose from and there are also different surgical techniques you can have. These will depend on your surgeon, insurance coverage or personal preference. 

Types of surgery

• Total hysterectomy (the entire uterus is removed, including the cervix)

• Salpingectomy (both fallopian tubes are removed)

• Oophorectomy (one or both ovaries are removed)

Why do people get a hysterectomy? 

There’s many reasons someone might get a hysterectomy. The most common is that it can help ease feelings of dysphoria, which improves your wellbeing. It will stop your periods permanently and can help you lower your dose of testosterone. If you have no history of gynecologic cancer then you will also no longer need pap smears. A hysterectomy is also a permanent contraceptive – this can be helpful if you’d like to prevent getting pregnant.

Alternative treatment options

Hormone therapy can be used to stop your periods or make them lighter. This can be done with testosterone or other hormones called GnRH analogues. These are medications that reduce your estrogen levels without having masculinizing effects. Contraceptives like the hormonal IUD  can also prevent pregnancy and stop or lighten your periods. The hormonal IUD is a small plastic device placed inside your uterus that releases the hormone progestin.

There are also multiple types of hysterectomy to choose from. If you would like to preserve fertility options for the future, you can choose a hysterectomy without a SO. This means you’ll be able to use your eggs for IVF (where your eggs would be removed, fertilized outside the body and then transplanted into another person).

Surgical techniques

You have four main options when it comes to hysterectomy. The options below are offered in Canada and covered by OHIP or Alberta Health, if you have received a funding approval letter. The method you choose will come down to your surgeon, your current anatomy and your goals. In your pre-surgery consultation you’ll have a chance to discuss all of your options and find what works best for you.

Vaginal hysterectomy

• The surgeon makes an incision through the vagina and removes the uterus

• It is possible to remove fallopian tubes and/or ovaries, based on anatomy 

Laparoscopic abdominal hysterectomy

• The surgeon makes 3-4 small incisions (1cm) in the abdomen 

• After inserting a small tube with a camera (laparoscope), the uterus is removed

• Fallopian tubes and/or ovaries are also removed if chosen

Laparoscopically-assisted vaginal hysterectomy

• This combines elements of the above two procedures

• The surgeon makes an incision through the vagina and removes the uterus (and fallopian tubes/ovaries, if chosen)

• A laparoscope is inserted through one small incision (1cm) in the abdomen to guide the surgeon

Abdominal hysterectomy

• The surgeon makes a large incision across the abdomen and removes the uterus

• Fallopian tubes and/or ovaries are also removed if chosen

Before and after surgery

Hysterectomy is a major surgery, so you’ll need a plan for how you’ll prepare and recover. You’ll need to take time off work afterwards and will also need someone you trust to help out in the days and weeks after surgery. Your pre-surgery assessments will give you a chance to discuss this. 

Each surgeon or clinic will have their own guidance for preparation and recovery. They’ll also stay in touch with you throughout the recovery process to ensure you’re healing well. After surgery you may have regular check-ups and aftercare appointments. If your surgeon does not offer follow-up appointments and you have any health concerns, you can visit your primary care provider or a walk-in clinic.

Side effects and risks

As with all surgery, hysterectomy comes with side effects and risks. A major side effect of hysterectomy is infertility, which is permanent and irreversible. This is because the uterus is removed during surgery, which means you cannot carry a pregnancy. If ovaries are also removed then you cannot produce eggs for IVF. If you would like to have biological children in the future then you can bank eggs before your surgery. You may have to pause your hormones to do this – speak to a fertility specialist for more information.Other risks include:

• Side effects of low estrogen (higher risk of osteoporosis, hot flashes, low sex drive, mood changes)*

• Loss of sensation and/or decreased intensity of orgasm

• Damage to surrounding tissues (bowel, bladder, rectum or other organs)

• Damage to blood vessels that could be needed for phalloplasty in future

• Urinary tract injury or infection

• Vaginal prolapse (the vagina falls outward)

• Fistula (connection) between the bladder, rectum or anus and vagina

• Ovarian remnant syndrome (pain and bleeding if ovarian tissue is left in the body)

• Vaginal cuff bleeding (bleeding from the top section of the vagina that is was closed)

* If you have a surgery that removes both of the ovaries, it is recommended that you stay on hormones for the rest of your life. This is because they produce sex hormones, and your body needs some form of sex hormone for optimal health (e.g. bone strength).

General surgery risks

There are some general risks that come with most surgeries. They are:

• Bleeding

• Blood clots in your legs or lungs

• Injury to surrounding organs, nerves or blood vessels

• Hematoma (a collection of blood) or seroma (a collection of fluid)

• Infection or abscess

• Wound opening or delayed healing

• Chronic pain

• Scarring

• Feeling dissatisfied with the outcome

• Feelings of regret about surgery

These risks can be higher with certain medications and health conditions, like immune or clotting disorders, or if you smoke. Tell your doctor about any medications and supplements you take, along with any health conditions you have (even if they don’t seem relevant!). 

Anesthetic risks

Bottom surgery requires going under general anesthetic. General anesthetic has the following risks (most of which are very rare):

• Nausea/vomiting

• Damaged teeth

• Aspiration pneumonia (pneumonia from inhaling liquid like saliva or vomit)

• Respiratory failure (i.e. stopping breathing)

• Heart attack

• Coma

• Death

Ready for surgery?

If you'd like to get hysterectomy and you live in Ontario, your surgeon will require two assessments to confirm you're ready for surgery. If you'd like to apply for OHIP funding to cover your surgery then you also need to submit an application to the Ministry of Health.

For Ontario patients, Foria can provide your assessments and we can also submit and track your funding application for you. See our Surgical Referrals in Ontario article for more information.

If you live in Alberta, your surgeon will require one assessment. This can be done by a family doctor or nurse practitioner, who can then refer you to a surgeon. Referrals are accepted at a surgeon's discretion – if they approve your referral, they will then apply to Alberta Health for funding.

Foria does not currently offer assessments in Alberta, but these services will be available soon. See our Surgical Referrals in Alberta article for more information.

This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s TRS Surgical Summary Sheets.

by Foria Clinical Team

Sep 15, 2023・ minute read

Share article