Detailed definition
Hysterectomy is one of the most common surgical procedures in US women — approximately one-third of women undergo hysterectomy by age 60. Approaches include vaginal, laparoscopic, robotic, and abdominal (open) routes. Subtypes include total hysterectomy (uterus and cervix removed) and supracervical/subtotal (cervix retained). Hysterectomy may or may not be accompanied by removal of the ovaries (oophorectomy) and fallopian tubes (salpingectomy). For benign indications, ovarian preservation is increasingly favored unless there is a specific risk-reducing indication, because removing healthy ovaries before natural menopause has long-term cardiovascular, bone, and possibly cognitive consequences. After hysterectomy without oophorectomy, ovaries continue functioning and menopause occurs at its natural age, although some studies suggest a slightly earlier onset due to potential disruption of ovarian blood supply. After hysterectomy without ovarian removal, women still need progestogen-free monitoring (no need for endometrial protection); HRT with estrogen alone is appropriate.
Why it matters in menopause
Hysterectomy plus ovarian removal produces immediate surgical menopause and almost always warrants HRT in women under 45. Hysterectomy with ovaries preserved means natural-timing menopause and standard HRT decisions when the time comes — without the progestogen requirement.