We Would Never Ask a Man to Remove His Testicles

Imagine a man walks into a clinic with a benign problem in his reproductive organs. Uncomfortable, recurring, not cancer. Now imagine the doctor says the simplest thing would be to remove his testicles. He is done having children anyway. He does not really need them. It would be easier this way.

No one says that to a man. We would find it barbaric.

Yet some version of that conversation happens to women every day. A benign condition, a fibroid, a cyst, heavy bleeding, endometriosis, and the answer offered is to remove the uterus, and often the ovaries with it. Not because it is the only option. Because it is the fastest, the most definitive, the most convenient. And because too often, no one stops to ask whether this woman actually needs to lose an organ at all.

This is not a small problem, and it is not history. It is happening now, this year, to women who deserved better. This essay is the long version, the one with the studies and the numbers, so you can walk into any appointment knowing exactly what to ask.

Hysterectomy is one of the most common major surgeries performed on women. In the United States, hundreds of thousands are done every year, and the large majority are for benign, non cancerous conditions: uterine fibroids, abnormal or heavy bleeding, endometriosis, adenomyosis, and uterine prolapse. Fibroids alone are the single leading reason.

Fibroids are extraordinarily common. By the age of fifty, the majority of women will have had at least one, and in many they never cause a single symptom. Common does not mean dangerous, and having a fibroid is not, by itself, a reason to remove anything.

Here is the number that should stop us. In one Mayo Clinic analysis of women who underwent hysterectomy for fibroids or abnormal bleeding, close to sixty percent had no documentation of receiving less invasive treatment first. They went straight to removal of the whole organ without being offered, or without a record of being offered, the steps that come before it. That is not informed choice. That is a missing conversation.

For most benign conditions, removing the uterus is the last resort, not the first. Before it, there is a real menu, and a woman deserves to hear all of it and to understand the trade offs of each.

Yes, some benign conditions can come back. A cyst can return. A fibroid can regrow. But recurrence is not a reason to remove an organ a woman may still need. We do not remove a whole system because it might act up again. We manage it, the way we manage almost everything else in medicine.

The deeper harm is what happens to the ovaries. When a woman’s healthy ovaries are removed before natural menopause, that is surgical menopause. It is, plainly, the female equivalent of castration, and the body feels it immediately and for the rest of her life.

To understand why, you have to understand what the ovaries actually do. They are not a switch that flips off at menopause. Even after periods stop, the ovaries continue to produce hormones, including androgens that the body converts into estrogen, for years. Estrogen is not only a reproductive hormone. It helps keep blood vessels flexible and protects the heart, it helps maintain bone density, and it supports the brain. Remove the ovaries early and you remove that protection early, all at once, with no gradual transition.

This is not opinion. It is some of the most striking long term data in women’s health.

Researchers at the Mayo Clinic followed thousands of women for decades in what became known as the Mayo Clinic Cohort Study of Oophorectomy and Aging. Women who had both ovaries removed before natural menopause, for benign reasons, showed meaningfully higher long term risks. Compared with women who kept their ovaries, early bilateral removal was associated with an increased risk of Parkinsonism and Parkinson disease on the order of about eighty percent, of dementia and cognitive impairment on the order of about seventy percent, of depression by roughly a half, and higher rates of anxiety. The risks were greatest in the women who had their ovaries removed at the youngest ages and who were not given estrogen afterward.

The cardiovascular picture is just as sobering. In the same body of research, removing the ovaries before about age forty five was associated with a significantly higher risk of dying from cardiovascular disease, roughly one and a half times, along with higher overall mortality, again most pronounced in women who did not receive estrogen replacement through the years they would otherwise have had their own.

The clinicians who have spent careers studying this have said it plainly: for benign disease, removing both ovaries may do more harm than good. That is why modern gynecology increasingly favors keeping the ovaries whenever there is no medical reason, such as ovarian cancer or a high risk genetic mutation, to remove them.

Here is the part that makes it worse. When a woman does lose her ovaries early, the one thing that softens the blow is hormone therapy. The guidance from menopause and women’s health bodies is consistent: a woman who has her ovaries removed before the natural age of menopause should be offered estrogen, generally at least until around age fifty one, the average age of natural menopause, unless she has a specific reason she cannot take it, such as a hormone driven cancer. Estrogen given through those years offsets much of the added risk to her heart, her bones, and her brain.

Yet many of these women are never offered it. They are sent home into a sudden, severe menopause with nothing, and told it is normal. It is not normal, and it is not necessary. To remove a woman’s hormones surgically and then withhold the hormones that would protect her is to harm her twice.

It is worth naming why this happened at scale. In 2002, early results from the Women’s Health Initiative were reported in a way that frightened a generation of women and clinicians away from hormone therapy. In the years since, that data has been re examined in detail. The picture that emerged is far more nuanced, and for many women, especially younger women and those in early menopause, the benefits of appropriately prescribed hormone therapy can outweigh the risks. A blanket fear of hormones, left over from headlines two decades old, is still costing women the protection they are owed.

None of this is because women are fragile or dramatic. It is because the system rewards the definitive surgery and moves quickly, because a woman’s symptoms are still too often waved away, and because it is easier to remove a part than to sit with a woman and walk her through the slower, organ sparing path. Financial and time pressures tilt the same direction. So women get told it is no big deal, that they do not need those parts anymore, that they will not have any luck keeping them anyway. They get talked, and sometimes frightened, into surgery.

That is not care. Care starts by believing her.

If you fought to keep your uterus or your ovaries and were made to feel guilty for it, hear this clearly. You were not wrong. You advocated for yourself and you were right to. Your organs were not a problem to be tidied away. Wanting to keep them was not stubbornness. It was wisdom.

Bring someone with you. Write the answers down. And know that you are allowed to say not yet.

Sometimes surgery is genuinely necessary, and it can be the right, even life saving choice. Those decisions are deeply personal, and they belong between a woman and her own qualified surgical team who know her full history. This piece is not here to tell any woman whether to have surgery, or when. It is here so that whatever she decides, she can decide it fully informed, with every option in front of her.

What is not right is what happens after, because necessary surgery does not end the care. It begins a new plan, and you are owed all of it:

You do not just lose an organ and get sent home. If a good team removes something you truly needed gone, a good team also replaces what it can and watches over the rest.

You would never be asked to give up an organ so casually if you were a man. You should never be asked to as a woman either.

This piece exists because of the women who trusted me with their stories. Thank you for your courage. May the next woman read this before her appointment, and walk in knowing her body, her options, and her worth.

With warmth,
Wahiba

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Educational content, not medical advice. Every woman and every diagnosis is different. If surgery has been recommended to you, talk with a qualified clinician about your options and consider a second opinion.