Nurse weighs female patient on scale in doctor’s office.

A gynecologic oncologist dispels a widespread misconception about this common surgery.

A hysterectomy, which is a surgery to remove the uterus, is the second most common surgical procedure performed on women in the United States after a cesarean section. It’s estimated that one in three women will have the surgery by about age 65.

A hysterectomy is used to treat gynecological cancers, uterine prolapse, chronic pelvic pain and conditions that cause abnormal uterine bleeding such as endometriosis and fibroids.

A frequently asked question women have about hysterectomies is whether they’re more likely to gain weight after the surgery. X. Mona Guo, MD, a gynecologic oncologist with the USC Gynecologic Oncology Program, part of Keck Medicine of USC, explains what women need to know.

Does a hysterectomy cause weight gain?

There are several types of hysterectomies, including:

Partial: Removes only the uterus
Total: Removes the uterus and cervix and commonly also both fallopian tubes
Total hysterectomy with bilateral salpingo-oophorectomy: Removes the uterus, cervix, ovaries and fallopian tubes
Radical: Removes the uterus, the cervix and surrounding tissue, the upper part of the vagina and often the ovaries and fallopian tubes

Removal of the uterus itself will not cause a patient to put on extra pounds, Dr. Guo says.

However, there is a more substantial impact when a premenopausal woman has her ovaries removed because this puts the patient into surgical menopause. Any weight gain is then related to entering menopause and all the changes that come with that transition.

During menopause, hormonal changes — particularly lower estrogen levels — can cause fat to accumulate around the hips and stomach. It’s also typical to experience reduced muscle mass and for the metabolism to slow during menopause.

“From a weight-gain perspective, it’s not like patients gain a lot of weight fast after entering menopause. There might be a slow progression,” Dr. Guo says. “Surgical menopause, however, is more jarring than natural menopause because your hormones are suddenly gone at one moment in time, rather than there being a slow transition into it.”

As Dr. Guo emphasizes, it’s also possible for women to gain a few pounds after a hysterectomy because, like most surgeries, the recovery requires rest time. Most patients are advised to avoid heavy lifting, core work and other vigorous activity for four to six weeks after surgery.

And especially for women who’ve had their ovaries removed, the sudden hormone drop can affect energy levels and mood. “Our eating habits are very much affected by how we feel. You might end up eating more because you’re not sleeping well. And if you’re not sleeping well, you may exercise less,” Dr. Guo says.

How can patients prevent weight gain after a hysterectomy?

For women whose hysterectomy also includes removal of the ovaries, Dr. Guo says hormone replacement therapy (HRT) can be beneficial. Starting HRT before the surgery can help prevent patients from experiencing an uncomfortable decrease in hormones.

She also recommends patients set themselves up for long-term success by implementing healthy lifestyle changes. To lose weight or prevent new weight gain, especially among women entering surgical menopause, Dr. Guo says patients should prioritize activities that increase their metabolic rate and builds muscle mass.

For exercise, this includes strength training and weightlifting. High-intensity interval training, which involves quick and intense bursts of exercise, is also helpful. As for nutrition, patients should focus on getting enough protein and fiber into their diets.

If patients are considering GLP-1 medications to help lose weight after a hysterectomy, Dr. Guo advises talking to their primary care provider. “Peptide medications have been shown to help with weight loss, but that won’t be the only thing in your health journey,” she says. “It’s also important to work with a provider who is comfortable managing potential side effects.”

Dr. Guo adds that women undergoing a hysterectomy don’t need to be embarrassed or shy about speaking to their doctors about weight gain. “It’s okay to have these concerns, and it doesn’t make you vain,” Dr. Guo says. “I want my patients to share with me what they’re going through so we can work through it together. They don’t need to go through this alone.”

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What to Know About Weight Gain After Hysterectomy