There's More to Your Uterus Than Housing Kids
Excerpted from Womb: The Inside Story of Where We All Began by Leah Hazard. Copyright © 2023 by Leah Hazard. Reprinted by permission of Ecco, an imprint of HarperCollins Publishers.
By Leah Hazard
The uterus is often inextricably linked to a person’s identity, and its removal is as powerful as its presence.
Indeed, evidence suggests that hysterectomy can have a substantial effect on a woman’s mental health. In a study that followed over 2,100 women for 22 years, hysterectomy was associated with an increased rate of new diagnoses of long-term mental health issues; specifically, a 6.6 percent higher risk of depression and a 4.7 percent higher risk of anxiety. For those women who had a hysterectomy between the ages of eighteen and thirty-five — arguably, the prime years of fertility and childbearing — the risk of depression was 12 percent greater.
Overall, hysterectomy was associated with a range of disorders, from agitation and reduced psychosexual function to psychosis. The NHS Online makes a brief, one-line acknowledgment of these potentially life-changing effects: “Having your uterus removed,” says the website, “can cause you to have feelings of loss or sadness.”
Womb or no womb, many women might rightfully bridle at the suggestion that one’s identity begins and ends with one’s reproductive potential. The idea that a person without children should resign herself to a sad, lonely life of gazing wistfully at self-penned sticky notes and longing for the babies she never had is dangerously retrograde, and should be resigned to the waste bin of history along with every other harmful cliché that puts female identity into a tidily reductive box. As many testify, hysterectomy can broaden — not narrow — one’s horizons under the right circumstances. However, what they may not know — and what was as much of a shock to me as it may now be to you — is that scientists are only just starting to understand how fundamentally hysterectomy can affect the very seat of identity, emotion, and day-to-day function: the brain.
To journey to the cutting edge of research into the uterus-brain connection, we must travel to Tucson, Arizona, where, nestled between the cactus-studded Saguaro National Park and the snow-topped peaks of the Rincon Mountains, a team of behavioral neuroscientists have been doing something unusual with rats. True, the University of Arizona markets itself as a kind of desert wonderland, where “everywhere you look is filled with wonder” and your imagination “ignites” beneath a sky of “cotton candy sunsets and diamond-filled nights,” but what the prof and her rats have revealed is more outlandish than even the hammiest prose.
Stephanie Koebele, the study’s lead author, and her team prepared four groups of rats: one group had just their ovaries removed, one had just their uterus removed, one had both ovaries and uterus removed, and a control group had a “sham” operation (opening and closure of the abdomen with no actual removal of organs). Six weeks post-op, the rats were trained to navigate a maze, and the results were shocking enough to make Jean-Martin Charcot turn in his elegant Montmartre grave.
The rats who had had an operation to remove the uterus alone made more navigational mistakes and overall were more challenged by the maze. There was no other difference between them and the other rats — no known hormonal deficit or change, no special drugs, no
other handicap — and yet the simple absence of the uterus was enough to have a demonstrable effect on these animals’ cognitive abilities. If this organ (or lack thereof) has an influence — even a small one — on memory and spatial awareness, then what other aspects of thought and function might it also affect?
“The dogma is that the non-pregnant uterus is dormant,” Koebele and her coauthors write. In other words, we’ve believed for millennia that a womb’s purpose is solely reproductive. It menstruates to prepare for a baby, it gestates and expels a baby, and then it waits, silent and useless in its owner’s pelvis, until death. However, the Arizona team argue that their findings point toward “an ovarian-uterus-brain system that becomes interrupted when the reproductive tract has been disrupted, leading to alterations in brain functioning.”
The nonpregnant uterus, they suggest, “is not dormant.” The womb, the team believe, is communicating with the brain in a way that is fundamentally powerful, albeit poorly understood. There appears to be some kind of critical uterine-cognitive dialogue — a conversation that stops abruptly when the womb is removed and sent to the hospital incinerator, like hundreds of thousands of these organs are each year.
Some would argue that this new data is illuminating and empowering: The womb can do amazing things never before thought possible! We are beautiful, mystical, multifaceted beings whose reproductive systems are far more sophisticated than science has yet understood! And yet, one could also regard these new findings with consternation, arguing that the Arizona study is yet another chapter in the reductive narrative that places a woman’s brain at the mercy of her uterus, mischievous and malfunctional as that organ may be. Perhaps, though, this research opens a door to a less binary, more nuanced way of thinking about the relationship between behavior and reproductive biology. Instead of assuming that a potential womb-brain relationship is something primitive, dangerous, and shameful, it may be more productive — and ultimately, more accurate — to consider the many possible cognitive and emotional implications of such a connection. A growing body of recent evidence has given credence to a similar relationship between the brain and the gut, a system that remains relatively unburdened by the weight of sociosexual constructs.
In time, the womb may escape its stigma as the seat of womanly folly; like the gut, the uterus may yet be recognized as one of many complex factors which influence — and even enhance — a person’s thoughts and feelings.
If anything, those lab rats should serve as reminders to practitioners and prospective patients that the effects of hysterectomy may not yet be fully understood, and as such, the procedure should always be approached with due diligence. A 2015 study from the University of Michigan adds further credence to the argument for caution: of 3,397 women undergoing hysterectomy for benign (i.e., non-life-threatening) conditions, 18 percent were found to have “unsupportive pathology” for the procedure. In other words, the findings of the surgery did not support the previously determined need for hysterectomy.
Nearly one in five operations were, in essence, unnecessary. This stark finding is now reflected in statutory guidance; the American Congress of Obstetricians and Gynecologists, for example, recommends other forms of hormonal and medical treatment as “primary management” in benign cases before hysterectomy is considered or performed.
Dr. Christine Metz says that, by and large, “If you have a healthy uterus, you should keep it for as long as you can.”