Hysterectomy Statistics: What the 2026 U.S. Data Actually Shows

Hysterectomy statistics answer different questions. In the 2021 National Health Interview Survey, 17.2% of U.S. women age 18 and older reported having had a hysterectomy; the age-adjusted estimate was 14.6%. A nationwide hospital analysis estimated 548,802 procedures in 2019. Prevalence, annual operations, and historical 500,000–600,000 claims are not interchangeable.

One number counts women who have ever had the surgery. The other counts operations performed during one year. Treating those as the same thing is how a real statistic turns into a misleading answer.

Age changes the prevalence estimate from 2.8% among women ages 18–44 to 41.8% among women age 75 and older. Geography matters too: the 2021 age-adjusted estimate was 19.0% in nonmetropolitan areas and 11.8% in large central metropolitan areas. The year and data system matter just as much, because many figures still circulating in 2026 describe hospital practice from the 1990s or early 2000s.^[1]

And there is one more thing. The word hysterectomy does not tell you whether the ovaries were removed. That distinction can change the menopause and hormone-care questions that come next. A procedure name on a discharge summary may not settle it; the operative report usually can.

Is this page for you?

This page is built for a U.S. reader who needs dated population numbers, wants to understand why published figures conflict, or needs to decode what a hysterectomy does—and does not—say about menopause. It is not a substitute for surgical advice, postoperative care, a diagnosis, or an individualized hormone-therapy decision.

Read this page if	Use another starting point if
You have had a hysterectomy and want to know where you fit in the national data	You are deciding whether to have surgery; that decision belongs with a gynecologist who knows your diagnosis and alternatives
You do not know whether your ovaries were removed	You are in early recovery or have a new postoperative concern; contact your surgical team
You were told you may need one and want to know how common it is	You need a personal prediction of whether you will need surgery; population prevalence cannot provide it
You need dated, citable U.S. numbers with the denominator explained	You want U.K., Canadian, or global estimates; this page is U.S.-only
Menopause statistics never seem to describe your situation	You want a medication, dose, or regimen selected; that requires a licensed prescriber who has reviewed your history

Bleeding after menopause, a new pelvic mass, or worsening pelvic pain needs prompt in-person assessment. Severe symptoms or emergency warning signs belong in urgent or emergency care, not on a statistics page.

The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.

The short version

The two headline numbers are 17.2% and 548,802, but they answer different questions. The first is crude prevalence in a 2021 household survey; the second is a weighted estimate of hospital inpatient and hospital-owned outpatient procedures in 2019. Every useful hysterectomy number needs its population, setting, and observation year attached.

Question	Best-supported answer	Source and data year
What share of U.S. adult women reported ever having had a hysterectomy?	17.2% crude; 14.6% age-adjusted	NHIS, 2021[1]
What was the prevalence among women ages 45–64?	22.1%	NHIS, 2021[1]
What is the latest nationwide annual estimate that combines inpatient and hospital-based outpatient data?	548,802 in 2019; 480,990 in pandemic-affected 2020	NIS + NASS analysis, 2019–2020[2]
When did inpatient volume peak in the 1998–2010 series?	681,234 in 2002	NIS, 1998–2010[3]
How wide was the recent state-and-territory prevalence range?	11.0% in Guam to 29.2% in Alabama	BRFSS pooled, 2012–2020[8]
Which route was most common in a large 2006–2020 benign-hysterectomy hospital sample?	Minimally invasive: 54.7%	PINC AI Healthcare Database, 2006–2020[11]
How often are both ovaries removed now?	No defensible current national percentage was found	Historical inpatient surveillance reported 55% in 1994–1999[6]

One honest note before you go further. There is no live 2026 hysterectomy counter in the United States. National data arrive on a delay, and different systems capture different settings. That is not a flaw to hide. It is the reason every number below carries the year it describes—not just the year this page was checked.

Before you read another number

The right online HRT provider isn't the same for every woman — it depends on your symptoms, your age and whether you have a uterus, your medication route preference (patch, pill, gel, or vaginal estrogen), your risk history, your insurance or cash-pay situation, and your state. Some situations belong with an in-person clinician first. Because a general answer can't resolve those for you, use The HRT Index's Find My HRT Path tool to match your situation to the right provider — and to flag when online care isn't the right starting point — before your first consult.

What did The HRT Index actually verify?

Under The HRT Index Verification Standard, we separated the year a source was updated from the year its data were collected. We also recorded whether each figure counts people or procedures, whether it includes inpatient and outpatient settings, and whether it is observed, weighted, projected, or calculated by The HRT Index.

Evidence source	What it measures	Population or setting	What it cannot answer
2021 National Health Interview Survey	Self-reported lifetime hysterectomy prevalence	U.S. civilian noninstitutionalized adult women	Annual procedure volume, exact age at surgery, or personal lifetime risk
2012–2020 Behavioral Risk Factor Surveillance System	Age-standardized self-reported prevalence and trends	1,267,013 adult respondents across states and territories	Surgical indication, ovary status, or current annual procedure count
2019–2020 NIS + NASS analysis	Weighted annual procedure estimates	Hospital inpatient and hospital-owned outpatient settings	Freestanding settings outside the sampled hospital systems or a live 2026 total
1998–2010 National Inpatient Sample	Inpatient volume and diagnosis trends	Hospital admissions only	The outpatient procedures that increasingly moved out of inpatient care
2006–2020 PINC AI hospital analysis	Route of benign hysterectomy	More than 1.5 million hospital cases	A complete census of every U.S. hysterectomy in every setting
Operative and pathology records	What happened in one person’s surgery	The individual patient	Whether a national prevalence estimate applies clinically to that person

What we could not verify—and are not going to fill with a guess:

• A live national procedure count for 2026.
• A current national percentage for bilateral ovary removal at hysterectomy, stratified by age, indication, and setting.
• A current national mean or median age at hysterectomy.
• An exact current percentage at age 60.
• A single national indication pie chart whose categories are mutually exclusive.
• A newer nationwide annual count than the 2019–2020 NIS + NASS analysis that measures the same inpatient-plus-hospital-outpatient universe.

We publish no patient testimonials or reviews on this page. A testimonial cannot prove a population statistic, and pretending otherwise would be the exact error this page exists to correct.

What percentage of women have had a hysterectomy?

In the 2021 NHIS, 17.2% of U.S. women age 18 and older reported ever having had a hysterectomy. The same survey’s age-adjusted estimate was 14.6%. The two figures are not competing answers: one is the observed crude share, and the other standardizes the age distribution for comparison.^[1]

Measure	2021 estimate	Use it for
Crude prevalence	17.2%	Describing the unadjusted share in the 2021 NHIS sample population
Age-adjusted prevalence	14.6%	Comparing populations or periods after standardizing age structure

That is roughly one in six women using the crude estimate, or one in seven after age adjustment. Keep the percentage beside the rounded phrase. “One in six” is a translation, not a new data point.

Here is the part that trips people up. Pages quote 14.6% and 17.2% as though two studies disagree. They come from the same survey, the same year, and the same underlying responses. The age-adjusted estimate uses the 2000 projected U.S. population and four broad age groups as the standard.^[1]

A separate surveillance system lands in the same general range without measuring the exact same thing. The BRFSS analysis covered 1,267,013 adult respondents in even-numbered years from 2012 through 2020. Its pooled age-standardized prevalence was 17.9%, and the estimate declined from 18.9% in 2012 to 17.0% in 2020.^[8]

That agreement is reassuring, but it is not duplication. NHIS is a household interview survey with one 2021 observation year. BRFSS is a state-based telephone survey pooled across multiple years. Different survey modes, time windows, and weighting systems can produce different estimates without either being wrong.

How reliable is self-report?

Self-report is strong for the hysterectomy itself and weaker for ovary status. In one validation study, self-reported hysterectomy had 91% sensitivity and a 97% positive predictive value against medical records. Self-reported bilateral oophorectomy had 64% sensitivity; among women who reported one ovary removed, 19% had actually had both removed.^[15]

That difference matters. A survey can estimate how many women report a hysterectomy. It cannot reliably tell you whether your ovaries were removed.

This is prevalence, not lifetime risk. It describes surgeries that had already happened by the interview date. It cannot tell a 34-year-old her probability of eventually having one.

How many hysterectomies are performed in the U.S. each year?

A weighted nationwide analysis estimated 548,802 hysterectomies in 2019 and 480,990 in 2020 using the National Inpatient Sample and National Ambulatory Surgery Sample. The 2020 number reflects a pandemic-disrupted year. The often-repeated “600,000 a year” figure belongs to an older inpatient-surveillance era.^[2]

Data year	Estimated procedures	What the number means
2019	548,802	Best pre-pandemic benchmark in the latest located analysis combining NIS and NASS
2020	480,990	Same measurement approach during a year of major elective-surgery disruption

The difference is 67,812 procedures, or about 12.4%. That percentage is The HRT Index’s arithmetic from the two published estimates: (548,802 − 480,990) ÷ 548,802.

The study reported its sharpest interruption in April 2020, with larger reductions for benign and preinvasive indications than for cancer. Do not turn 480,990 into “the normal annual number.” It describes a year when scheduled surgery stopped, restarted, and varied across the country.^[2]

The databases matter. NIS covers hospital inpatient stays. NASS covers major ambulatory surgery performed in hospital-owned facilities. Together they are broader than inpatient-only surveillance, but they still are not a live census of every procedure performed in every U.S. setting.

Where did “600,000 hysterectomies a year” come from?

It is a real historical figure. CDC inpatient surveillance reported approximately 600,000 hysterectomies per year during earlier periods, including 1994–1999, when the overall rate was about 5.5 per 1,000 women. Those data came from nonfederal short-stay hospitals and did not represent today’s outpatient landscape.^[5][6]

The problem is not that the number was fabricated. The problem is that its date and setting are usually stripped away.

The provenance trap, in one live example

As of this page’s September 2026 verification, the federal Office on Women’s Health page says nearly 500,000 women have hysterectomies each year. The page was updated in February 2025, but the reference attached to that sentence is the 2010 National Hospital Discharge Survey.^[7]

Nobody needs to accuse the page of dishonesty. The visible update date is recent; the underlying observation is not. A reader can easily mistake “updated 2025” for “measured in 2025.” That gap between page date and data date explains half the confusion on this topic.

Before quoting any annual number, attach the unit, setting, and year. A sentence that loses any one of those can change meaning without changing a single digit.

Publish this	Do not publish this
“A nationwide hospital analysis estimated 548,802 procedures in 2019.”	“About 549,000 women have hysterectomies every year.”
“Historical inpatient surveillance reported roughly 600,000 procedures annually.”	“The CDC says 600,000 hysterectomies happen each year now.”
“The 2021 crude prevalence was 17.2%.”	“In 2026, 17.2% of women have had a hysterectomy.”
“The 2020 estimate of 480,990 reflects a pandemic-disrupted year.”	“About 481,000 hysterectomies are performed annually.”

Why do hysterectomy statistics give different answers?

Hysterectomy statistics diverge for five structural reasons: they count women versus operations, include different care settings, report crude versus age-adjusted estimates, use surveys versus billing records, and describe different decades. Once those labels are restored, most apparent contradictions stop being contradictions.

The Hysterectomy Number Ledger

We assembled the major figures into one ledger so the denominator does not disappear. “Use in 2026” means whether the figure can answer a present-day reader’s question—not whether the old study has somehow become invalid.

Number or claim	What it measures	Setting or population	Data year	Use in 2026
More than one-fourth by age 60	Historical cumulative projection	U.S. inpatient surveillance	1988–1993	Historical context only; not a current age-60 estimate[5]
About 600,000 a year	Annual procedures	Nonfederal short-stay hospitals	1994–1999	Historical inpatient benchmark[6]
681,234 → 433,621	Inpatient procedures from peak to 2010	National Inpatient Sample	2002 → 2010	Documents a 36.4% inpatient decline, not total all-setting volume[3]
64,612 in 16 states; 100,000–200,000 extrapolated nationally	Ambulatory hysterectomy volume	State ambulatory surgery data	2011	Shows the outpatient procedures missing from inpatient series[4]
548,802	Weighted annual procedures	NIS + hospital-owned outpatient NASS	2019	Best located pre-pandemic inpatient-plus-hospital-outpatient benchmark[2]
480,990	Same measure in a disrupted year	NIS + NASS	2020	Accurate for 2020; not a normal annual baseline[2]
“Nearly 500,000”	Annual figure on a federal consumer page	Underlying citation is hospital discharge data	2010 citation	Current webpage, old measurement[7]
17.2%	Crude lifetime prevalence	2021 NHIS adult women	2021	Use for the unadjusted share in that survey population[1]
14.6%	Age-adjusted prevalence	Same survey and responses	2021	Use for age-standardized comparisons[1]
17.9%; 18.9% → 17.0%	Pooled and trend estimates	BRFSS states and territories	2012–2020	Independent state-based prevalence evidence[8]
“One in three by age 60”	Undated cumulative shorthand	Frequently repeated without a traceable current denominator	Usually legacy	Do not present as the current national estimate
55% had both ovaries removed	Bilateral oophorectomy at hysterectomy	Inpatient surveillance	1994–1999	Historical practice, not a current national percentage[6]

Four labels every hysterectomy number needs

1. What is being counted? Women who report ever having had surgery, or procedures performed during one year?
2. Which year does the data describe? This is not the same as the article’s update date.
3. Which settings are included? Inpatient admissions, hospital-owned outpatient surgery, freestanding facilities, or a household survey?
4. What can the number legitimately answer? Population context—not a personal forecast, diagnosis, or treatment recommendation.

Get those four right and the number becomes useful. Leave one out and it becomes marketing copy.

Calculations we refuse to make

• We will not divide one year’s procedure count by the female population and call it “lifetime risk.” The units do not match.
• We will not add inpatient and outpatient estimates from different years and call the result a national total.
• We will not turn 14.6% into the plain observed share; it is the age-adjusted estimate.
• We will not infer an exact age-60 figure from a 45–64 average.
• We will not turn a regional average into a state estimate.
• We will not use the 55% bilateral-oophorectomy figure from 1994–1999 as though it describes surgery today.

The ledger can tell you what a national number means. It cannot tell you what happened in your surgery.

Skip to the operative-report decoder →

Is “1 in 3 women by age 60” still true?

No current national source we located provides an exact age-60 estimate. CDC analysis of 1988–1993 data said more than one-fourth by age 60, while later pages often repeated one in three. The 2021 NHIS publishes broad age bands, and those bands cannot be used to calculate the figure at age 60.^[1][5]

Current age group	Share reporting a hysterectomy in 2021	What you cannot conclude
18–44	2.8%	The chance a woman in this band will eventually have surgery
45–64	22.1%	The exact figure at age 60 or the average age at surgery
65–74	35.0%	What the rate was when these women originally had surgery
75 and older	41.8%	The present-day procedure rate among women this age

The tempting shortcut is to compare 33.3% with the 22.1% average across ages 45–64 and declare the old statement impossible. Do not do that. Age 60 sits near the top of a 20-year band, and prevalence rises with age. A band average cannot prove the value at one age.

That correction does not rescue the claim as a current statistic. The original CDC surveillance said more than one-fourth by age 60 based on 1988–1993 data.^[5] The later “one in three” wording spread widely, often without a data year or a directly traceable national calculation.

Our verdict: treat “one in three by age 60” as legacy shorthand, not the current U.S. answer. The honest replacement is not a cleaner slogan. It is: no current national source publishes an exact age-60 estimate.

What age are most women when they have a hysterectomy?

Current national prevalence data do not report a mean or median age at surgery. They group women by their age when surveyed, which is a different measure. Historical inpatient surveillance found the highest procedure rates among women ages 40–44, but that is not the same as saying the average patient was 42.^[6]

You will find “the average age is 42” on many pages. We could not trace that sentence to a current national primary source. It may be a distortion of the older finding that the highest rate occurred at ages 40–44.

A peak age band is not an average. Prevalence by current age is not age at operation. And neither can answer “am I too young?”

If that is the real question, the useful variables are the diagnosis, severity, treatment history, fertility goals, alternatives, cancer risk, and what the surgeon expects the operation to change. A population number cannot decide any of those.

Which women report hysterectomies most often?

In the 2021 age-adjusted NHIS estimates, prevalence was 16.3% among Black non-Hispanic women, 15.6% among White non-Hispanic women, 12.5% among Hispanic women, and 6.1% among Asian non-Hispanic women. The survey describes differences; it does not establish why they exist or who clinically “needs” surgery.^[1]

Group	Age-adjusted prevalence
Asian, non-Hispanic	6.1%
Hispanic, any race	12.5%
White, non-Hispanic	15.6%
Black, non-Hispanic	16.3%
Women with disabilities	20.9%
Women without disabilities	14.1%
Less than high school	16.0%
High school diploma or GED	16.2%
Some college or associate degree	18.0%
Bachelor’s degree or higher	10.6%
Family income below 200% of the federal poverty level	15.6%
200%–399% of the federal poverty level	16.1%
400% or more of the federal poverty level	12.9%

The Black–Asian gap is 10.2 percentage points. Dividing 16.3 by 6.1 gives about 2.67. Both are The HRT Index’s descriptive calculations from the CDC estimates—not risk ratios, biological explanations, or claims about clinical necessity.

The education and income patterns are real, but they are not a perfect staircase. The lowest education estimate was not the highest; some college or an associate degree was. The two lower-income bands were close to each other, while the group at 400% or more of the federal poverty level was lower than both.^[1]

Research discusses several contributors that may sit behind population differences: variation in fibroid and other gynecologic disease burden, access to specialists and alternatives, insurance, referral patterns, local surgical practice, patient preferences, and structural inequities. This table cannot separate them.

A second trend matters. Among women age 50 and older, NHIS prevalence declined from 36.6% in 2008 to 31.7% in 2018. It declined among White and Hispanic women, but the change among Black women—from 40.4% to 36.8%—was not statistically significant.^[9] The decline did not land evenly.

Where in the U.S. is hysterectomy prevalence highest?

In the 2021 age-adjusted NHIS, prevalence was highest in the South at 16.9% and lowest in the Northeast at 10.2%. It also rose as urbanization decreased: 11.8% in large central metropolitan areas versus 19.0% in nonmetropolitan areas. These are prevalence estimates, not annual surgical rates.^[1]

Geography	Age-adjusted prevalence
Large central metropolitan area	11.8%
Large fringe metropolitan area	12.8%
Medium or small metropolitan area	16.8%
Nonmetropolitan area	19.0%
Northeast	10.2%
West	13.3%
Midwest	15.5%
South	16.9%

The rural–large-city difference is 7.2 percentage points, and 19.0 divided by 11.8 is about 1.61. The South–Northeast difference is 6.7 points, and 16.9 divided by 10.2 is about 1.66. Those are The HRT Index’s descriptive comparisons.

What they are not: a claim that living in one place causes surgery, a personal probability, or proof that disease burden is identical everywhere. Geography can bundle together disease prevalence, access, referral pathways, availability of alternatives, insurance, patient preference, and local practice. NHIS shows the pattern. It does not isolate the mechanism.

Which states have the highest hysterectomy prevalence?

State-level data do exist, but the best recent analysis pools BRFSS responses from 2012 through 2020. The age-standardized estimates ranged from 11.0% in Guam to 29.2% in Alabama. Four high estimates specifically identified in the report were Alabama at 29.2%, Mississippi at 27.8%, Louisiana at 27.4%, and Arkansas at 27.0%.^[8]

Jurisdiction	Pooled age-standardized prevalence, 2012–2020
Alabama	29.2%
Mississippi	27.8%
Louisiana	27.4%
Arkansas	27.0%
District of Columbia	11.7%
Guam	11.0%

The pooled national estimate in that analysis was 17.9%, and the South’s pooled estimate was 21.1%. Even within the South, the range ran from 11.7% in the District of Columbia to 29.2% in Alabama. Regional labels hide large within-region differences.^[8]

Do not read this as a 2026 leaderboard. The analysis combines even-numbered BRFSS years from 2012 to 2020, uses self-report, and reports wide confidence intervals for some jurisdictions. It also cannot tell whether differences reflect indications, access, alternatives, surgical thresholds, or all of them together.

This corrects a common overreaction: the current NHIS brief does not publish states, but that does not mean state-level evidence is absent. It means you have to use a different survey with a different timeframe and explain the trade-off.

Are hysterectomy rates going up or down?

The major national measures point downward over the periods studied. Inpatient volume fell 36.4% from its 2002 peak to 2010. BRFSS age-standardized prevalence declined 1.9 percentage points from 2012 to 2020. Among women age 50 and older, NHIS prevalence fell 4.9 points from 2008 to 2018.^[3][8][9]

Measure	Earlier estimate	Later estimate	Change
Inpatient procedures	681,234 in 2002	433,621 in 2010	−36.4%
BRFSS age-standardized prevalence	18.9% in 2012	17.0% in 2020	−1.9 percentage points
NHIS prevalence among women age 50+	36.6% in 2008	31.7% in 2018	−4.9 percentage points

Three data systems, three time windows, same general direction. But the inpatient decline exaggerates the fall in total surgery because some operations moved into outpatient settings that inpatient databases did not capture.

Cohen and colleagues identified 64,612 ambulatory hysterectomies in 16 states in 2011 and estimated that this represented roughly 100,000–200,000 outpatient procedures nationally. Of the ambulatory cases in their data, 81.5% were laparoscopic and 16.0% vaginal.^[4]

Likely contributors to the longer decline include broader use of uterine-preserving procedures, medical management, changing patient preferences, and movement between care settings. The observational trend cannot assign a single cause.

There is also a consequence most consumer pages miss. Women without a uterus or cervix are no longer in the population at risk for uterine or cervical cancer. Cancer rates calculated across all women can therefore understate risk among women who still have the relevant organ. Hysterectomy prevalence is used to correct those denominators.^[8]

Why are hysterectomies performed?

Most hysterectomies are performed for noncancer conditions. National surveillance has repeatedly identified uterine fibroids, abnormal bleeding, endometriosis, and pelvic organ prolapse among the major diagnoses. Exact percentage “pie charts” are unreliable when diagnoses overlap, settings differ, and one operation can carry more than one diagnosis code.^[6][7]

Reason	What it means	What a national statistic cannot decide
Uterine fibroids	Noncancerous growths in the uterine muscle that can cause bleeding, pressure, or pain	Whether your symptoms warrant surgery or a uterus-preserving alternative
Abnormal uterine bleeding	A symptom category with multiple possible causes	What is causing your bleeding
Endometriosis	Tissue similar to uterine lining growing outside the uterus	Whether hysterectomy would address disease outside the uterus
Adenomyosis	Endometrial-type tissue growing into the uterine muscle	Whether you are a surgical candidate
Pelvic organ prolapse	One or more pelvic organs descending from their usual position	Which repair or surgical route fits your anatomy and goals
Cancer or precancer	Disease involving the uterus, cervix, ovaries, tubes, or nearby tissue	An oncology treatment plan

How much did inpatient surgery fall by diagnosis?

Between 2002 and 2010, inpatient hysterectomies declined by:^[3]

• 65.3% for endometriosis
• 63.1% for benign ovarian mass
• 47.6% for fibroids
• 39.4% for pelvic organ prolapse
• 28.9% for abnormal bleeding

Those are large declines, but the label inpatient matters. They do not prove the same percentage fall across outpatient surgery, and they do not tell you how many women had more than one diagnosis.

Why there is no pie chart here: if fibroids and abnormal bleeding appear together on the same claim, assigning the operation to one exclusive slice creates false precision. We would rather publish a defensible ranking and dated trend than a clean graphic built from incompatible denominators.

How common a surgery is tells you nothing about whether it is right for you. The useful questions are what is being treated, what alternatives remain, what organs are planned for removal, and what is expected to change afterward.

How are hysterectomies performed today?

In a hospital database analysis of 1,558,107 benign hysterectomies from 2006 through 2020, 54.7% were minimally invasive, 30.3% abdominal, and 15.0% vaginal. The vaginal share fell from 22.6% in January 2006 to 8.3% in December 2020. These are route data—not organ-removal data.^[11]

Route category	Share across the 2006–2020 study	What the route tells you
Minimally invasive, including laparoscopic and robotic approaches	54.7%	Small-incision camera-guided access
Abdominal	30.3%	Access through an abdominal incision
Vaginal	15.0%	Removal through the vagina

The study’s model projected vaginal hysterectomy to reach 7.3% by January 2030. That is a forecast, not an observed 2030 result.^[11]

The most useful sentence in this section is not the percentage. It is this: the route tells you how the surgeon reached and removed the uterus. It does not tell you whether the cervix, tubes, or ovaries were removed.

Any page still presenting a 2005 route split as “how hysterectomies are done now” needs a date attached. Surgical practice changed too much for an old distribution to travel without one.

What does each type of hysterectomy remove?

A hysterectomy removes all or part of the uterus. A total hysterectomy also removes the cervix, but it does not automatically include the ovaries. Ovary removal is an oophorectomy; tube removal is a salpingectomy. Those procedures must be named separately on the operative record.^[7]

Term on the record	What was removed	Does it mean both ovaries were removed?
Total hysterectomy	Uterus and cervix	No
Subtotal, supracervical, or “partial” hysterectomy	Upper uterus; cervix remains	No
Radical hysterectomy	Uterus, cervix, nearby tissue, and upper vagina	No; the ovary plan is separate
Unilateral oophorectomy	One ovary	No; one ovary was removed
Bilateral oophorectomy	Both ovaries	Yes
Salpingectomy	One or both fallopian tubes	No
Bilateral salpingo-oophorectomy, or BSO	Both tubes and both ovaries	Yes

The single most misunderstood word on this topic

“Partial hysterectomy” does not mean “they left my ovaries.” It refers to the cervix being left in place. A woman can have a subtotal hysterectomy with both ovaries removed, or a total hysterectomy with both ovaries conserved.

The words total and partial describe the uterus and cervix. They do not settle the ovaries.

Bleeding status is not hormone status

No uterus means no menstrual periods. It does not automatically mean no ovarian hormone production. That is why a woman can have no bleeding marker and still move through the menopause transition later.

How often are the ovaries removed during a hysterectomy?

There is no defensible current national percentage that answers this across ages, indications, and settings. The widely quoted 55% figure comes from 1994–1999 inpatient surveillance. More recent evidence shows declining bilateral ovary removal in a defined population and sharply rising—but highly variable—tube removal with ovaries conserved.^[6][12][13]

Evidence	Population and years	What it establishes
55% bilateral oophorectomy	National inpatient surveillance, 1994–1999	Historical practice; not the current national share[6]
Bilateral oophorectomy declined after 2000	Rochester Epidemiology Project, geographically defined population through 2018	Direction of change in one population, not a national percentage[12]
Salpingectomy rose from 0.01% to 43.3% among lower-adopting physicians and 10.5% to 81.3% among higher-adopting physicians	33,401 patients ages 18–49 having benign inpatient hysterectomy without oophorectomy, 2011–2021	Enormous physician-level variation in removing tubes while conserving ovaries[13]
ACOG recommends routine bilateral salpingectomy at hysterectomy	Clinical Practice Update, August 2026	Current professional guidance applied through shared decision-making and the individual surgical situation[14]

The 2026 physician study is easy to misuse. It deliberately included patients having benign inpatient hysterectomy without oophorectomy, ages 18–49. It therefore measures salpingectomy adoption within that selected group. It does not tell you the percentage of all hysterectomies that remove ovaries.^[13]

The inversion, stated accurately

Older national surveillance often captured both ovaries being removed with the uterus. Current guidance increasingly targets the fallopian tubes while conserving ovaries when ovary removal is not otherwise indicated. That is a real change in practice—but it is not proof of what happened in your operating room.

The strongest finding in the recent salpingectomy data is not one national percentage. It is the spread between physicians treating similar cases. Practice varied from near-zero adoption to more than 80% in the same decade.^[13]

And that leads to the honest limit: no national number can tell you whether your ovaries came out. Your record can.

How do I find out whether my ovaries were removed?

Request the operative report from the hospital or surgical practice and, when available, the pathology report. “Total” and “partial” hysterectomy do not identify ovary status. The operative report records what the surgeon did; pathology identifies the tissue submitted to the laboratory, but it may not list tissue that was left in place.

Words to look for in the operative report

• Right ovary / left ovary — identifies the side discussed.
• Oophorectomy — an ovary was removed; check whether the record says unilateral or bilateral.
• Bilateral salpingo-oophorectomy / BSO — both ovaries and both fallopian tubes were removed.
• Bilateral salpingectomy with no oophorectomy — both tubes were removed; that wording alone does not remove the ovaries.
• Ovaries conserved / ovaries preserved / adnexa preserved — indicates conservation, but read the full report for side-specific detail.
• Specimens — the pathology list shows what was sent to the laboratory. It can confirm removed tissue, but silence about an ovary is not by itself proof that the ovary remains.

The exact request to send

I’m requesting a copy of my operative report and pathology report for the hysterectomy performed on [date] at [hospital or practice]. I specifically need to confirm whether my cervix, right ovary, left ovary, right fallopian tube, and left fallopian tube were removed or conserved.

Under HIPAA, people generally have the right to inspect and obtain copies of records held by health plans and healthcare providers covered by the Privacy Rule, subject to limited exceptions. A covered entity generally must act within 30 calendar days and may charge a reasonable cost-based copying or mailing fee. Old-record availability and retention periods can still vary.^[16]

You do not need to invent a medical reason for asking. The record is yours to request.

If surgery is upcoming

Ask the organ question as a list before consent:

Which organs are planned for removal: the uterus, cervix, right tube, left tube, right ovary, and left ovary? What findings would cause that plan to change during surgery?

“Will this be a total hysterectomy?” will not get you the whole answer. Total does not cover the ovaries.

Once you know what was removed, you can stop asking a statistics page to answer a records question. The free Find My HRT Path tool can then route your next online-care question by symptoms, menopause stage, safety history, preferences, budget, and state. No email is required to see the result; a licensed clinician makes treatment decisions.

Map your situation before your next consult →

Does a hysterectomy cause menopause?

A hysterectomy causes immediate surgical menopause only when both ovaries are removed before natural menopause. Removing the uterus stops periods but does not automatically stop ovarian hormone production. When one or both ovaries remain, menopause can still occur later—and the loss of bleeding makes its timing harder to recognize.^[7]

What was removed	What happens to periods?	What happens to menopause timing?
Uterus; both ovaries conserved	Periods stop	No immediate surgical menopause; ovarian function may continue and may end earlier than it otherwise would
Uterus and one ovary	Periods stop	The remaining ovary may continue to function; timing cannot be read from bleeding
Uterus and both ovaries before natural menopause	Periods stop	Surgical menopause begins at surgery

If both ovaries were removed before natural menopause

The change is immediate rather than the gradual transition of natural menopause. Symptoms, risks, and treatment decisions depend on age, indication, cancer history, contraindications, and the individual—not on a population percentage.

If the ovaries were kept

You are not in immediate surgical menopause simply because the uterus is gone. But “ovaries kept” does not mean nothing changed.

A prospective study followed 406 women ages 30–47 who had hysterectomy with ovarian conservation and 465 controls. Ovarian failure occurred more often in the hysterectomy group: adjusted hazard ratio 1.92. By four years, the estimated cumulative incidence was 14.8% versus 8.0%. With one ovary removed, the hazard ratio was 2.93; even with both ovaries retained, it was 1.74.^[17]

That is an association from one cohort, not proof that every hysterectomy causes earlier ovarian failure. It is still strong enough to correct the opposite claim that ovarian timing is guaranteed to be unchanged.

There is also a measurement problem: natural menopause is usually dated after 12 consecutive months without menstruation.^[19] After hysterectomy, that bleeding marker no longer exists. Menopause can still happen. It just becomes harder to date from the calendar alone.

Numbers we will not repeat

Commercial pages publish precise claims such as “hormones fall 95% in 48 hours,” “hot flashes improve 87%,” or “sexual function returns in 65%–75%.” We did not find primary evidence supporting those universal percentages. Fabricated precision is still fabrication, even when the number sounds clinical.

What did the Women’s Health Initiative find for women after hysterectomy?

The WHI did not test one treatment in one population. Women with a uterus received estrogen plus progestin; 10,739 women with a prior hysterectomy were randomized to oral conjugated equine estrogen alone or placebo. The estrogen-alone trial found no coronary-disease benefit and more stroke, while long-term breast-cancer findings differed from the combined-therapy trial.^[21]

WHI estrogen-alone finding	Estimate for conjugated equine estrogen vs placebo	What it means
Coronary heart disease during intervention	HR 0.91 (95% CI 0.75–1.12)	No statistically significant benefit
Breast cancer during intervention	HR 0.77 (0.59–1.01)	Lower point estimate; confidence interval included 1
Stroke during intervention	HR 1.39 (1.10–1.77)	Increased risk in this trial
Hip fracture during intervention	HR 0.61 (0.41–0.91)	Reduced risk in this trial
Breast cancer incidence in long-term follow-up	HR 0.78 (0.65–0.93)	Lower incidence after prior randomized CEE alone
Breast cancer mortality in long-term follow-up	HR 0.60 (0.37–0.97)	Lower breast cancer mortality after prior randomized CEE alone

The point is not that estrogen is universally safe or universally right after hysterectomy. It is that uterus status changes the regimen studied, and the trial results cannot be collapsed into one sentence about “HRT.” The estrogen-alone intervention used one oral product and dose in women ages 50–79; route, dose, timing, and individual risk still matter.^[18][19]

A number we are going to argue against

Sarrel and colleagues estimated that 18,601 to 91,610 excess deaths occurred over ten years among hysterectomized U.S. women ages 50–59 because estrogen use declined after 2002.^[22]

That number supports a dramatic headline. It is also a modeled projection, not a body count.

WHI investigators formally challenged the calculation. The estimate relied on an age-subgroup all-cause mortality hazard ratio of 0.73 with a 95% confidence interval of 0.53–1.00, based on 65 versus 89 deaths. They noted that the all-ages estrogen-alone mortality estimate was 1.02 (0.91–1.15), not a mortality reduction. The original authors responded and stood by their analysis.^[23][24]

That disagreement belongs on the page. Quoting “91,610 deaths” as an observed fact erases the model, the uncertainty, and the published rebuttal.

The defensible conclusion is narrower: the WHI’s combined-therapy and estrogen-alone trials studied different populations and produced different outcome patterns. A clinician should make an individualized decision using the patient’s age, time since menopause or ovary removal, symptoms, route, medical history, and contraindications—not a recycled headline from either side.^[19]

Do you need progesterone if you do not have a uterus?

Usually not for the standard reason it is prescribed with systemic estrogen. Progestogen protects the endometrium from estrogen stimulation. After a total hysterectomy, there is no uterine lining to protect, so systemic estrogen is generally used without progestogen. Individual exceptions depend on the surgical and medical history.^[18][19]

The logic is straightforward: no uterus means no endometrium. But “usually” is doing real work here.

Questions that can change the decision include:

• Was the hysterectomy total or supracervical?
• Could endometrial tissue remain?
• Is there residual endometriosis?
• Was surgery performed for endometrial cancer, precancer, or another hormone-sensitive condition?
• Is the treatment systemic estrogen or low-dose local vaginal estrogen?
• Are there other reasons a clinician is considering a progestogen?

This page will not select a regimen, dose, or duration. That is the prescriber’s job.

One distinction is non-negotiable if you compare online care: FDA-approved and compounded hormone products are not equivalent regulatory categories. FDA-approved products undergo premarket review for safety, effectiveness, and manufacturing quality. Compounded drugs are not FDA-approved, and FDA does not verify their safety, effectiveness, or quality before marketing. A compounded product may meet a specific medical need; it is not an FDA-approved generic, and its finished formulation should not be represented as equivalent to an approved product.^[20]

Why do menopause statistics fail to describe some women after hysterectomy?

Because a major eligibility rule can remove them before the study begins. SWAN—one of the most influential U.S. menopause cohorts—required participants to have had a recent menstrual period and excluded women with hysterectomy or bilateral oophorectomy. A 2023 reanalysis showed that this selection masked racial differences in menopause timing.^[25]

The Study of Women’s Health Across the Nation screened 15,695 women and enrolled a longitudinal cohort of 3,302. Cohort eligibility included age 42–52, no current hormone therapy, no hysterectomy or bilateral oophorectomy, and a menstrual period within the prior three months.^[25]

Reeves and colleagues used the screener and cohort data to adjust for selection into and out of the study:

Analysis	Black–White difference in menopause timing
Unadjusted for selection	No difference: HR 0.98 (95% CI 0.86–1.11)
Adjusted—natural menopause	Earlier for Black women: HR 1.13 (1.00–1.26)
Adjusted—surgical menopause	Much earlier for Black women: HR 3.21 (2.80–3.62)
Overall modeled difference	About 1.2 years earlier

The study did not say every menopause statistic is wrong. It showed something sharper: eligibility rules can systematically remove women who reached the outcome earlier, especially when surgical menopause is unequally distributed.

The women most likely to have had a hysterectomy were also more likely to be excluded from a cohort designed to tell everyone when menopause happens. The surgical disparity became an evidence disparity.

If you have had a hysterectomy and cannot date menopause from twelve months without bleeding, that is not a failure of your memory. The standard marker was removed by surgery. For the natural-timing question and why credible sources use different ages, see the average age of menopause and why the numbers disagree.

What can hysterectomy statistics not tell you?

National statistics describe populations, not the appropriateness or outcome of one operation. They cannot determine whether your surgery was necessary, whether your ovaries were removed, when ovarian function will end, whether a symptom is caused by menopause, or whether hormone therapy is suitable for you.

Six honest limits:

1. Self-report does not settle ovary status. It is accurate enough for population hysterectomy prevalence and materially weaker for oophorectomy.
2. Procedure counts do not measure appropriateness. A billing record shows that surgery occurred, not whether it was the best choice.
3. Prevalence is built from the past. Older women in a 2021 survey may have had surgery under practice patterns from decades earlier.
4. Geographic differences do not identify a cause. Disease burden, access, alternatives, referral pathways, insurance, preferences, and local practice can all contribute.
5. There is no live 2026 count. Anyone publishing one is estimating and should disclose the method.
6. Common is not the same as indicated—in either direction. A common surgery is not automatically right. It is not automatically wrong, either.

That last point is deliberate. Statistics have been used both to normalize unnecessary care and to make women feel foolish for having surgery that helped them. Frequency is not a verdict on your body or your decision.

What should you verify before paying for HRT care after a hysterectomy?

Before paying an online HRT provider, verify whether a clinician can review your operative records, whether the service treats your state, what insurance it accepts, which exact products may be prescribed, what labs or follow-ups cost, and how cancellation works. Provider marketing is not the same as confirmed eligibility at intake.

Decision point	What a page may say	What you need verified before payment
Surgical history	“Personalized menopause care”	Will the clinician review an operative or pathology report, or only your questionnaire answers?
State access	“Available nationwide” or a broad state map	Is a licensed prescriber available for your state and your requested care on the date you enroll?
Insurance	“We accept insurance”	Is your exact plan in network? Are Medicare, Medicaid, or other public-program rules different?
Medication	“Estrogen,” “bioidentical,” or “HRT options”	What exact product and route may be prescribed, and is it FDA-approved or compounded?
Labs and imaging	“Labs as needed”	Which tests are included, which are external, who orders them, and what you may pay separately?
Follow-up	“Ongoing care”	How often are visits included, who answers messages, and what triggers an additional fee?
Cancellation	“Cancel anytime”	When does cancellation take effect, what remains billable, and is a long plan charged upfront?

Use this checklist on every provider, including companies with which The HRT Index has an affiliate relationship. That is the point of publishing it before any recommendation.

Do not let “bioidentical” answer the FDA question. The regulatory categories are FDA-approved or not FDA-approved; compounded drugs do not become approved because of the ingredient description.^[20]

If your ovaries were removed before the usual age of menopause, if surgery involved cancer or precancer, if you have unexplained bleeding or a pelvic mass, or if you need an examination or coordinated specialty care, online-only care may not be the right starting point.

The Find My HRT Path tool asks about symptoms and priorities, menopause stage, safety history, treatment preferences, budget, and state. It shows a best-fit online route plus backup options, labels FDA-approved and compounded paths separately, and tells you when a licensed clinician—not the tool—must make the decision.

Get your best-fit care path before you pay →

Already know the care model you need? Compare current online HRT providers, prices, insurance language, and state access →

How was this page verified?

Who made it. The HRT Index Editorial Team. No clinician-review badge, invented credential, or first-person treatment claim has been added. This is editorial research and is labeled that way.

How we made it. We read the original CDC/NCHS prevalence brief and its methodology; the annual-volume analyses; historical inpatient surveillance; the BRFSS state paper; the current route paper; the self-report validation study; the ovarian-function cohort; the SWAN selection-bias reanalysis; FDA compounding materials; federal record-access guidance; current ACOG salpingectomy guidance; WHI trial reports; and the published dispute over the estrogen-avoidance mortality model.

What we did differently. We built the Hysterectomy Number Ledger, separated update dates from observation years, reconciled inpatient and outpatient universes, added a state-and-territory layer, labeled every in-house calculation, and refused to manufacture an exact age-60 figure, current bilateral-oophorectomy percentage, or national average age.

Our source order. Federal primary data first. Then peer-reviewed analyses of named datasets. Then current regulatory and clinical guidance. Consumer pages are used only when their own sourcing is the point being audited.

Our calculation policy. Every calculation performed by The HRT Index is labeled as descriptive arithmetic. None is presented as a causal estimate, clinical risk ratio, or personal forecast.

Corrections. Send a dated primary source through the site’s corrections page. Material corrections should be logged, not silently replaced.

Why this page exists. A statistic can travel for twenty years after its data have aged out. This page exists so a woman can see the observation year, denominator, setting, and limit before a headline number influences a decision about her body.

Frequently asked questions

What percentage of U.S. women have had a hysterectomy?

In the 2021 NHIS, the crude estimate was 17.2% among U.S. women age 18 and older in the civilian noninstitutionalized population. The age-adjusted estimate from the same survey was 14.6%.^[1]

Why do some sources say 14.6% and others say 17.2%?

They are two versions of the same 2021 result. 17.2% is the crude observed share; 14.6% is standardized to a reference age distribution for comparison.^[1]

How many hysterectomies are performed each year in the U.S.?

The latest located nationwide analysis combining NIS and NASS estimated 548,802 procedures in 2019 and 480,990 in 2020. The second number reflects a pandemic-disrupted year, not a normal baseline.^[2]

Is “600,000 hysterectomies a year” still accurate?

It is a valid historical shorthand from an inpatient-surveillance era. It should not be published as a current all-setting annual count without the historical date and hospital-only scope.^[5][6]

Is “one in three women by age 60” still true?

No current national source located for this audit publishes an exact age-60 estimate. Older CDC analysis said more than one-fourth by age 60 using 1988–1993 data. The 2021 45–64 average cannot be converted into the exact value at age 60.^[1][5]

What is the average age for a hysterectomy?

A current national mean or median was not found. Historical inpatient surveillance found the highest rate among women ages 40–44, which is not the same as an average age at surgery.^[6]

What percentage of women under 45 have had a hysterectomy?

The 2021 NHIS estimate was 2.8% for ages 18–44. That is a 27-year band and does not provide the value at any single age.^[1]

Which racial or ethnic group had the highest 2021 prevalence estimate?

Among the four groups reported in the brief, Black non-Hispanic women had the highest age-adjusted estimate at 16.3%; Asian non-Hispanic women had the lowest at 6.1%. These are descriptive estimates, not biological explanations or personal risk scores.^[1]

Are hysterectomies more common in rural areas?

Reported lifetime prevalence was higher in the 2021 NHIS: 19.0% in nonmetropolitan areas versus 11.8% in large central metropolitan areas. The survey establishes the pattern, not its cause.^[1]

Which U.S. region had the highest prevalence?

The South had the highest 2021 age-adjusted estimate at 16.9%, followed by the Midwest at 15.5%, the West at 13.3%, and the Northeast at 10.2%.^[1]

Which state had the highest recent estimate?

In the pooled 2012–2020 BRFSS analysis, Alabama had the highest state estimate at 29.2%. The overall jurisdiction range was 11.0% in Guam to 29.2% in Alabama.^[8]

Are hysterectomy rates going up or down?

Major national measures have moved down over the intervals studied. Inpatient volume declined after 2002, BRFSS age-standardized prevalence declined from 2012 to 2020, and prevalence among women age 50 and older declined from 2008 to 2018.^{[3][8][9][10]}

What is the most common reason for hysterectomy?

Uterine fibroids have been among the most frequent diagnoses in national surveillance, alongside abnormal bleeding, endometriosis, and pelvic organ prolapse. Exact shares vary because diagnoses overlap and datasets cover different settings.^[6][7]

Does a total hysterectomy include the ovaries?

No. A total hysterectomy removes the uterus and cervix. Ovary removal is a separate procedure called oophorectomy and must be specified separately.^[7]

Does “partial hysterectomy” mean the ovaries were kept?

No. Partial, subtotal, or supracervical hysterectomy means the cervix was left in place. It says nothing by itself about either ovary.^[7]

Does a hysterectomy cause menopause?

It causes immediate surgical menopause when both ovaries are removed before natural menopause. If one or both ovaries remain, periods still stop because the uterus is gone, but ovarian function may continue.^[7]

How do I find out whether my ovaries were removed?

Request the operative report and, when available, the pathology report. Look for oophorectomy, bilateral salpingo-oophorectomy, BSO, ovaries conserved, and side-specific references to the right and left ovary.

Do I need progesterone if I do not have a uterus?

Usually not for endometrial protection after a total hysterectomy, because there is no uterine lining to protect. Supracervical surgery, residual endometriosis, cancer history, and other individual factors can change the decision.^[18][19]

Can I still need cervical cancer screening after a hysterectomy?

It depends on whether the cervix was removed and the reason for surgery. ACOG’s July 2026 guidance says routine cervical cancer screening is not recommended after hysterectomy with removal of the cervix when there is no history of high-grade cervical precancer or cervical cancer. If the cervix remains or the history is higher-risk, different recommendations apply.^[26]

Does a common procedure mean it was right—or wrong—for me?

No. National frequency cannot establish whether one person’s operation was indicated, whether alternatives were reasonable, which organs should have been removed, or what outcome she should expect.

Still not sure which HRT program is right for you? Take our free matching quiz.

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Sources

¹ Gorina Y, Elgaddal N, Weeks JD. Hysterectomy Among Women Age 18 and Older: United States, 2021. NCHS Data Brief No. 494. 2024.

² Emont JP, Wen T, Friedman AM, Wright JD. Trends in Hysterectomy Rates Associated With the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstetrics & Gynecology. 2023.

³ Wright JD, Herzog TJ, Tsui J, et al. Nationwide Trends in the Performance of Inpatient Hysterectomy in the United States. Obstetrics & Gynecology. 2013.

⁴ Cohen SL, Vitonis AF, Einarsson JI. Outpatient Hysterectomy Volume in the United States. Obstetrics & Gynecology. 2017.

⁵ CDC. Hysterectomy Surveillance—United States, 1980–1993. MMWR. 1997.

⁶ Keshavarz H, Hillis SD, Kieke BA, Marchbanks PA. Hysterectomy Surveillance—United States, 1994–1999. MMWR Surveillance Summaries. 2002.

⁷ Office on Women’s Health. Hysterectomy. Updated February 27, 2025; annual-volume citation points to 2010 National Hospital Discharge Survey data.

⁸ Gopalani SV, Dasari SR, Adam EE, et al. Variation in Hysterectomy Prevalence and Trends Among U.S. States and Territories—BRFSS, 2012–2020. Cancer Causes & Control. 2023.

⁹ CDC/NCHS. Percentage of Women Aged 50 Years and Older Who Have Had a Hysterectomy, by Race/Ethnicity and Year—NHIS, 2008 and 2018. MMWR QuickStats. 2019.

¹⁰ Harvey SV, Pfeiffer RM, Landy R, Wentzensen N, Clarke MA. Trends and Predictors of Hysterectomy Prevalence Among Women in the United States. American Journal of Obstetrics & Gynecology. 2022.

¹¹ Lerner V, Chen L, Xu X, Myers E, Wright JD. Current and Future Trends in Performance of Vaginal Hysterectomy in the United States. Obstetrics & Gynecology. 2025.

¹² Erickson Z, et al. Time Trends in Unilateral and Bilateral Oophorectomy in a Geographically Defined American Population. Obstetrics & Gynecology. 2022.

¹³ Xu X, Desai VB, Gross CP, et al. Physician-Level Variability in Adopting Opportunistic Salpingectomy for Ovarian Cancer Prevention at the Time of Hysterectomy. International Journal of Gynecological Cancer. 2026.

¹⁴ American College of Obstetricians and Gynecologists. Salpingectomy for the Prevention of Epithelial Ovarian Cancer. Clinical Practice Update. August 2026.

¹⁵ Phipps AI, Buist DSM. Validation of Self-Reported History of Hysterectomy and Oophorectomy Among Women in an Integrated Group Practice Setting. Menopause. 2009.

¹⁶ U.S. Department of Health and Human Services. Your Medical Records and HIPAA access timing guidance.

¹⁷ Moorman PG, Myers ER, Schildkraut JM, et al. Effect of Hysterectomy With Ovarian Preservation on Ovarian Function. Obstetrics & Gynecology. 2011.

¹⁸ National Cancer Institute. Menopausal Hormone Therapy and Cancer.

¹⁹ The Menopause Society. The 2022 Hormone Therapy Position Statement. Menopause. 2022.

²⁰ U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers and Human Drug Compounding.

²¹ Anderson GL, Limacher M, Assaf AR, et al. Effects of Conjugated Equine Estrogen in Postmenopausal Women With Hysterectomy: The WHI Randomized Controlled Trial. JAMA. 2004; and Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-Term Follow-up of the WHI Randomized Clinical Trials. JAMA. 2020.

²² Sarrel PM, Njike VY, Vinante V, Katz DL. The Mortality Toll of Estrogen Avoidance. American Journal of Public Health. 2013.

²³ Prentice RL, Manson JE, Anderson GL, et al. Women’s Health Initiative View of Estrogen Avoidance and All-Cause Mortality. American Journal of Public Health. 2013.

²⁴ Katz DL, et al. Katz et al. Respond. American Journal of Public Health. 2013.

²⁵ Reeves A, Elliott MR, Karvonen-Gutierrez CA, Harlow SD. Systematic Exclusion at Study Commencement Masks Earlier Menopause for Black Women in SWAN. International Journal of Epidemiology. 2023.

²⁶ American College of Obstetricians and Gynecologists. Screening for Cervical Cancer. Committee Statement. July 2026.