Weight Gain or Weight Loss After Hysterectomy: What the Research Shows

A hysterectomy does not make you gain weight or lose weight by itself. The uterus has no role in metabolism, and removing it does not change how your body burns calories. What research does show is a modest tendency to gain weight in the years after surgery, a larger effect when both ovaries are removed before menopause, and a shift of fat toward the belly as estrogen falls, whenever that happens.^{[1][2][3][6][7]} This guide separates the short-term changes on the scale in the first weeks from the long-term ones, explains what the studies actually found, and covers what helps.

The short answer

• First few weeks: the scale can go up or down for reasons that have little to do with fat: fluid from the operation, bloating, a smaller appetite, and less movement while you heal.
• First year, ovaries kept: on average the extra gain is small. In one prospective US study, women gained about 3 lb in the year after hysterectomy compared with about 1.3 lb in a comparison group, a difference that was not statistically clear.^[1]
• Both ovaries removed before menopause: this causes immediate (surgical) menopause, and BMI rose faster in the following years than after natural menopause in a large US study.^[2]
• Belly fat: the drop in estrogen around menopause moves fat toward the abdomen, even when total weight barely changes.^[6][7]
• Weight loss you did not plan beyond the first weeks is not an expected effect of the surgery and is worth checking with your doctor.^[12]

The first weeks: why the scale moves

Many women step on the scale a week or two after surgery and see a number that makes no sense. Short-term changes are common and usually have simple explanations.

Reasons the number may go up

• Fluid and swelling. You receive fluids through a drip during and after the operation, and the tissues around the surgery hold water while they heal.
• Bloating and gas. The bowel slows down after surgery and pain medicines can cause constipation, so the belly may look and feel bigger for weeks. Our guide to swelly belly after hysterectomy explains why this happens and how long it usually lasts.
• Less movement. You are told not to lift heavy objects and to rest, so daily activity drops for several weeks.^[10]

Swelling and bloating go down gradually as you recover. A few pounds of extra fluid in the first weeks is not fat, and it is not a sign that the surgery has changed your metabolism.

Reasons the number may go down

• Smaller appetite. Nausea after anesthesia, pain medicines and simply feeling unwell can mean you eat less for a while.
• The weight of what was removed. A normal uterus weighs only a few ounces, so its removal makes no visible difference. An enlarged uterus is another matter: in a German series of 138 laparoscopic hysterectomies for very large uteri, the median uterus weighed about 600 g (around 1.3 lb) and the largest 1,860 g (about 4 lb).^[9] If you had large fibroids, part of the drop on the scale is simply that tissue.
• Fluid leaving. As swelling settles, the extra water from surgery is lost again.

For what to expect at each stage of healing, see our week-by-week recovery guide.

What studies show about weight gain after hysterectomy

Only a handful of studies have followed women’s weight before and after hysterectomy. They point in the same direction, but the effects are modest and none of them can prove that the surgery itself is the cause.

The first year, ovaries kept

A North Carolina study weighed 236 premenopausal women before a hysterectomy that left at least one ovary in place, and again one year later, alongside 392 women who had not had surgery. Average gain was 1.36 kg (about 3 lb) after hysterectomy and 0.61 kg (about 1.3 lb) in the comparison group, a difference that did not reach statistical significance. However, 23% of the hysterectomy group gained more than 10 lb, compared with 15% of the other women, and after adjusting for other factors the hysterectomy group had about 1.6 times the odds of gaining that much.^[1]

Two cautions: the women having surgery were already heavier at the start, and the groups differed in other ways too. The authors suggested that women who were heavier or whose weight had gone up and down in adulthood may be most likely to gain.^[1]

Over many years

A Mayo Clinic study compared 2,094 Minnesota women who had a hysterectomy for a benign reason with both ovaries kept against women of the same age who had not had the operation, and followed them for a median of about 22 years. The hysterectomy group had an 18% higher risk of developing obesity, and slightly higher risks of high cholesterol, high blood pressure and heart disease, especially when surgery was done at age 35 or younger.^[3]

This was an observational study. Women who need a hysterectomy may differ in many ways from women who do not, so it shows a link, not proof that removing the uterus causes weight gain. It is still a useful reminder to keep an eye on weight, blood pressure and cholesterol after surgery.

Does it matter whether your ovaries were removed?

Yes, and this is the most important question for your own situation. Your ovaries, not your uterus, make most of your estrogen before menopause. If you are not sure what was removed, check your operation notes or ask your surgeon; our guide to partial vs total hysterectomy explains the terms.

Both ovaries removed before menopause

Removing both ovaries before menopause brings on surgical menopause straight away. In the Study of Women’s Health Across the Nation (SWAN), which followed nearly 2,000 midlife women for up to 10 years, BMI rose by about 0.21 kg/m² a year after hysterectomy with removal of both ovaries, compared with about 0.08 kg/m² a year after natural menopause. Women who had a hysterectomy but kept their ovaries gained at a rate (0.13 kg/m² a year) that was not clearly different from natural menopause.^[2]

For a woman of average height, 0.21 kg/m² is roughly 1.2 lb a year. Small on its own, but it adds up over a decade. Our guide to surgical menopause covers symptoms and treatment in detail.

Ovaries kept

If your ovaries were left in place, you do not go into menopause at the time of surgery. Menopause may arrive somewhat earlier than it otherwise would: two studies found that ovarian function ended sooner in women who had a hysterectomy, by about two to four years on average.^[4][5] Because you no longer have periods, the weight and body-shape changes of menopause may be the first thing you notice. See menopause after hysterectomy with ovaries intact for the signs to watch for.

Belly fat after hysterectomy

Many women notice that their waist thickens even when the scale barely moves. That matches what menopause research has found. A review written for the International Menopause Society concluded that weight gain itself cannot be blamed on menopause, but the hormonal change at menopause is linked to more total body fat and more fat around the abdomen.^[7]

The SWAN study measured body composition with body scans and found that during the menopause transition the rate of fat gain almost doubled while lean (muscle) mass started to fall. Total weight kept rising at the same slow pace as before, which is why the change shows more in clothes than on the scale. After about two years past the final period, these changes leveled off.^[6]

Belly fat matters for more than appearance: fat stored around the abdomen is linked to a higher risk of heart disease and type 2 diabetes.^[7] It is also different from post-surgical swelling, which is softer, changes through the day and fades over the first weeks and months.

Does hormone therapy cause weight gain?

This is a common worry, and the evidence is reassuring. A Cochrane review of 28 randomized trials with more than 28,000 women found no difference in weight or BMI between women taking estrogen, alone or with a progestogen, and women not taking it.^[8] The International Menopause Society review also notes that estrogen therapy appears to lessen the shift of fat toward the abdomen.^[7]

Hormone therapy is not a weight-loss treatment, and it has its own benefits and risks that depend on your age, your health and what was removed. But fear of weight gain is not a good reason to avoid it if you need it for symptoms. Our article on hysterectomy and hormones has more background.

Weight loss after hysterectomy

Some women lose weight after a hysterectomy, usually for the reasons above: a smaller appetite while healing, fluid leaving the body, and the removal of a large fibroid uterus. Others find that once heavy bleeding, pain or anemia are gone, they have more energy to be active, and their weight comes down over time. Our guide to life after hysterectomy covers other longer-term changes.

Steady weight loss you are not trying for is different. Mayo Clinic advises seeing a doctor if you lose more than 5% of your body weight in 6 to 12 months without trying, for example about 8 lb for a woman who weighs 160 lb.^[12] That is not an expected result of a hysterectomy and deserves a check-up.

What helps

There is no special diet or exercise plan for women who have had a hysterectomy. The same basics that work at midlife apply, with some care in the first weeks.

During recovery

• Walk early and often. Walking starts the day after surgery and is encouraged throughout recovery; swimming is usually fine once your wounds have healed.^[10]
• Do not diet hard while healing. Your body needs enough food, especially protein, to repair tissue. Fluids, fruit and fiber help prevent constipation, which also eases bloating.^[10]
• Avoid heavy lifting during recovery and follow your surgeon’s advice on when to go back to the gym.^[10] Gentle pelvic floor exercises can usually start early.

Once you are healed

• Build up to the standard target. Adults are advised to get at least 150 minutes a week of moderate activity, such as brisk walking, or 75 minutes of vigorous activity.^[11]
• Add strength training. At least two days a week of muscle-strengthening activity is recommended.^[11] This matters at midlife because lean muscle tends to fall during the menopause transition.^[6]
• Watch portions, not just food choices. Small daily surpluses explain most midlife weight gain. A registered dietitian can help if you want a plan that fits your health conditions.
• Protect your sleep. Night sweats and poor sleep make it harder to keep to healthy habits. See our tips on sleeping after hysterectomy.
• Check the numbers that matter. Ask your doctor to measure blood pressure, cholesterol and blood sugar at your regular check-ups, given the small long-term increase in these risks seen after hysterectomy.^[3]

When to call your doctor

• Swelling, redness or pain in one leg, or sudden shortness of breath or chest pain: these can be signs of a blood clot and need urgent care.^[14]
• A belly that becomes harder, more swollen or more painful after surgery instead of slowly settling, especially with fever, vomiting or being unable to pass gas.^[14]
• Bloating that is persistent and new, feeling full quickly or a loss of appetite that goes on for weeks. If your ovaries were kept, these can rarely be symptoms of ovarian cancer and should be checked.^[13]
• Weight loss of more than 5% of your body weight in 6 to 12 months without trying.^[12]
• Rapid weight gain with swelling of the legs or face, or with new symptoms you cannot explain.

Frequently asked questions

Will I gain weight after a hysterectomy?

Not necessarily. Studies show a small average gain in the years after surgery, larger when both ovaries are removed before menopause, but many women’s weight does not change much.^[1][2] Age, activity, diet and menopause usually matter more than the operation itself.

Why is my stomach bigger after a hysterectomy?

In the first weeks and months it is usually swelling and bloating from the surgery. Later, a thicker waist is more often due to the fat redistribution that comes with menopause, whether natural or surgical.^[6][7]

How much weight do you lose when the uterus is removed?

Usually only a few ounces. With a large fibroid uterus it can be a pound or more, and occasionally several pounds.^[9]

Is it harder to lose weight after a hysterectomy?

There is no good evidence that removing the uterus makes weight loss harder in itself. The falling estrogen of menopause and the gradual loss of muscle at midlife can make it slower, which is why strength training and steady activity are worth the effort.^[6][11]

Will HRT make me gain weight?

Randomized trials have not found that estrogen therapy, with or without a progestogen, causes weight gain.^[8]

Sources

1. Moorman PG, Schildkraut JM, Iversen ES, et al. A prospective study of weight gain after premenopausal hysterectomy. Journal of Women’s Health. 2009;18(5):699–708. pubmed.ncbi.nlm.nih.gov
2. Gibson CJ, Thurston RC, El Khoudary SR, Sutton-Tyrrell K, Matthews KA. Body mass index following natural menopause and hysterectomy with and without bilateral oophorectomy. International Journal of Obesity. 2013;37(6):809–813. pubmed.ncbi.nlm.nih.gov
3. Laughlin-Tommaso SK, Khan Z, Weaver AL, et al. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018;25(5):483–492. pubmed.ncbi.nlm.nih.gov
4. Farquhar CM, Sadler L, Harvey SA, et al. The association of hysterectomy and menopause: a prospective cohort study. BJOG. 2005;112(7):956–962. pubmed.ncbi.nlm.nih.gov
5. Moorman PG, Myers ER, Schildkraut JM, et al. Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics & Gynecology. 2011;118(6):1271–1279. pubmed.ncbi.nlm.nih.gov
6. Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. insight.jci.org
7. Davis SR, Castelo-Branco C, Chedraui P, et al. Understanding weight gain at menopause. Climacteric. 2012;15(5):419–429. doi.org
8. Kongnyuy EJ, Norman RJ, Flight IHK, Rees MCP. Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution. Cochrane Database of Systematic Reviews. CD001018. cochrane.org
9. Schöller D, Taran FA, Wallwiener M, et al. Laparoscopic supracervical hysterectomy and laparoscopic total hysterectomy in patients with very large uteri: a retrospective single-center experience at a major university hospital. Geburtshilfe und Frauenheilkunde. 2017;77(3):251–256. pubmed.ncbi.nlm.nih.gov
10. NHS. Hysterectomy: recovery. nhs.uk
11. Centers for Disease Control and Prevention. Adult activity: an overview. cdc.gov
12. Mayo Clinic. Unexplained weight loss: when to see a doctor. mayoclinic.org
13. NHS. Ovarian cancer: symptoms. nhs.uk
14. MedlinePlus (U.S. National Library of Medicine). Abdominal hysterectomy: discharge. medlineplus.gov

This article is for general information and is not a substitute for medical advice. Weight changes after surgery depend on what was removed, your age and your general health, so always discuss your own situation with your gynecologist or doctor, and contact them or emergency services if you are worried about any symptom.