A hysterectomy is the surgical removal of the uterus. At times it is combined with an oopherectomy, in which the ovaries are removed.
There are two primary types of hysterectomy. In a total hysterectomy, the entire uterus, including the cervix, is removed. In a subtotal hysterectomy, the uterus is removed, but the cervix (and occasionally some uterine tissue) is left intact.
Hysterectomy is a form of sterilization, which is generally considered a rabbinic prohibition for women. Nevertheless, hysterectomy is halachically permitted when medically indicated and when there are no comparable medical alternatives that preserve fertility.
Hysterectomy is even more readily permitted when a woman is no longer fertile.
Niddah after Hysterectomy
Since niddah status only results from uterine bleeding, a woman who has had a total hysterectomy can no longer become niddah, regardless of whether her ovaries remain in place.
Following a subtotal hysterectomy, it is possible for a woman to become niddah again from residual uterine tissue. We recommend following the precautions outlined here to avoid becoming niddah unnecessarily from staining. If a woman who has had a subtotal hysterectomy experiences bleeding that could make her niddah, we recommend that she seek individualized halachic guidance.
Does a hysterectomy make a woman niddah?
Bleeding following a hysterectomy can be attributed to the surgery itself and is thus considered dam makkah, blood from a wound, which does not make a woman niddah. However, halachic authorities disagree as to whether or not the hysterectomy itself renders a woman niddah. Among those who maintain that the procedure does not cause niddah status, some nevertheless rule that a woman should conduct herself as though she is in niddah and immerse afterwards as a stringency.
We follow the view that a woman should observe this stringency specifically if she had a sub-total hysterectomy performed vaginally (with or without laparoscopic assistance). Otherwise, there is no need for her to immerse, unless she so wishes. If observing this stringency presents particular difficulty, a woman should consult with a halachic authority.
A woman immersing voluntarily or as a matter of stringency does not recite a bracha over her immersion.
Prior to immersion, a woman who has recently undergone a hysterectomy should consult her doctor about when it is safe to immerse taking additional health precautions such as: preparing with a shower (and no bath), arranging to be the first to immerse after the water is treated, and taking only one dip in the mikveh.
See here for guidelines for a husband providing care for his wife when she is in niddah.
A woman who was in niddah prior to her hysterectomy, or who is observing the stringency to immerse after the procedure, will need to undertake the process of becoming tehorah. Usually, this would entail performing a hefsek taharah and bedikot in order to check for uterine bleeding.
Following a total hysterectomy, since there is no possibility of uterine bleeding, there is no need for a hefsek taharah or any bedikot during the clean days. A woman merely counts seven days and immerses.
Since niddah status only results from uterine bleeding, and a woman who has had a total hysterectomy has no uterine tissue, she also cannot become niddah at any point in time after the surgery, regardless of whether her ovaries remain in place.
Following a subtotal hysterectomy, a woman should perform a hefsek taharah and bedikot, on the chance that she has residual uterine tissue that can make her niddah.
In this case, she may have difficulty navigating the clean days for a few weeks because of bleeding from the procedure, which is dam makkah. To ease this process, she may omit the moch dachuk, limit her bedikot to the hefsek taharah and one each on days one and seven. She may also wear pantyliners or colored undergarments during the clean days for the first post-operative cycle, to avail herself of the leniencies of stains. If these measures are insufficient to enable a woman to get to the mikveh within a reasonable amount of time, she should ask a specific halachic question.
A woman who has a hysterectomy before she has naturally entered menopause might want to give particular thought to her post-operative immersion and to taking leave of the niddah cycle personally and within her relationship. Some women find it helpful to mark this immersion prayer. It can be especially meaningful to create and recite a personal prayer.
Couples may also benefit from discussing the implications of no longer having niddah as part of their relationship.
A married woman who is tehorah is permitted to immerse voluntarily, without a bracha. Some women incorporate mikveh into their post-hysterectomy lives by continuing to immerse voluntarily, by finding ways to contribute to the mikveh or taharat hamishpacha observance, or by adopting the custom of Yom Kippur eve immersion.
This page was updated on 31 January, 2024.