Surgery. The word can bring up feelings of fear, anxiety or even relief. No one wants to have surgery, but the need can arise despite our best efforts to maintain a healthy lifestyle. Women face unique medical issues specific to the reproductive system that may require surgical intervention. Conditions such as endometriosis, pelvic inflammatory disease, fibroids, or cancer may be treated with a surgery known as a hysterectomy.
A hysterectomy is a surgical procedure to remove a woman’s uterus. The Center for Disease Control says that about one-third of women will have a hysterectomy by the age of 60. Even though this procedure is common, hysterectomies result in considerable changes to the body. This is especially true when other organs are removed during surgery including the cervix, fallopian tubes, or ovaries.
There are different types of hysterectomy procedures. First, a partial hysterectomy removes the uterus and leaves the cervix intact. A total hysterectomy removes the uterus and cervix and may involve moving one or both ovaries and/or fallopian tubes. A radical hysterectomy removes the uterus, cervix and the top part of the vagina. A radical hysterectomy is usually performed when malignancy is involved.
A 2016 report from the Agency for Healthcare Research and Quality showed that more than half of all hysterectomies include oophorectomy (ovary removal), rising to over 75% of those performed in women over the age of 45. It is important to note the effects of a hysterectomy with oophorectomy are most severe in patients who are pre or peri-menopausal. Because ovaries are responsible for the production of estrogen, sudden loss of this hormone is the biggest contributor to age-related health consequences following this surgery. Women who have gone through menopause should have few side effects caused by loss of hormones.
Side effects of hysterectomy
Removing both ovaries as part of a hysterectomy will cause menopause in women who have not yet gone through it, and these symptoms are often exaggerated. Early menopause caused by sudden loss of estrogen can mimic age-related processes. These side effects are not eagerly welcomed as we age and are more difficult when they occur before we reach our golden years. Here are some of the symptoms that might have you feeling older than you should:
- Hot flashes are the most common side effects experienced after loss of estrogen. Women experience a quick feeling of heat in the upper body and face. The skin might become flushed and red. When hot flashes occur at night, they are referred to as night sweats. Hot flashes can occur as few as a couple of times a week up to several times an hour. Most hot flashes last only a minute or so.
- Mood swings and depression often follow a radical hysterectomy, and fluctuating levels of the hormones estrogen and progesterone are the major cause. This imbalance of hormones negatively impacts levels of serotonin in the brain. Serotonin is a mood boosting neurotransmitter that prompts mood swings when reduced. Fatigue, night sweats, and stress of major surgery further exaggerate mood swings. For those women already at risk for depression, it is important to maintain communication with your loved ones and healthcare providers about how you are feeling. A good support system is crucial for both your physical and mental recovery.
- Bladder control or urinary incontinence may be another side effect of hysterectomy, though not as common. This can happen because of damage to the bladder nerves or because the pelvic floor muscles have weakened following surgery. You may experience a sudden urge to urinate, have difficulty holding it long enough to get to a facility, or urine may leak during laughing, sneezing, or exercise. These symptoms occur more often in older women. A 2000 study showed that women at age 60 and who have undergone hysterectomies have a 60% higher risk of urinary incontinence later in life than those who never underwent the procedure.
- Bone loss also results from low estrogen levels. A decrease in bone mineral density is called osteoporosis. Osteoporosis can lead to bone fractures, especially as we age. This condition occurs even more frequently in women over 60 who have undergone hysterectomy and oophorectomy regardless of how old they were at the time of the surgery. Bone density scans are recommended more frequently to women following hysterectomy.
- Sex drive is often lessened following ovary and uterus removal. Vaginal dryness and decrease of the testosterone hormone also hinder sex drive. Mood, fatigue, and anxiety can also make sex undesirable. For women who undergo hysterectomy for uterine fibroids or other painful conditions, the surgery can actually improve physical intimacy because pain is relieved and heavy periods are a thing of the past.
You should recognize that menopause, whether caused early by surgery or naturally as we age, will happen to all women eventually. This overview of some symptoms following hysterectomy may not apply to everyone, and your doctor will help you understand the advantages and disadvantages of having this surgical procedure. Help may be available in the form of hormone-replacement therapy and lifestyle adjustments that can ease transition and healing.
While research shows that hysterectomy is a safe and common procedure for women, it is still a challenging decision that is not made lightly. Knowledge is key in knowing you have made the right choice for yourself. Ask as many questions as you need from your healthcare providers. While side effects are part of the consideration, your overall health and wellbeing are the ultimate goal of any procedure.
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Brown JS, Sawaya G, Thom DH, et al. Hysterectomy and urinary incontinence: a systematic review. Lancet 2000;356:535-9.
