Hysterectomy has like any other surgery certain risks and side effects.
Mortality and surgical risks
Short term mortality (within 40 days of surgery) is usually reported in the range of 1-6 cases per 1000 when performed for benign causes. The mortality rate is several times higher when performed in patients that are pregrant, have cancer or other complications.
Long term effect on all case mortality is relatively small. Women under the age of 45 years have a significantly increased long term mortality that is believed to be caused by the hormonal side effects of hysterectomy.
Approximately 35% of women after hysterectomy undergo another related surgery within 2 years.
Hospital stay is 3 to 5 days or more for the abdominal procedure and between 2 to 3 days for vaginal or laparoscopically assisted vaginal procedures.
Time for full recovery is very long and practically independent on the procedure that was used. Depending on the definition of "full recovery" 6 to 12 months have been reported. Serious limitations in everyday activities are expected for a minimum of 4 months.
Unintended oophorectomy and premature ovarian failure
Removal of one or both ovaries is performed in a substantial number of hysterectomies that were intended to be ovariesparing.
The average onset age of menopause in those who underwent hysterectomy is 3.7 years earlier than average even when the ovaries are preserved. This has been suggested to be due to the disruption of blood supply to the ovaries after a hysterectomy or due to missing endocrine feedback of the uterus. The function of the remaining ovaries is significantly affected in about 40% women, some of them even require hormone replacement treatment. Surprisingly, a similar and only slightly weaker effect has been also observed for endometrial ablation which is often considered as an alternative to hysterectomy.
Substantial number of women develop benign ovarian cysts after hysterectomy.
Premature menopause and its effects
Estrogen levels fall sharply when the ovaries are removed, removing the protective effects of estrogen on the cardiovascular and skeletal systems. This condition is often referred to as "surgical menopause", although it is substantially different from a naturally occurring menopausal state; the former is a sudden hormonal shock to the body that causes rapid onset of menopausal symptoms such as hot flashes, while the latter is a gradually occurring decrease of hormonal levels over a period of years with uterus intact and ovaries able to produce hormones even after the cessation of menstrual periods.
When only the uterus is removed there is a three times greater risk of cardiovascular disease. If the ovaries are removed the risk is seven times greater. Several studies have found that osteoporosis (decrease in bone density) and increased risk of bone fractures are associated with hysterectomies. This has been attributed to the modulatory effect of estrogen on calcium metabolism and the drop in serum estrogen levels after menopause can cause excessive loss of calcium leading to bone wasting.
Hysterectomies have also been linked with higher rates of heart disease and weakened bones. Those who have undergone a hysterectomy with both ovaries removed typically have reduced testosterone levels as compared to those left intact. Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density, while increased testosterone levels in women are associated with a greater sense of sexual desire.
Oophorectomy before the age of 45 is associated with a fivefold mortality from neurologic and mental disorders.
Urinary incontinence and vaginal prolapse
Urinary incontinence and vaginal prolapse are well known adverse effects that develop with high frequency very long time after the surgery. Typically those complications develop 10-20 years after the surgery. For this reason exact numbers are not known and risk factors poorly understood, it is also unknown if the choice surgical technique has any effect. It has been assessed that the risk for urinary incontinence is approximately doubled within 20 years after hysterectomy. One long term study found a 2.4 fold increased risk for surgery to correct urinary stress incontinence following hysterectomy
The risk for vaginal prolapse is over 80% within 20 years of hysterectomy.
Effects on social life and sexuality
Some women find their natural lubrication during sexual arousal is also reduced or eliminated. Those who experience uterine orgasm will not experience it if the uterus is removed. The vagina is shortened and made into a closed pocket and there is a loss of support to the bladder and bowel.
Other rare problems
Hysterectomy may cause an increased risk of the relatively rare renal cell carcinoma. Hormonal effects or injury of the ureter were considered as possible explanations.
Removal of the uterus without removing the ovaries can produce a situation that on rare occasions can result in ectopic pregnancy due to an undetected fertilization that had yet to descend into the uterus before surgery. Two cases have been identified and profiled in an issue of the ''Blackwell Journal of Obstetrics and Gynecology''; over 20 other cases have been discussed in additional medical literature.
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