A hysterectomy is a major procedure in which a woman’s uterus is removed from the pelvis. It has both physical and emotional side-effects, some of which are detailed below.
Following a hysterectomy in which the ovaries are retained, the woman can expect to enter menopause within approximately five years. This is because the blood supply to the ovaries is disturbed to varying degrees by the procedure.
When the ovaries are removed with the uterus, the woman will experience the onset of menopause immediately afterwards. This is because normal ovarian function is responsible for the production of female reproductive hormones.
This is called surgical menopause and the symptoms of this include:
- Hot flushes
- Vaginal dryness
- Disturbed sleep
If the woman is below the age of 40, she has entered premature menopause. This can increase her risk of osteoporosis, Alzheimer’s disease and heart disease, due to the loss of the protective hormone, estrogen.
The physician may prescribe estrogen replacement therapy to alleviate the symptoms or alternative medications to prevent osteoporosis. Which measure is chosen, depends on coexisting medical conditions. For instance, if the woman has had liver disease, breast cancer or a strong family history of these conditions, hormone replacement may not be the best option for her.
Reduced sexual drive
Since women differ, it is not possible to predict the effect of a hysterectomy on the sexual drive of an individual woman. However, many women report increased enjoyment of sex after a hysterectomy, especially if the operation was done to relieve major bleeding or for painful conditions of the uterus. Women who have had as many children as they desire, may enjoy the freedom that comes with knowing they can no longer become pregnant.
However, some women complain of losing interest or enjoyment during intercourse, perhaps because the uterine contractions have been lost or there is reduced cervical pressure. Vaginal dryness further complicates the problem, making penetration uncomfortable. In most women, the loss of pleasure is temporary. The use of lubricant gels or hormone replacement therapy may increase their comfort level, while an understanding partner will be able to help them work through these problems.
Some women feel depressed at the thought that they have lost their uterus or that they are incapable of bearing children. Others resent the loss of their monthly periods. This may precipitate depression of varying degrees.
The symptoms include a feeling of loss or of a permanent change in their perceptions of femininity or fertility, a feeling of sadness, a loss of interest in things that they enjoyed previously, and a lack of energy. They may last for many weeks or months after the surgery. Counseling, whether by a friend, a doctor, or a support group, is helpful in this situation. In most women, the feeling of let-down is temporary. Talking to someone who has come through a hysterectomy successfully is often helpful in preparing for the side effects.
After a hysterectomy, some women may complain of constipation. This is usually temporary and may be prevented by increasing the amount of fiber and fruit in the diet. At first, a laxative may be helpful in order to avoid straining when defecating, which might slow down healing. Gentle abdominal pressure may also help to evacuate the bowels more easily in some cases.
While a moderate amount of vaginal discharge (less than during a monthly period) is normal for up to six weeks, some women may report heavy bleeding, passing clots or having a strong-smelling discharge. These may indicate complications of some kind, and should be reported to the doctor.
Long-term health effects
The loss of ovarian function is most sudden if the ovaries are removed along with the uterus. However, even otherwise, blood supply to these organs is interrupted by the surgery, leading to their eventual failure to produce female hormones. This may increase the woman’s risk of bone loss, ischemic heart disease and urinary incontinence. Incontinence is usually temporary and may be averted by regular pelvic floor exercises, which your medical team should advise before the patient is discharged. Urinary infections should be avoided by drinking plenty of water.
Reviewed by Yolanda Smith, BPharm