Many women with uterine fibroids, abnormal vaginal bleeding, endometriosis, and a variety of other non-cancerous gynecological conditions are recommended to have a hysterectomy — almost as if the removal of the uterus is a routine procedure. Did you know, in fact, that hysterectomies are the second most commonly performed gynecological surgery, with only c-sections being more frequent? Did you know that a woman in the US has a 45 percent risk of losing her uterus to hysterectomy in her lifetime?
Definition of hysterectomy
Before discussing hysterectomy side effects, let's explain what a hysterectomy is. A hysterectomy is the second most common surgery among women in the United States: each year, more than 600,000 hysterectomy procedures are done, which leads to conclusion that one in three women in the United States has had a hysterectomy by age 60. A hysterectomy is an operation to remove a woman's uterus (womb), where where a baby grows when a woman is pregnant. In some cases, the ovaries and fallopian tubes also are removed during the same surgical procedure.
There are several (three types) of hysterectomies:
- Total or complete hysterectomy. The most common type of hysterectomy, where both the cervix and uterus are removed.
- Subtotal or partial hysterectomy. Only the upper part of the uterus is removed, while the cervix is left in place.
- Radical hysterectomy. This type of hysterectomy is performed in some cases of cancer, and as its name states it is the most radical. In a radical hysterectomy the uterus, cervix, the upper part of the vagina, and its supporting tissues are removed.
There are also three types of surgical approaches to hysterectomies:
- Vaginal
- Abdominal
- Laparoscopy-assisted vaginal hysterectomy
Hysterectomy side effects
The kinds of side effects that may occur following a hysterectomy depend on a number of things. They would include the patient's age, condition, the type of hysterectomy performed, and whether you are still having periods (in other words, whether you are of reproductive age). If you were still having periods before surgery, they will stop after the operation, so one clearly known side effect of hysterectomy will be surgically-induced menopause.
The other potential side effects depend on the type of hysterectomy performed. That means that if the ovaries are not removed as well during the surgery (this is called an oophorectomy), a woman will continue to have hormonal changes that essentially represent the menstrual cycle, but she will not have bleeding with monthly periods any longer. But if her ovaries are removed, then the operation will immediately induce a surgical menopause.
Or in other words: for a woman who is premenopausal, having a complete hysterectomy will result in changes in hormonal balance because the ovaries are no longer able to provide any hormone production, while with a partial hysterectomy we would expect a different set of side effects, but there is not much difference. Even after having a partial hysterectomy, a hysterectomy can result in a hormone imbalance. This is because the hormonal functions of the ovaries will decline over a period of one to two years due to reduced circulation.
Side effects of hysterectomy also depend on the type of surgical approach to hysterectomy. An abdominal or open hysterectomy is the most common surgical procedure, and it is done through an incision in the abdomen. The surgeon will then detach the uterus from the ligaments that support it and the blood vessels that supply it: in short, the vagina is "peeled away" from the cervix.
If the surgeon doesn't pay enough attention to details, another side effect could be a shorter vagina, which would make sex very uncomfortable. Abdominal hysterectomy has several other potential side effects or complications: bleeding, bowel injury, injury to the ureter, adhesions to other organs, and bladder injury.
A vaginal hysterectomy is done through the vagina, where four ligaments supporting the uterus are cut, sutured, and then the uterus is taken out through the vagina. Side effects of vaginal hysterectomy could include bladder injuries, fever, infection, and some adhesions, but this vaginal approach is typically considered safer, with a much shorter recovery time, and it is also less costly to perform.
The third surgical approach to hysterectomy is laparoscopic and is relatively new. It is not appropriate for all hysterectomies, especially if the patient has cancer of the uterus or ovaries. Laparoscopy is done in many other fields that involve the abdomen and surrounding organs. In this less invasive surgery, a small abdominal incision is made to insert a viewing tool called a laparoscope. In some cases, the procedure can further be robot-assisted, which is relatively new. Possible hysterectomy side effects after laparoscopy could be hemorrhage, because sometimes the arteries do not get properly secured during this procedure. Laparoscopy can be the mode of surgery, but a vaginal hysterectomy can also be assisted by a laparascope. Again, this approach can reduce recovery times and the risk of complications for the right patients.
Other side effects that can happen during or right after surgery include:
- Effects of anesthesia are common after every kind of surgery. Patients feel tired and weak for a few days after the surgery. It is possible to feel a little sick to your stomach (nausea) after anesthesia. It is also possible to feel pain in chest and around your collar bone, especially when moving from lying to sitting position. Side effects of anesthesia are present three to five days after the surgery.
- Infections. As with any other type of surgery, there is always a risk of infection if you have a hysterectomy. If infection occurs, antibiotics are needed.
- Too much bleeding. The risk that a patient will bleed too much during an operation (hemorrhage) and need a transfusion is always present during surgeries. It would be wise to ask your doctor if you should donate some of your own blood before the operation.
- Damage to nearby organs. During surgery, damage to organs near the uterus is possible, and of course that doesn't mean it will happen to you. You should ask your doctor what might happen if an organ is damaged.
Possible side effects that you may experience following hysterectomy:
- Pain in the joints
- Hot flashes
- Insomnia
- Depression
- Irritability
- Anxiety
- Dizziness
- Nervousness
- Memory lapses
- Weight gain
- Headaches
- Fatigue
- Urinary problems
- Heart palpitations
- Heart disease
- Low sex drive
- Painful sexual intercourse
- Vaginal dryness
- Hair loss
- Osteoporosis
Read More: Endometriosis & Hysterectomy
While the risks and benefits of a hysterectomy should carefully be weighed between a patient and her medical team, research does indicate that hysterectomies have been overused in the US. There are even indications that male gynecologists, who perhaps do not recognize importance of the hormonal aftermath of a hysterectomy in a woman of reproductive age, are more likely to recommend hysterectomies.
Patients could always ask their doctors about alternatives to hysterectomy. Depending on the condition being treated, these alternatives may be very viable. They could range from hormonal treatments such as birth control pills or injections, to more minor surgical procedures like fibroidectomy. If you are considering a hysterectomy, you will want to know that it is indeed the best treatment option for you.