Pregnancy after hysterectomy

The cervix is the lower end of the uterus and ovaries are organs that produce eggs and hormones. The fallopian tubes the “pipes” that carry eggs from the ovaries to the uterus. Hysterectomy ranks as one of the most common surgical procedures among women. Most women are concerned because they don’t know if the pregnancy is possible after the hysterectomy.

Incidence of the procedure

Hysterectomy is the second most common major surgery among women in the United States. Each year, more than 600,000 hysterectomies are done. About one third of women in the United States have had a hysterectomy by age 60.

 

Number of Hysterectomies
in the United States(1975-1997)

Year

Number

Rate per 1,000 Women (age 15+)

1997

603,000

4.4

1996

591,000

5.5

1995

583,000

5.5

1990

591,000

5.8

1985

670,000

6.9

1980

649,000

7.1

1975

724,000

8.6

Major Diagnostic Indications for Hysterectomies*
(1988-1993)

Reason

Percent
Diagnosis

Fibroids

33.3

Endometriosis

18.8

Prolapse

16.4

Other

15.9

Cancer

10.1

Endometrial Hyperplasia

5.3

 

Types of hysterectomy operation

When making a decision about the hysterectomy, a patient should consider that it is not reversible. After the hysterectomy, a patient will no longer be able to bear children and will no longer menstruate. During the operation a surgeon detaches your uterus from the blood vessels and connective tissue that supports it, as well as from the vagina.

Types of hysterectomy surgery include:

Partial (subtotal) hysterectomy
Removes the uterus but leaves the cervix in place. By keeping the cervix, your risk of cervical cancer remains, so you'll still need regular Pap tests for screening.

Total hysterectomy
During this operation, a surgeon removes the uterus, including the cervix.

Hysterectomy and bilateral salpingo-oophorectomy
During this type of hysterectomy, surgeon removes the uterus, cervix, fallopian tubes and ovaries. If you haven't already experienced menopause, removing your ovaries initiates it.

Radical hysterectomy
This operation extends even farther, removing the upper portion of the vagina and some surrounding tissue and lymph nodes. The doctor removes not only uterus, but also the cervix, the upper part of the vagina, and supporting tissues. This is done in some cases of cancer. A hysterectomy is typically performed under general anesthesia, and the procedure itself lasts about one to two hours.



Incisions in the operation can be different and done in different places:

• An incision in the vagina
• A small incision just at or above the pubic hairline
• A large incision made in the lower abdomen
•  Laparoscopy, which is less invasive than other methods. In this procedure, a special viewing instrument (laparoscope) is inserted through a small incision. The uterus can then be removed through a vaginal incision or a small abdominal incision.

Indications for the operation

There are several indications for this kind of operation. Some of the most common are:

Cancers in this region
If a patient has some kind of gynecologic cancer, such as cancer of the uterus or cervix, a hysterectomy could be the best treatment option. Depending on the specific cancer the patient might have other options including radiation or chemotherapy.

Fibroids
Fibroids are benign uterine tumors that cause persistent bleeding, anemia, pelvic pain or bladder pressure. Hysterectomy is the only certain, permanent solution for fibroids. Of course, there are some non-surgical treatments but most of them offer minimal relieving of symptoms.

Endometriosis
Endometriosis is a specific pathological process in which the tissue lining the inside of your uterus called endometrium, grows outside the uterus on ovaries, fallopian tubes, or other pelvic or abdominal organs. Although there are some non-invasive methods and medications available, hysterectomy is probably the most effective method.

Uterine prolapse
Uterine prolapse is a specific condition characterized by the descent of the uterus into your vagina which can happen when the supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. 

Persistent vaginal bleeding
If on the patient complains about periods which are heavy and irregular or last for many days every time, a hysterectomy may bring relief when the bleeding can't be controlled by non-surgical methods.

Chronic pelvic pain
Occasionally, this surgery is the last resort for women who experience chronic pelvic pain that clearly arises in the uterus. 

Hysterectomy side effects

Most experts estimate that 25 to 50 percent of hysterectomy patients will have one or more complications although they consider most of them to be minor or reversible.

Pregnancy issue
First, a hysterectomy ends a woman's ability to become pregnant.
 
Incontinence
Studies also indicate that women who have had hysterectomy have a 60 percent greater risk of being incontinent by 60 years of age.
 
Increased blood clotting
Additionally, since the uterus produces prostacyclin, a hormone that inhibits blood clots, removal of this organ may make blood more likely to clot and could be a factor in the increased risk of heart attack among women who have had a hysterectomy.

Hormone replacement therapy
If the ovaries are taken out along with the uterus, a woman will definitely loose most of her supply of the female sex hormone, estrogen.
 
Other operation complications
Other postoperative complications may include severe vaginal bleeding, injury to the bowel or bladder, infection, persistent pain and diminished sexual response. Many women also report fatigue, weight gain, aching joints, urinary tract disorders and depression after having a hysterectomy.

Hysterectomy and pregnancy

Patients, especially younger women, should know that hysterectomy will definitely end their ability to become pregnant. If they think they might want to become pregnant in the future, they should ask their doctor about the alternatives to this surgery. In case of cancer, hysterectomy might be the only option. The most important thing to know is that, once a hysterectomy of any kind is performed, pregnancy is no longer possible. If the ovaries of a premenopause woman are removed, the ovulation will also stop. This means there will be a drop in production of the sex hormones estrogen and progesterone, which can cause vaginal dryness, hot flushes, sweating and other associated symptoms of natural menopause. 

Hysterectomy alternatives

Doctors often recommend hysterectomy to relieve conditions like chronic pain or heavy bleeding even though there are a variety of other therapies that can be tried. All these methods are intended to leave woman fertile and able to get pregnant.

Some of the most common alternatives are:

Medications
Several different medications may be given to reduce or stop heavy bleeding and they are generally used on the short term basis to provide symptom relief.

Endometrial ablation
This is a procedure which involves the removal or stripping of the lining of the uterus, which is shed each month in the form of a period. It is proven that endometrial ablation can successfully reduce or stop heavy bleeding in 85 per cent of cases.

Conservative treatment of fibroids
The size, number and position of the fibroids determines the treatment options offered but they can be treated using medication. They can also be starved of a blood supply required for growth.

Surgical removal of endometriosis
This procedure involves cutting or burning out tissue deposits and adhesions from such areas as the ovaries, bladder, bowel, uterus, pelvic walls and ligaments which support the uterus.

Removal of adenomyosis
Adenomyosis can be literally cut out leaving the uterus intact. This procedure is recommended for those women who wish to become pregnant.
 
Myomectomy
If a patient has fibroid tumors, a myomectomy can surgically remove the tumors while leaving the uterus intact. Although there's a risk that the tumors could come back, this may be the best option if you want to have children.

Hysterectomy and ectopic pregnancy

Many women who had their uterus removed but still have her ovaries and tubes are worried that they might develop an ectopic pregnancy. Even though this might sound strange, it is possible.

The pregnancy may occur in the fallopian tube (ectopic pregnancy) or in the abdominal cavity. In both cases, this is not a pregnancy that has a good future. However, this is incredibly uncommon as there are only 36 reports of such pregnancies in the world's literature. Most of the reported cases happened immediately after the hysterectomy, apparently because an already fertilized egg was in transit down the fallopian tubes at the time of the surgery. The chance of an ectopic pregnancy occurring after a hysterectomy is so uncommon that there is no need to use any form of contraception afterwards.