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Guide To Hysterectomy
Effects of Menopause
|What Are The Side Effects Of A Hysterectomy?
Quite a bit of research has been carried out into the effects of a hysterectomy procedure on a woman's body and general well-being. As with so much of science, many of the results have been conflicting. The Maine Women's Health Study is one important piece of research which has shed a better light on the subject. Researchers investigated the long term effects on nearly 800 women who had undergone a hysterectomy between 1989 and 1991. Overall it appears that the surgery improved a woman's quality of life, particularly if she underwent the procedure for less 'serious' problems like fibroids or endometriosis (as opposed to cancer). It found that hysterectomies performed to correct severe pelvic pain and heavy periods left 71 percent of women feeling much happier (physically, mentally and sexually). New problems that arose as a result of the hysterectomy (where the woman did not have the problem before the operation) included hot flashes (13 percent), weight gain (12 percent), depression (8 percent) and less interest in sexual intercourse (7 percent).
A hot flash is where you feel a sudden intense heat which starts in the neck and flows up to the face. Hot flashes usually last around 30 seconds and can be one of the first signs of menopause. Women who have their ovaries removed immediately enter menopause (if the woman is still young, it is referred to as premature menopause). They may be given short-term estrogen replacement therapy to help manage the problem. Interestingly, for reasons unknown, women who have not had their ovaries removed can still have hot flashes. Presumably this is because their hormone balance is upset. Fortunately this is usually a temporary complication.
Although a minority of women gain weight after a hysterectomy, it is thought this is less to do with the procedure and more to do with inactivity during the recovery period. Weight gain is avoidable by following a healthy calorie controlled plan until you resume normal activity. See also our article weight gain during menopause.
While some women may feel depressed after a hysterectomy, there is no evidence to suggest that it is a physical or chemical response to the operation itself. It may rather be a psychological reaction to loss of fertility (in younger women) or a feeling of despondency if they did not participate enough in the decision to have the surgery (more common in non-elective hysterectomies which are performed as a medical emergency). For most, research shows that a hysterectomy rarely causes long term depression. In the initial post-operative period, women do much better if they have the support of their family and friends. You may find it useful to read about the side effects of depression, just in case.
Physically, you should be able to return to having sex within 8 weeks of surgery (see hysterectomy recovery). There have been lots of studies into women's sexual function and desire after a hysterectomy. Older studies which used slightly different measuring methods estimated that 50 percent reported improved sexual function (usually because sex was painful before surgery), 25 percent reported no change and the remaining 25 percent said it was worse. Newer studies estimate that only about 5 percent of women report worsening sexual problems. The most common complaint is vaginal dryness (atrophy) - that is where the lining of the vagina becomes thinner and there is less lubrication so sex becomes more painful. This can happen if the ovaries are removed and estrogen levels fall. Other women report increased problems in becoming sexually aroused or in having orgasms. The removal of the womb and cervix means that there is less tissue to become 'engorged' during sexual arousal. Also as there is no womb, there no longer is a sensation of it expanding during an orgasm, which may make the orgasm less intense. These changes are very apparent in some women but completely unnoticed in most.
The Alternatives: Surgery vs. Non-Surgery
The Maine Women's Health Study also investigated women who chose to manage their condition (fibroids, uterine bleeding or chronic pelvic pain) with non-surgical methods. These alternatives to hysterectomy included hormone therapy, pain medications, endometrial ablation and uterine artery embolization. 25 percent went on to have a hysterectomy within one year of the study because their symptoms persevered or reappeared. However, more studies are required before concluding whether surgery or non-surgical intervention is best. These studies are notoriously difficult to carry out, and one recent large-scale attempt was abandoned because of difficulties in recruiting participants and in implementing the trial. 90 percent of hysterectomies are performed on women for non-cancer reasons, such as fibroids or uterine bleeding. As most hysterectomy alternatives are considered safe, doctors are advised to completely exhaust these more conservative options before recommending surgery. While this is considered best practice, unfortunately not all doctors do this. One study by the Department of Obstetrics and Gynecology, University of California discovered that 76 percent of women who underwent a hysterectomy did not meet the standard guidelines for the procedure (as set down by the American College of Obstetricians and Gynecologists). The most common reasons cited why the operation was considered inappropriate were: (1) the doctor did not order enough tests to adequately diagnose the patient's condition before recommending a hysterectomy or (2) the doctor did not try enough alternative treatments.
Bottom Line: Given the potential side effects, as well as possible hysterectomy complications, it is important to educate yourself on all possible alternatives before agreeing to undergo a hysterectomy. Question your doctor, and if you are not satisfied with the answers, seek a second or even third opinion if necessary. At the end of the day, it is your body and you will be the one who has to live with the result.
Related Useful Articles
Endometriosis alternative treatments: Supplements, foods and alternative natural therapies.
Fibroids treatment: An explanation of the various treatments on offer.
What is a hysterectomy? A basic overview of this surgery procedure.