How many times have you heard the words, “be careful what you wish for…” And the older and wiser we get, the more we learn the value of that sentiment. Looking back, many of our post-menopausal women bemoan all the times they wished they would never have their period again (Whoops! Enter menopause, and some of the side-effects they weren’t anticipating…). We’ve also notices that some of our post-hysterectomy patients remember making comments like, “I wish there was a way to just make the whole kit-and-caboodle disappear.”

The thing is, while a hysterectomy can solve certain problems, it can also cause others. Sometimes, the problems it causes, can surprise patients and make them feel as if they weren’t fully informed before they made a very important and body-changing decision.

Therefore, it’s important that you are 100% certain that a hysterectomy is the right solution before you schedule the surgery date.

Hysterectomy 101

Hysterectomies are the second most common surgical procedure performed in the United States, preceded by cesarean sections. There are a few different versions of hysterectomy. They are:

  • Full or total hysterectomy – which removes the entirety of the uterus as well as the cervix.
  • Supracervical (more commonly called a partial hysterectomy) – which removes the upper-part of the uterus but leaves the cervix in place.
  • Radical hysterectomy -this is like a total hysterectomy but in addition, we remove the structures around the uterus as well. A radical hysterectomy is the least common and is typically recommended in cases where cancer is either diagnosed or suspected, in order to prevent it from spreading further into the reproductive organs. If you get a radical hysterectomy, the loss of your ovaries will cause further side-effects than the ones listed below because estrogen productions is stopped.

There are several instances where a hysterectomy may be introduced or recommended as a treatment method.

  • Uterine fibroids
  • Severe endometriosis
  • Unusually heavy and extensive menstrual bleeding
  • Adenomyosis
  • Chronic pelvic pain
  • Cancer that affects reproductive organs

However, there can be, and typically are, side-effects of removing the uterus. Keep in mind that in the modern era, anything other than a radical hysterectomy will keep your ovaries intact. This means that your body will still have its natural estrogen supply, and your hormone levels shouldn’t vary any more than they did before your uterus was removed. The removal of the ovaries is called oophorectomy, and is typically not part of full- or partial- hysterectomy procedures.

Is a hysterectomy really worth it?hysterectomy

Here are things you may not know about post-hysterectomy life.

Surgical complications

A hysterectomy is an invasive surgery. Although surgical methods have improved, and many hysterectomies are now done via laparoscopy, there is still a risk involved. The two most common are post-surgical bleeding and infection. Women who are overweight or obese have the highest risk of post-surgical complications for partial- or full-hysterectomies that aren’t related to a cancer diagnosis. It’s important that your doctor share all the risks with you so you can make a fully informed decision.

You may grieve

If you are a younger woman with severe fibroids and/or who suffers from such heavy menstrual bleeding you require transfusion or you have a cancer diagnosis, a hysterectomy may be the only realistic solution. However, the resulting infertility grief can be devastating. The good news is that (assuming you haven’t had a radical hysterectomy) you still have ovaries. Using fertility medications, a specialist can retrieve eggs and you can still have a biological child with the use of a gestational carrier. If you have cancer, and you still want to have children, we recommend meeting with a fertility specialist to discuss fertility preservation.

We also recommend visiting a licensed therapist to discuss the loss of “fertility as you knew it.” Even women who are done having children, or past their child bearing years can experience a surprising amount of grief at the loss of their womb – it was the space they grew their babies, after all.

Sex may change

The next time you have a powerful orgasm, think about what’s happening inside your pelvis. What do you feel? Odds are that your uterine muscles are contracting away. Once there’s no uterus, there are no uterine muscles to contract and this can feel quite a bit different – and, sometimes, less powerful.

It may increase your risk of pelvic organ prolapse (POP)

Ironically, hysterectomy is often a treatment for severe pelvic organ prolapse, most often when the uterus itself is prolapsing beyond what exercise or physical therapy can correct. We say, “ironic”, because recent studies are showing that for women without prolapse, a hysterectomy can increase their risk of developing pelvic organ prolapse.

This is because it removes a substantial organ from the pelvic cavity, with nothing else to fill the space. If you have a family history of POP, or you are already in a higher-risk bracket, it’s worth discussing this risk with your doctor.

There is also some debate in the medical field regarding the connection between hysterectomy and increased risk of urinary incontinence, but there is no definitive evidence available just yet.

Odds are, if your doctor recommends a hysterectomy, it’s the best mode of treatment for your condition. Even so, do take the time to get a second opinion and/or to talk at greater lengths about how what the procedure will look like for you in the long-term.

Looking for a second opinion or to learn more about hysterectomies or the conditions that lead up to them? Contact us here at Overlake OB/GYN and schedule an appointment.

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