Why Do Women Have Hysterectomies
Hysterectomies are most often done for the following reasons:
- Uterine fibroids common, benign tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Sometimes fibroids cause heavy bleeding or pain.
- Endometriosis another benign condition that affects the uterus. It is the second leading reason for hysterectomies. It occurs when endometrial tissue begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding and loss of fertility.
- Uterine prolapse a benign condition in which the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues, and can lead to urinary problems, pelvic pressure or difficulty with bowl movements. Childbirth, obesity and loss of estrogen after menopause may contribute to this problem.
- Cancer the reason for about 10 percent of all hysterectomies. Endometrial cancer, uterine sarcoma, cervical cancer, and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of cancer, other kinds of treatment such as radiation or hormonal therapy may be used as well.
- Hyperplasia thought to come from too much estrogen and occurs when the lining of the uterus becomes too thick and causes abnormal bleeding.
Reasons For A Hysterectomy
Conditions that may be treated by hysterectomy include:
- fibroids non-cancerous growths that form within the muscular walls of the uterus, outside the uterus or within the uterine cavity
- heavy or irregular menstrual periods however, new techniques now used to treat this include endometrial ablation or use of a levonorgestrel-releasing inter-uterine device
- severe period pain due to adenomyosis or severe recurrent endometriosis
- cancer of the cervix, uterus, ovaries or fallopian tubes
- endometriosis a condition in which cells similar to those in the lining of the uterus grow in other areas of the body, especially around the ovaries and peritoneum in the pelvis
- adenomyosis a condition where endometrial-like cells grow in the muscle of the uterus
- prolapse the uterus falls into the vagina because of loose ligaments or damage to the pelvic floor muscles, usually from childbirth
- pelvic inflammatory disease , caused by bacterial infection, often from sexually transmitted infections .
Management & Treatment After Surgical Menopause
Because symptoms of a surgical menopause are likely to be more severe, often the best way to manage and treat symptoms is with menopausal hormone therapy, or MHT . Your doctor can advise you about the risks and benefits of using MHT.
If the ovaries have been removed but not the uterus , MHT will include both oestrogen and progestogen, with or without testosterone. Progestogen is used to protect against uterine cancer. When a woman is on oestrogen therapy, she needs a progestogen to stabilise the lining of the uterus, which reduces her risk of cancer of the uterus.
If both an oophorectomy and hysterectomy are performed, oestrogen and possibly testosterone are needed. Progestogen is not needed, as there is no risk of cancer of the uterus. The hormone therapy is best started within 2448 hours after surgery.
Sometimes MHT is not an option after surgical menopause, perhaps because of a woman’s increased risk of breast cancer, or a clotting condition such as Factor V Leiden mutation, which increases the risk of deep vein thrombosis .
The alternatives to MHT may include:
- some complementary therapies, although there is no evidence to support their use in surgical menopause for more information go to Menopause & herbs
- some antidepressant, anticonvulsant and migraine/blood pressure medications, which work to reduce hot flushes.
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Other Complications Of Estrogen Loss
Estrogen also helps maintain bone strength. In people with a sudden loss of the hormone, low bone mineral density is a risk. This can lead to arthritis and osteoporosis. People who have their ovaries removed early in life should be monitored closely for signs of these conditions.
The loss of estrogen is also connected to the acceleration of tissue loss typically associated with aging. In addition to age-related health issues, a sudden loss of estrogen has been linked to increased risks of:
If you have both ovaries removed in addition to a hysterectomy, these symptoms will likely come on suddenly and be more severe. For people who have just one ovary removed, the signs may be more gradual or less severe. Your body is still producing estrogen, but it may take some time for your body to align itself with the new, lower levels of the hormone.
Lastly, if you have a hysterectomy without removing your ovaries, odds are you wont experience signs of low estrogen at first, but these symptoms may become more common. This is likely a sign that the ovaries are failing.
How Will I Know I Am In Menopause After My Hysterectomy
No periods for 12 months is the common sign that menopause has arrived. But what about for you? Youve had a hysterectomy, so you have hadnt periods in years. How are you going to know when menopause arrives?
No worries. More than likely, menopause is going to arrive with plenty of notice. More than you want.
Potential Negative Effects Of Surgical Menopause
- Sudden and more severe onset of menopausal symptoms: in particular hot flushes, night sweats and vaginal dryness
- Loss of bone density and increased risk of osteoporosis and fracture
- Impaired sexual function due to reduced desire and to discomfort from vaginal dryness
- Reduced sex drive associated with loss of ovarian testosterone production
- Loss of fertility
- Increased risk of cardiovascular disease
Surgical menopause may have other adverse effects on health including affecting mood , cognition , dementia and potential increased risk of
Parkinsons disease but the evidence for these is not well established. Large population based studies have reached different conclusions about whether surgical menopause impacts on cardiovascular, cancer or all cause mortality.
Use of Menopausal Hormone Therapy , also known as Hormone Replacement Therapy may reduce these risks, but again there is insufficient evidence. The proven value of MHT after surgical menopause is in managing vasomotor symptoms and maintaining bone density.
Do Ovaries Release Eggs After Hysterectomy
Where do the eggs go? In some cases, the ovaries may also be removed during a hysterectomy. This is particularly true if theyre affected by conditions like endometriosis or cancer. If you retain one or both of your ovaries and you havent reached menopause, an egg will still be released every month.
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Indications For Surgical Menopause
Surgical menopause is commonly performed at the time of hysterectomy for benign disease, most commonly for heavy menstrual bleeding or fibroids . Another common reason to remove normal ovaries at the time of hysterectomy is to reduce the risk of ovarian cancer. This has been shown to be beneficial in women with an inherited increased chance of developing ovarian cancer , and for some women with very strong family histories of ovarian cancer, but is not recommended for other women as the disadvantages of removing normal ovaries at the time of hysterectomy are likely to be greater than their very small risk of ovarian cancer . Very little is known about the impact of removing normal ovaries from postmenopausal women.
Some premenopausal women will elect to have their ovaries removed for other indications, such as endometriosis or chronic pelvic pain. Depending on the circumstances, removal of the ovaries may improve pain, but it is not always effective. Some doctors may suggest a trial of a drug to bring on a short term chemical menopause before surgery to try and mimic the effects of surgical menopause. However, it is not currently possible to predict how surgical menopause will affect individual women.
Although surgical menopause is common, there have been remarkably few studies which have followed women before and after oophorectomy to try and understand how surgery affects their menopausal symptoms and short and long term health.
Do You Have A Question
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How Can I Manage Hot Flashes After A Hysterectomy
Most doctors recommend a healthy diet, regular exercise, lifestyle changes, and alternative medicine to manage hot flashes. If you are seeking medicinal treatment, talk to your doctor to find a treatment that is right for you.
- National Health Service. . Hysterectomy. Retrieved from http://www.nhs.uk/conditions/hysterectomy/Pages/Introduction.aspx
- Office on Womens Health. . Hysterectomy. Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html
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The Cons: Reasons To Lean Against Hrt After Surgical Menopause
- Your menopausal symptoms aren’t bothering you, or other treatments work fine. Some women don’t have very severe symptoms after surgical menopause and don’t want or need treatment. Even if you do have acute symptoms, HRT is not the only way to control them. Other drugs or lifestyle changes can help. Talk to your doctor.
- You’re 50 or older. Many women who go into surgical menopause at 50 or older — the natural time of menopause – decide not to get HRT. That’s because their supply of estrogen would naturally drop during menopause anyway. There is some evidence that the older you are when you start HRT, the higher the cardiovascular risks – at least initially.
- You have liver disease. Estrogen pills can put a lot of stress on the liver. So if you have liver disease, your doctor may not want you to take oral HRT. Other ways of getting estrogen – like patches and gels – bypass the liver and are safer options.
- You’re concerned about the side effects. HRT can also cause symptoms of its own. Many resemble the symptoms of premenstrual syndrome — swollen and painful breasts, headaches, and nausea.
- You’re at a higher risk of health problems like:
o Strokes. Hormone therapy can increase the risk of stroke, although your odds are still very low.
o Blood clots. Oral estrogen, at least, may also raise the risk of blood clots. Estrogen patches and creams may pose a lower risk, but that’s still unclear.
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What Are Some Of The Treatments Offered For Menopause After A Hysterectomy
There are various treatments that can be given to ease the symptoms of menopause. For vaginal dryness, a vaginal moisturizer is recommended by doctors while for hot flashes and other related symptoms menopause hormone therapy can be administered.
Its also advisable to lead a healthy lifestyle by changing your diet and exercising regularly. Additionally, joining a support group consisting of women who have undergone the same surgical procedure will help in alleviating the psychological effects.
Acceptable Light Housekeeping After Week 1
- Wiping the counter.
- Very light cooking that requires no lifting and little standing.
- Folding laundry someone brings to you.
- Making lists of chores for others.
- Light dusting.
Its a good idea to clarify with your doctor what is and is not allowed for you during your recovery. Everyone is different and every doctor does things just a bit differently, too. Its better to err on the side of caution and leave questionable tasks for others. Youve heard it before: You only have one chance to heal right the first time, so take advantage of i
This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support. Reprinted with permission: Do This Not That: Housekeeping Tips After Hysterectomy
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Difficulty Concentrating And Forgetfulness Or Brain Fog
âI was on the phone earlier and it does make it awkward to hold a conversation when the little grey cells are having a dance instead of doing their job.â
As much as 60% of women experience âbrain fogâ or forgetfulness as a result of menopause or other menopausal symptoms themselves, such as lack of sleep. It usually occurs during perimenopause when hormones start to change and, for some, it can subside relatively quickly. For others, however, long-term memory issues may require specific treatment, like HRT, or more general lifestyle changes.
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When Will You Go Through Menopause After A Hysterectomy And How Will You Know It It Depends On The Type Of Hysterectomy
After trying various treatments with little improvement or success, Iâm scheduled for a total hysterectomy. Iâm OK about this, because Iâm finished having children, and, frankly, Iâll be relieved to end the frequent bleeding and pain.
Many of my friends are starting to go through menopause and commiserating over hot flashes, insomnia, vaginal dryness and the like. That makes me very curious about something: I havenât gone through menopause yet, so how will I know if Iâm going through it if Iâve had a hysterectomy?
Waiting for Menopause
First, letâs discuss what a total hysterectomy is. Your uterus and cervix will be removed. If you are having your fallopian tubes and ovaries removed as well , that makes it much more likely that menopause will begin abruptly, since your body will no longer be producing as much estrogen.
You will experience menopause differently than your friends who are going through a ânaturalâ menopause. Your menopause is known as a surgical or induced menopause, and symptoms will likely begin immediately after the procedure. Because a surgical menopause is more sudden and abrupt than a gradual and natural menopause, itâs likely your symptoms will be more severe.
Management Of Surgical Menopause
Ideally, a menopause specialist should review younger women prior to surgical menopause to explain the potential consequences of surgery and to make a plan for symptom management and long-term health.
Current international guidelines advise use of MHT for all women who undergo menopause under the age of 45 years provided that they do not have other contraindications to MHT . Treatment should continue until the average age of menopause and then be reviewed. Those with a personal history of breast cancer should avoid both MHT and tibolone, as they have been associated with an increased risk of breast cancer recurrence . For high risk women without a personal history of breast cancer, observational data suggest that MHT appears to be safe . Women should be aware that discontinuation of MHT will be associated with a recurrence of hot flushes and night sweats in around 50% of cases.
Use of MHT will resolve hot flushes and sweats in 80-90% of women, although there is evidence that hot flushes and night sweats as well as vaginal dryness may persist despite MHT use in younger women . There are no specific guidelines on the type of MHT to use but oestrogen only MHT is generally prescribed for those women who have had a hysterectomy . Women who retain their uterus should use an oestrogen and progestogen combination preparation
In those without contraindications to MHT, suggest starting treatment within a week following oophorectomy.
Before Choosing A Hysterectomy
If, after talking about all the options with your doctor, you choose to have a hysterectomy, your doctor should discuss several things with you before the operation. These include:
- your medical history as some pre-existing conditions may influence decisions on surgery and anaesthetics
- the pros and cons of abdominal surgery versus vaginal surgery
- your support options after surgery
- your feelings about the surgery.
You will have a range of tests before your hysterectomy, including a complete blood-count test to check for problems such as anaemia .
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Potential Positive Effects Of Surgical Menopause
- Reduced risk of ovarian cancer in women who are known to be at high inherited risk. Having this operation also usually reduces anxiety about developing ovarian cancer. In some high risk women, surgical menopause may also reduce their risk of breast cancer.
- Reduced pelvic pain for women with endometriosis or dense adhesions around the ovary.
What Are The Symptoms Of Menopause After Hysterectomy
For most women, menopause occurs when they are between the ages of late 40s to early 50s. However, women who undergo hysterectomy surgery may start experiencing the symptoms of menopause much earlier than this.
The procedure involves removal of the uterus and is used to treat a variety of conditions such as chronic pain, infection and even certain kinds of cancer. Typically, the extent of surgery required will vary depending on the reason why you are having hysterectomy. Sometimes the doctor may also recommend taking out the cervix and ovaries, which can ultimately affect the symptoms you are experiencing.
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What Should I Do If I Am Told That I Need A Hysterectomy
Talk to your doctor. If you have a condition that is not cancer, such as fibroids, endometriosis or uterine prolapse, there are other treatments that can be tried first. In most cases, a hysterectomy need not be done immediately. There is usually time for you to get more information, look into possible alternatives or seek a second opinion. In cases of serious disease, such as cancer, a hysterectomy may not be optional and may be a life-saving choice. Before you decide what to do, it is important you understand your condition and your options for dealing with it. If you are suffering from continuing severe problems with pelvic pain and abnormal uterine bleeding and other treatments have not helped, a hysterectomy may provide relief. Studies have shown that a hysterectomy often improves sexual functioning and quality of life for women suffering from these problems.
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