Hysterectomy

Frequently asked questions With answers by Mary Jane Minkin, MD

• What are the risks of hysterectomy surgery?
• How can I prepare for the operation?
• Should I stop taking my medications?
• What can I expect from recovery?
• When can I go back to work?
• What symptoms should I watch for after a hysterectomy?
• Will hysterectomy bring on menopause?
• How will a hysterectomy affect me emotionally?
• How will a hysterectomy affect my sex life?
• Does hysterectomy have an effect on PMS?

What are the risks of hysterectomy surgery?
As much as we would like everything to go perfectly, things can go wrong. Luckily, very serious problems are uncommon in hysterectomies.

There are the usual surgical risks of blood loss, infection and problems with the anesthesia. What is unique about a hysterectomy is that the pelvic organs are packed closely together in a small space, and sometimes they adhere to other abdominal organs. This poses the danger of an inadvertent puncture of the bowel, bladder or ureters, and that risk increases for patients with severe endometriosis or large fibroids. Obviously, the goal is to spot such a puncture during surgery and repair it.

How can I prepare for the operation?
You will withstand surgery better and recover more quickly if you are in good physical shape. That means doing aerobic exercise and quitting or at least cutting down on smoking if you are a smoker. You should also stay as close as possible to your ideal weight, since too much extra weight puts you at major risk for complications with the anesthesia as well as the surgery. Take iron to build up your blood, and get plenty of rest so that your immune system is not stressed by fatigue.

I stop taking my medications?
It’s important to ask your doctor which medications are safe to take before surgery. Anti-inflammatories Motrin, Naprosyn and other drugs that many people use for arthritis, headaches and other conditions could be hazardous because they can interfere with clotting. You should absolutely not take MAO inhibitors. Also, be sure to talk to your doctor about any allergies you have to medication.

If you are a woman with serious heart or lung disease, you should meet with your anesthesiologist well before surgery to plan your anesthesia in advance.

What can I expect from recovery?
Whether you have an abdominal or a vaginal hysterectomy, you should anticipate a six-week recovery. Abdominal hysterectomy patients must wait for the stitches that hold the skin together to heal. Even vaginal hysterectomy patients may find that they need more time than they anticipated to recover. (It’s a good idea to schedule the time in case the vaginal operation they anticipated turns into an abdominal one.) Keep in mind recuperation time can vary depending in part on your age, your physical shape and other factors that cannot be anticipated.

When you go home, avoid strenuous activities, especially if they affect your abdominal muscles. Climb stairs slowly and infrequently and don’t drive during the week or two after surgery.

Ask your doctor about intercourse. I tell my patients to avoid it until I can check to see that everything is healed. Sexual stimulation and orgasmic responses are OK, but you should not have anything in your vagina.

When can I go back to work?
I generally recommend waiting six weeks before you go back to work. Even if you are not in pain two weeks after surgery, you may find that you are tired and need to rest in the afternoons. Whether you have a laparoscopically assisted vaginal hysterectomy, an abdominal hysterectomy or a vaginal hysterectomy, you should also avoid lifting for six weeks.

What symptoms should I watch for after a hysterectomy?
Keep an eye on bleeding. You will have some staining or discharge from the vagina as stitches dissolve, but call your doctor if it is more than the bleeding of a normal menstrual period. Also, call your doctor about fevers that are higher than 100°F.

You should feel less pain each day. You may also feel hot flashes related to changes in estrogen levels, whether or not your ovaries have been removed. If you did have an oophorectomy and your ovaries were working well before they were removed, you may need a large dose of estrogen. You may need less estrogen if you were going through menopause at the time of your hysterectomy and oophorectomy. But call your physician if you find you are having hot flashes, sleep problems and other menopausal symptoms.

Will hysterectomy bring on menopause?
If you are premenopausal and your ovaries are removed, you can expect to undergo surgical menopause and may experience symptoms such as hot flashes. Because their symptoms will be more severe than they would be in a natural menopause, women whose ovaries are removed usually decide to have estrogen replacement therapy (ERT) postoperatively.

Some women who keep their ovaries experience temporary hot flashes after a hysterectomy. This is not menopause, but temporary estrogen replacement therapy (ERT) can usually do a good job of alleviating the symptoms.

How will a hysterectomy affect me emotionally?
Every woman will have a different reaction to her hysterectomy. Those who have their ovaries as well as their uterus removed can have particularly strong emotions. It can help to address questions of femaleness, sexuality and sexual response before the operation. Some women will have a lot of concern about their hysterectomy even if they have finished childbearing. Others will think of it as a necessary operation, not much different than an appendectomy.

Call your doctor if something really starts to bother you. If you feel foolish calling your doctor, try your doctor’s nurse. Most nurses have been through hysterectomies with a lot of patients and understand the issues.

How will a hysterectomy affect my sex life?
Many women experience some temporary pain during intercourse the first few times after a major operation. Others find permanent changes.

Obviously, you will not have uterine contractions with orgasms after a hysterectomy. You will have no cervix, so if you are among the women whose pleasure involves pressure against the cervix, the hysterectomy will affect your sexual response. If you had your hysterectomy because of endometriosis or fibroids, this painful tissue will no longer be jabbed and you may be much more comfortable during intercourse.

Since estrogen keeps the vagina moist, you will have to lubricate your vagina if your ovaries are taken out. You can choose a standard lubricant such as K-Y Jelly or vaginal estrogen if you do not go on ERT postoperatively. Estrogen preparations that also contain small amounts of testosterone may be helpful if you suffer from loss of libido.

The psychological issues surrounding hysterectomies and sexuality can be complex. If a woman thinks she will have a problem, then she probably will. If her sexual self-image is tied to having a uterus, even if she is past her childbearing years, a hysterectomy may be a problem for her. For this reason, women who are electing to have a hysterectomy should make the decision carefully and even consider talking about it with a counselor before the operation.

Does hysterectomy have an effect on PMS?
Many women find their PMS symptoms disappear after a hysterectomy when the ovaries are removed; some find relief even if their ovaries are not removed. In light of our scientific knowledge today, this doesn’t make sense. PMS is related to ovarian function and has little to do with the uterus. But, while it may be hard to explain, physicians do report that patients find relief from PMS after a hysterectomy.

Mary Jane Minkin, MD, is a clinical professor of obstetrics and gynecology at the Yale University School of Medicine and a partner of Gynecology & Infertility P.C., a private practice in Connecticut. She appears regularly on public radio.

Last revised: October 5, 2004 (jj)

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All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.