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While a hysterectomy means the woman can no longer have a baby, let’s look into the other side effects and possible complications of uterus removal.
“You can use your womb if you want – it’s the most beautiful thing to do if you want – but it’s not our only reason to be put on this earth.” ~ Aisling Bea
About 3.2- 6% of women between the ages of 30-49 years undergo a hysterectomy, more commonly known as ‘uterus removal’ in India, each year. The most common reasons for uterus removal are excessive menstrual bleeding/pain for any reason (56%) followed by fibroids/cysts (20%).
According to the National Family Health Survey (2015-16) the media age for having undergone the procedure was found to be approximately 34 years. Which is well below global trends, which suggest the procedure is performed closer to menopause.
Removal of the uterus may or may not be accompanied with oophorectomy, which is the removal of one or both ovaries, depending on the age and ovarian health of the patient. While this may save the life of the patient, it also accelerates the age of menopause.
This is known as surgical menopause, and is far harsher than the otherwise gradually occurring natural menopause which allows time for the body to adjust. This leads to an abrupt loss of estrogen and its protective effects. A woman without ovarian function is more prone to rapidly decreased bone health leading to pathological fractures and cardiovascular issues, among other things.
There can be other, lesser known, but significant, side effects as well.
Take the case of Mamta, a 32 year old woman, with a history of recurrent pregnancy loss.
In her pregnancy following 4 miscarriages, she was found to have a morbidly adherent placenta. This simply means the placenta, or afterbirth, had penetrated deep into and beyond the uterine walls. Such a placenta cannot come out naturally, and often not at all, despite the doctor’s best efforts. Because Mamta was facing pregnancy related high blood pressure, which is only cured by delivery, she underwent an emergency cesarean when her blood pressure shot up, and she had warning signs suggesting imminent brain damage.
After the baby was delivered, the surgeons noted that the placenta was simply not separating naturally from the uterine wall. In which case they attempted to remove it manually, which also was not possible without leading to massive blood loss. Drugs injected into the site were not working. Taking a judgement call between saving her life and her uterus, an obstetric hysterectomy was performed. Her family members were informed and the procedure performed. She received 1 unit of packed blood cells, and was safe. The ovaries were healthy, and left untouched.
About 2 months after the surgery, she was brought in by her husband. The baby was well. Mamta had physically recovered from the surgery. However, she was becoming increasingly high strung, anxious, nervous, unable to sleep well or at all sometimes, unable to eat well. Her husband has also observed her weeping without apparent cause on several occasions. She was growing thinner. Having difficulty getting out of bed, taking a bath, combing her hair. She would be sad persistently. Even playing with the baby was not making her smile.
It was a good thing Mamta was brought in on time. Her gynecologist referred her to a psychiatrist. She was diagnosed with generalised anxiety disorder coupled with depression. She was given medicines for this, and it took all of 2 weeks for her to be almost back to her old self.
What caused this severe depression in Mamta? Turned out she was extremely sad about the loss of her uterus and her inability to physically bear another child. She was stressed that her husband and society in general would think of her as less than a whole woman. It was even causing her libido to diminish severely. With some counselling, some medication, she became just fine.
It is a misconception that uterus removal causes reduced sexuality. While this may be true sometimes, in some cases, libido is actually increased due to the absence of fear of unwanted pregnancy.
This is what happens when you can recognise and treat mental health issues at the soonest possible time. The patient and their family, both benefit.
Let us take another case. This time, 56 year old Meena, who had delivered 5 children over the course of her life, found her uterus coming out of the vaginal since the age of 50. By the time she was 56 years old, her insides were literally on the outside.
She underwent a vaginal hysterectomy (removal of uterus from below, no incision on the abdomen). The surgery was uncomplicated. She recovered well.
A month later she was brought in by her family members with complaints of constant watery vaginal discharge, persistent foul odour like that of ammonia, and inability to pass urine properly if and when she managed to reach the bathroom in time. They were unable to afford adult diapers as a long term solution, and wanted to find out what the problem was exactly.
After physical examination, and a swab test, Meena was diagnosed with a vesicovaginal fistula. In layman’s terms a passage had formed between Meena’s bladder and vagina. This was leading to passage of urine from the bladder to the vagina through this tract, and causing the constant urinary dribbling from her vagina. This was causing her to be an unfortunate inconvenience to her family, what with the foul odour, affecting her quality of life both socially and her activities of daily living. She was frustrated and beginning to regret the operation altogether. What was a prolapsed uterus compared to urine leaking vaginally?
Eventually she was referred to a urologist, the fistulous tract was repaired, and she went on to be happy and sociable. This is a known complication of even an uneventful surgery. While it is disconcerting, it is also repairable and quick action will improve a woman’s quality of life significantly. Not to mention her will to live.
40 year old Samantha pretty much had the life she had always wanted. A nice husband, a house to call their own, 2 kids, a progressive career. However she was unhappy. Anyone would be if they suffered from endometriosis, a condition wherein uterine tissue is present in other parts of the body apart from the uterus. For instance, the ovaries.
She could be found crying in pain during her menses, taking a leave from work, taking strong painkillers. This was after getting regular treatment from her gynecologist. Conservative (medical) management was no longer working for her. So she opted for a removal of the uterus as well as both ovaries, since the ovaries were constantly developing blood filled cysts. She had already undergone several laparoscopic surgeries for removal of these cysts and now, despite medical treatment, they were recurring. They were painful too.
So along with her uterus, her ovaries were removed as well, laparoscopically. She was in and out of the hospital in 2 days flat. Recovered very well and even resumed work in 2 weeks.
Then came the hot flashes. Sudden attacks of hot waves, sweats, nervousness and palpitations making her want to throw herself into the freezer. She was also experiencing dryness of vagina, pain during intercourse, and decreased libido mostly because of the pain.
Now, while this may not seem as significant a problem as the first two cases, it can be very limiting for the person suffering. It makes it hard to focus on work, and puts a strain on marital life of the patient. So under her doctor’s guidance, Samantha went on Hormone Replacement Therapy (HRT) for about 2 years. She quit smoking, changed her lifestyle, ate more soy and exercised. She avoided hot foods and places as much as possible. During this time the dosage of medicines was kept low and eventually tapered till her body had time to adjust to this drastic change. Again, a slightly lesser known side effect, which can be remedied.
Anita, 50 years of age, broke her right hip one day 4 years after her uterus and ovaries were removed. The surgery was done because she had been bleeding excessively on and off for 2 years. A biopsy of the uterine lining showed the beginnings of cancerous changes and hence, prompt action was taken.
She slipped down the stairs one day, and fractured her hip. She explained to the orthopedician that she really didn’t fall hard enough to break any bones, but there it was. The orthopedician checked her bone density and diagnosed her to have osteoporosis. A known side effect of menopause.
Once the fractured hip was set, her doctor started her on supplements to help treat osteoporosis. She was also advised to increase her intake of calcium rich foods, quit smoking and alcohol, get daily exercise and take her supplements on time. Thereafter she did just that and additionally got her bone mineral density checked regularly by DEXA scans.
Here’s the thing. There are so many side effects of surgeries in general and uterus removal in particular. Entire books have been written on the subject. With the advent of expert surgical and anesthetic technology, not to mention medications, we see fewer and fewer side effects.
Usually when a patient who undergoes removal of ovaries with or without uterus removal are advised regarding supplements and lifestyle changes in order to avoid any of the above issues. Whether it is hot flashes or a dry vagina or cardiovascular issues. Take your time to ask and get all of your questions answered. Do your own research. Do not be in a rush to get surgery done, unless emergently advised by your doctor. Take as many opinions as you need.
Most importantly, take good care of yourself postoperatively both short and long term. Be on the lookout for signs of trouble. Discuss what kind of lifestyle changes you need to make in the long term. Then, make those changes religiously.
In closing, permit me to share a quote by the late Professor Rachad W Te Linde, professor of gynaecology at Johns Hopkins University, and the author of one of the most detailed surgical text books on gynaecology surgeries.
“The ease with which the average hysterectomy may be done has proven both a blessing and a curse to womankind. There is no doubt that a hysterectomy done with proper indications may restore a woman to health and even save her life. However, in the practice of gynaecology, one has ample opportunity to observe countless women who have been advised to have hysterectomies without proper indications…I am inclined to believe that the greatest single factor in promoting unnecessary hysterectomies is a lack of understanding of gynecologic pathology. The greatest need among those who are performing pelvic surgery is a better knowledge of gynaecologic pathology.”
Image source: shutterstock
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Very feminist gynecologist. Cannot do without coffee and dogs. Bibliophile. Apart from seeing patients, most
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