Hysterectomies & Hormones :: UAB Experts Answer Our Most Probing Questions

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The female body is an amazing, complex machine. As mothers, we experience the wonder of it in a new way when we grow and give birth to children. It’s truly amazing what the body can do! At the same time, some women do encounter issues or concerns. For women with complications who are no longer considering pregnancy, having a hysterectomy can be a wise medical decision. Health matters naturally bring an array of questions and concerns, so we talked with the UAB Women and Infants Services team to shed light on this important topic. The UAB Women and Infants experts have vast experience in this area, performing around 1300 hysterectomies each year. They cover the entire spectrum of indications for hysterectomy including benign disease, cancer and prolapse. We were thrilled to lean on their experience and expertise to learn more about who should consider a hysterectomy and what to expect before and after.

What are common causes for needing a hysterectomy?

Common reasons for hysterectomies are uterine fibroids, abnormal uterine bleeding, pelvic pain, premalignant and malignant conditions of the cervix, uterus, or ovaries. It’s also done as a component of a pelvic prolapse procedure.

Are all women who undergo a hysterectomy encouraged to take estrogen afterwards?

For a large fraction of women undergoing a hysterectomy, the ovaries remain in place and continue to make the hormones that prevent menopausal symptoms. Depending on the woman’s age at the time of hysterectomy, the ovaries may be removed. In this instance, the decision to start hormone replacement therapy is determined through shared decision making with the patient’s physician based on the severity of her symptoms and her risk factors.

What is the difference between a partial and a total hysterectomy and does each affect hormones differently? Can both cause hormonal imbalances?

Technically, there is no such thing as a “partial hysterectomy.” Many women use this term to denote that they retained their ovaries at the time of a hysterectomy. From a medical perspective, we use the following terms:

    1. Total hysterectomy (What is sometimes referred to as a “partial hysterectomy”)
    2. Total hysterectomy with salpingoo-phorectomy (“Total hysterectomy”)
    3. Subtotal or supracervical hysterectomy (Hysterectomy with the cervix retained)

Hormones are only affected if the ovaries are removed.

Is a hysterectomy a definite cure for endometriosis?

Endometriosis is a complex and challenging disorder. Depending on the stage of the disease, a hysterectomy can alleviate a significant amount of the pain related to endometriosis. Some women, however, require removal of the ovaries to experience complete relief of their endometriosis.

There are a few different outcomes for hysterectomies due to endometriosis:

    1. If the surgeon removes all endometriosis and does a hysterectomy, about 60-70% of women will achieve pain control after the hysterectomy.
    2. If the surgeon removes all endometriosis and does a hysterectomy with ovarian removal (oophorectomy), approximately 90% of women will achieve pain control.
    3. About 10% of women will continue to have pain issues regardless.

What does recovery look like after a hysterectomy?

Recovery depends on the mode of hysterectomy. With a vaginal/laparoscopic/robotic hysterectomy, surgery is a one-day procedure, pain meds are required for three to five days, light work can be resumed within two to three weeks, and full activity can be resumed within six weeks. With an abdominal hysterectomy, a patient is admitted for 48 hours for surgery, pain meds are required for five to seven days, light work can be resumed within four weeks, and full activity can be resumed within six to eight weeks. 

What are some symptoms of pre-menopausal hormone changes that we should look for as we age?

Changes in your menstrual cycle are expected. Most women will first see their cycles decrease from 28-32 days to approximately 23–25-day intervals. After this time period, many women will begin to miss cycles intermittently. Most women will transition from regular cycles to absent cycles over 18-24 months.

Well-proven menopausal symptoms include hot flashes, night sweats, insomnia, mood swings, and vaginal dryness. Suspected but not proven symptoms include decreased mentation (“brain fog”), decreased libido, and skin changes.

What does life look like after a hysterectomy?

For over 98% of women, life should look no different after a hysterectomy. After recovering from surgery, most women can participate in the same activities they participated in prior to hysterectomy.

A small percentage of women will experience depression, complications of surgery, or postoperative pain.

How common are hysterectomies over 40?

Hysterectomy is much less common now. In 2000, there were approximately 600,000 hysterectomies in the U.S. Currently, there are approximately 400,000. The most common age range for benign hysterectomy is 35 – 50. This age range is related to the increasing irregularity of menstrual cycles and completion of childbearing for most women.

How soon should I get a preventative hysterectomy for BRCA gene?

We usually recommend having a risk-reducing hysterectomy with bilateral oophorectomy once childbearing is completed and usually no later than age 40.

What is one thing doctors wish women understood better about their hormones?

  1. In most cases, a hysterectomy will not affect your hormones. It is whether you choose to remove your ovaries that affects hormones.
  2. While hormones do affect your health and well-being, they are not the cause of all challenges. The majority of gynecologic problems caused by a woman’s hormones are not necessarily due to the hormones individually but rather how the hormones fluctuate during the menstrual cycle. If a patient is concerned about her hormonal status, we recommend she keep a symptom and menstrual calendar to be reviewed by her physician.

Interested in learning more? Visit the UAB Women & Infants Services website to learn more about their services and to make an appointment.

This post was written in partnership with UAB Women & Infants Services. This is sponsored content.

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