Surgical Removal of the Uterus: Definitions, Classifications, and Functions
A hysterectomy, a surgical procedure that either completely or partially removes a person's uterus, may be recommended by doctors for various reasons, including chronic pain conditions, certain types of cancers and infections, or conditions such as uterine fibroids, uterine prolapse, endometriosis, adenomyosis, or cancer of the uterus, cervix, ovaries, or endometrium.
While a hysterectomy can offer relief from these conditions, a specific type of hysterectomy - the total hysterectomy with bilateral salpingo-oophorectomy (BSO) - carries long-term effects that patients should be aware of. This procedure involves the removal of both ovaries and fallopian tubes.
One significant benefit of BSO is the reduced risk of ovarian and endometrial cancer. Removal of both ovaries and fallopian tubes during BSO significantly lowers the risk of ovarian cancer, and total hysterectomy eliminates the risk of endometrial cancer as the uterus (site of this cancer) is removed.
However, BSO also induces early menopause, which carries increased risks of cardiovascular disease, osteoporosis, and other hormone-related health issues. Patients undergoing BSO experience surgically induced menopause, leading to symptoms such as hot flashes, night sweats, mood changes, and vaginal dryness. Early loss of ovarian hormones can increase long-term risks for osteoporosis, cardiovascular disease, and possibly cognitive decline or dementia.
For women with breast cancer, undergoing hysterectomy combined with BSO has been linked to improved survival rates, possibly by reducing the risk of subsequent gynecological cancers. However, surgical removal of ovaries may increase the risk of stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE), especially in hormone-deprived states.
It is crucial for patients to discuss personalized follow-up care with their surgeon to manage and monitor these risks effectively after surgery. People should also be aware that activities to avoid for 4-6 weeks after surgery include lifting heavy objects, pushing or pulling objects, swimming, using tampons, douching, sexual intercourse, and high-intensity exercise.
Despite these risks, it is essential to remember that a hysterectomy can provide significant relief for many women suffering from debilitating conditions. It is always advisable to discuss all options, including alternatives such as hormone therapy for endometriosis, Kegel exercises for uterine prolapse, surgery to treat endometriosis or uterine fibroids without removing the uterus, and procedures that shrink uterine fibroids, with a healthcare professional before making a decision.
[1] American Cancer Society. (2021). Hysterectomy: What You Need to Know. https://www.cancer.org/treatment/surgery/hysterectomy.html [2] National Cancer Institute. (2021). Ovarian Cancer: Risk Factors. https://www.cancer.gov/types/ovarian/hp/ovarian-risk-factors-pdq [3] Mayo Clinic. (2021). Hysterectomy: Risks. https://www.mayoclinic.org/tests-procedures/hysterectomy/about/risks/cne-20394155 [4] American Society for Reproductive Medicine. (2020). Menopause, Surgically Induced. https://www.asrm.org/globalassets/asrm/asrm-us/resources/patient-resources/fact-sheets/fact-sheets-for-patients/menopause-surgically-induced.pdf
Women's health and wellness can be significantly improved through a hysterectomy, a surgical procedure that may be recommended for various medical conditions, including certain types of cancers and health issues like endometriosis and uterine fibroids. However, a specific type of hysterectomy, the total hysterectomy with bilateral salpingo-oophorectomy (BSO), carries long-term effects like an increased risk of cardiovascular disease, osteoporosis, and other hormone-related health issues due to early menopause.
