<\/p>\n\n\n\n
According to the CDC<\/a>, \u201cIn 2021, the age-adjusted percentage of women age 18 and older who had received a hysterectomy was 14.6%,\u201d making it one of the most common procedures for women. With around 129 million adult women in the US (per the 2020 census<\/a>), that puts us in a ballpark estimate of 19 million \u201cuterus-less\u201d women in the US alone. Since millions and millions of women have experienced a hysterectomy, it must be a procedure that we understand forwards and backwards. Right? Maybe not.<\/p>\n\n\n\n Hysterectomy is a controversial topic, and we\u2019re still learning more about how the uterus interacts with the rest of the body, revealing new information about the risks involved with the procedure. Proponents argue that it is a permanent solution to serious reproductive conditions like large uterine fibroids<\/a>, adenomyosis<\/a>, endometriosis<\/a>, and pelvic organ prolapse<\/a> with few downsides. Opponents argue that the removal of an entire organ should be considered a last resort and reserved for cancer, emergency situations, or when less invasive treatment options have already failed. So how serious is hysterectomy<\/a>? After childbearing years are past, is there any harm in removing a now \u201cuseless\u201d organ, or is prioritizing saving the uterus more important than we once thought?<\/p>\n\n\n\n A hysterectomy<\/a> is the removal of the uterus. A partial hysterectomy removes the upper portion of the uterus and leaves the cervix<\/a> intact, while a complete hysterectomy removes the entire uterus and cervix. Sometimes hysterectomy is paired with salpingectomy<\/a> (removal of the fallopian tubes<\/a>) and oophorectomy (removal of the ovaries<\/a>). <\/p>\n\n\n\n Because having all the reproductive organs removed comes with more complications than removal of the uterus alone, this article will simply focus on the long-term risks of hysterectomy.<\/p>\n\n\n\n According to a 2018 Mayo Clinic study<\/a> published in Menopause<\/em>, \u201cWomen who underwent hysterectomy with ovarian conservation were at higher risk of developing de novo (meaning new onset) cardiovascular and metabolic conditions compared with age-matched referent women.\u201d The study compared over 2,094 women who had undergone hysterectomy, and compared their medical records to 2,094 women with intact uterus, randomly selected from the same geographical region. The study found that women in the hysterectomy group had a 14% higher risk of hyperlipidemia, 13% higher risk of high blood pressure, 18% higher risk of obesity, 17% higher risk of cardiac arrhythmia, and, concerningly, 33% higher risk of coronary artery disease<\/em>, which can lead to heart attack. The study noted that women undergoing hysterectomy were more likely to have pre-existing cardiovascular issues than their healthy-uterus counterparts (perhaps because fibroids<\/a> and endometriosis<\/a> are both linked to cardiovascular issues), and the researchers adjusted the statistical analysis to account for this difference. Additionally, cardiovascular risk was much higher for women younger than 35 years who underwent hysterectomy; these women had a 4.6-fold increased risk of heart failure, and 2.5-fold increased risk of developing coronary heart disease [1].<\/p>\n\n\n\n The study found that women in the hysterectomy group had a 14% higher risk of hyperlipidemia, 13% higher risk of high blood pressure, 18% higher risk of obesity, 17% higher risk of cardiac arrhythmia, and, concerningly, 33% higher risk of coronary artery disease<\/em>, which can lead to heart attack.<\/p><\/blockquote><\/figure>\n\n\n\n So, why would removing the uterus cause problems for the heart? While the uterus has no direct impact on the heart that we know of, the ovaries do<\/em> have a big impact on the cardiovascular system. <\/p>\n\n\n\n Estrogen, mainly produced by the ovaries, is a key hormone for heart health<\/a>. Without the uterus there to (literally) support the ovaries, ovarian health suffers. <\/p>\n\n\n\n The uterus connects to the ovaries<\/a> through blood vessels and the ovarian ligament. Without these vessels, blood flow to the ovaries is decreased. Additionally, some studies suggest that the uterus and ovaries share two-way communication to coordinate ovulation, and ovulation may suffer without the uterus present (as evidenced in this 2001 study<\/a> on uterine receptors, and this even older 1994 study<\/a> on capuchin monkeys that found that separating the ovary from the ovarian ligament impaired ovulation [2] [3]). When ovulation is impaired, estrogen and progesterone production is impaired, affecting the rest of the body.<\/p>\n\n\n\n Let\u2019s take a closer look at how the ovaries respond to the abduction of their dear neighbor:<\/p>\n\n\n\n Clearly, and as discussed in the above-mentioned Menopause<\/em> article, \u201covary-saving\u201d hysterectomy procedures don\u2019t spare the ovaries entirely. The increased risk of ovarian failure, early menopause, and severe menopausal symptoms after hysterectomy highlight the important role the uterus has on long-term ovarian (and therefore whole-body) health.<\/p>\n\n\n\n Clearly, \u201covary-saving\u201d hysterectomy procedures don\u2019t spare the ovaries entirely. The increased risk of ovarian failure, early menopause, and severe menopausal symptoms after hysterectomy highlight the important role the uterus has on long-term ovarian (and therefore whole-body) health.<\/p><\/blockquote><\/figure>\n\n\n\n The effects of hysterectomy don\u2019t stop with cardiovascular risks and early menopause. Some women also experience negative mental health after hysterectomy as well. <\/p>\n\n\n\n A 2020 national study<\/a> from South Korea found that hysterectomy increased the risk of depression by 16% overall, and 18% in patients under 50 [7]. A Mayo Clinic<\/a> study from the same year found that hysterectomy increased the risk of de novo<\/em> (new) depression by 26%, and the risk of anxiety was increased by 22%. The study followed health data for 2,094 women over a span of 23 years. In patients who were 35 or under at the time of their hysterectomy, there was a 1.5-fold increased risk of depression and 1.7-fold increased risk of anxiety [8]. Presumably, the high risk of depression for young women following hysterectomy is connected to grief over their loss of fertility. However, even women past their reproductive years can face grief following the loss of their uterus as a symbol of their femininity and motherhood.<\/p>\n\n\n\n Whether a hysterectomy helps or hurts your pelvic floor<\/a> will largely depend on your starting point. Did your hysterectomy take place because of a grapefruit-sized fibroid that overtook your uterus? Then your pelvic floor<\/a> is probably doing much better without all that weight and pressure bearing down on it! Did you have severe uterine prolapse<\/a> that physical therapy failed to help? Then your urinary and bowel pelvic floor issues<\/a> related to prolapse are probably much improved. <\/p>\n\n\n\n However, it\u2019s important to note that your organs are not just floating in the body (like the ancient Greek belief that hysteria<\/a> was caused by the uterus literally roaming around). The pelvic organs (bladder, uterus, and rectum) are held in place by connective tissue like fascia and ligaments, and supported by the muscles of the pelvic floor. The uterus sits in the center of these pelvic structures and provides support to the bladder and rectum. Taking out the middle of this pelvic set-up will change how weight and strain are distributed. <\/p>\n\n\n\n Additionally, this 2013 review<\/a> on how hysterectomies can harm the pelvic floor highlights that hysterectomy can lessen ligament support of the vagina, leading to prolapse, and there is also the potential for nerve damage that can affect pelvic function. The authors cite pelvic organ prolapse, urinary incontinence, bowel dysfunction, decreased sexual function<\/a>, and pelvic organ fistula (in which two pelvic organs become connected via a new opening) as possible complications of hysterectomy [9]. <\/p>\n\n\n\n According to Dr. Sara Reardon (aka the Vagina Whisperer<\/a>), there are simple exercises that can be added to your daily routine to help with any pelvic floor symptoms that may arise or persist after a hysterectomy. (Note: these are also great to try both before and after childbirth!)<\/p>\n\n\n\n Increase your level of activity at a slow-and-steady pace that feels good. <\/p>\n\n\n\n One upside is that exercise is also beneficial for cardiovascular health, mental health, and managing menopause<\/a> symptoms\u2014all the key areas that hysterectomy can affect long term.<\/p>\n\n\n\n Some women feel a great deal of relief after having a hysterectomy, and may only experience the benefits with none of the side effects or risks. And for many women with a variety of issues, hysterectomy may truly be the best option. But while there will likely always be cases where hysterectomies are medically necessary, continuing to learn about the body as an integrated system rather than a collection of independently-functioning parts will hopefully push less-invasive treatment options to the forefront. And, in cases where hysterectomy is still the best way forward, understanding the need to monitor ovarian health, explore additional hormone support, and support recovery through physical therapy can help women live healthier lives after surgery.<\/p>\n\n\n\nWhat is a hysterectomy?<\/span><\/h2>\n\n\n\n
Hysterectomy and heart health<\/span><\/h2>\n\n\n\n
Lonely ovaries can cause problems <\/span><\/h2>\n\n\n\n
How the uterus supports the ovaries <\/span><\/h3>\n\n\n\n
\n
Mental health<\/span><\/h2>\n\n\n\n
What happens when you remove the door from the pelvic floor<\/span><\/h2>\n\n\n\n
Supporting pelvic health after a hysterectomy<\/span><\/h2>\n\n\n\n
\n
The bottom line<\/span><\/h2>\n\n\n\n
References<\/span><\/h4>\n\n\n\n[1] Laughlin-Tommaso SK, Khan Z, Weaver AL, Smith CY, Rocca WA, Stewart EA. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018 May;25(5):483-492. doi: 10.1097\/GME.0000000000001043. PMID: 29286988; PMCID: PMC5898981.<\/p>\n\n\n\n[2] Stewart EA. Gonadotropins and the uterus: is there a gonad-independent pathway? J Soc Gynecol Investig. 2001 Nov-Dec;8(6):319-26. PMID: 11750866.<\/p>\n\n\n\n[3] Nagle, C.A., Digiano, L., Paul, N., Terlato, M., Quiroga, S. and Mendizabal, A.F. (1994), Interovarian communication for the control of follicular growth and corpus luteum function in the cebus monkey. Am. J. Primatol., 34: 19-28. https:\/\/doi.org\/10.1002\/ajp.1350340106<\/a><\/p>\n\n\n\n[4] Farquhar, C.M., Sadler, L., Harvey, S.A. and Stewart, A.W. (2005), The association of hysterectomy and menopause: a prospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 112: 956-962. https:\/\/doi.org\/10.1111\/j.1471-0528.2005.00696.x<\/a><\/p>\n\n\n\n[5] Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol. 2011 Dec;118(6):1271-1279. doi: 10.1097\/AOG.0b013e318236fd12. PMID: 22067716; PMCID: PMC3223258.<\/p>\n\n\n\n
References Continued<\/span><\/h4>\n\n\n\n[6] Hot flushes and night sweats symptom profiles over a 17-year period in mid-aged women: The role of hysterectomy with ovarian conservation. Wilson, Louise F. et al. Maturitas, Volume 91, 1 – 7<\/p>\n\n\n\n[7] Choi HG, Rhim CC, Yoon JY, Lee SW. Association between hysterectomy and depression: a longitudinal follow-up study using a national sample cohort. Menopause. 2020 May;27(5):543-549. doi: 10.1097\/GME.0000000000001505. PMID: 32049924.<\/p>\n\n\n\n[8] Laughlin-Tommaso SK, Satish A, Khan Z, Smith CY, Rocca WA, Stewart EA. Long-term risk of de novo mental health conditions after hysterectomy with ovarian conservation: a cohort study. Menopause. 2020 Jan;27(1):33-42. doi: 10.1097\/GME.0000000000001415. PMID: 31479034; PMCID: PMC7089568.<\/p>\n\n\n\n[9] Forsgren, C., & Altman, D. (2013). Long-Term Effects of Hysterectomy: A Focus on the Aging Patient. Aging Health<\/em>, 9<\/em>(2), 179\u2013187. https:\/\/doi.org\/10.2217\/ahe.13.7<\/p>\n","protected":false},"excerpt":{"rendered":"Beaucoup d'entre elles sont li\u00e9es \u00e0 des \u201covaires solitaires\u201d","protected":false},"author":98,"featured_media":24291,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5181],"tags":[],"class_list":{"0":"post-24285","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-reproductive-and-menstrual-disorders","8":"cs-entry","9":"cs-video-wrap"},"acf":[],"yoast_head":"\n