Hysterectomy: Long-Term Care

A hysterectomy is a common and generally safe surgery that entails removing a woman's uterus. The surgery has many potential benefits (e.g., relief of symptoms like pain or bleeding).

You may experience various long-term changes after hysterectomy as well. These can include symptoms of menopause (if your ovaries were also removed) and changes in mood or sex drive. Rare complications that may necessitate future surgeries can also occur.

Benefits of Surgery

The main benefit of a hysterectomy is the treatment of the underlying health problem, such as:

• Fibroids
• Endometriosis
• Uterine prolapse
• Abnormal uterine bleeding
• Gynecological cancer

With the surgery comes the relief of uncomfortable or unpleasant symptoms associated with the underlying condition, like vaginal bleeding or pelvic pain.

In addition, research suggests that a woman who undergoes a hysterectomy, along with the removal of her ovaries and fallopian tubes, may have a lower risk of developing cancer.

Preventive Care

After your hysterectomy, it's important to continue seeing your healthcare provider for your regular gynecologic and preventive care. Depending on the type of hysterectomy you have, and the reason it was performed, you still may need pelvic exams and cervical cancer screening.

The American Cancer Society guidelines for cervical cancer screening after a hysterectomy include the following:

• Total hysterectomy: Women can stop undergoing cervical cancer screenings (e.g., Pap smears and HPV tests) unless the hysterectomy was performed to treat cervical cancer or pre-cancer.
• Partial hysterectomy: Women should continue to undergo regular cervical cancer screenings.

Possible Future Surgeries

While a hysterectomy is generally a very safe surgery, future surgical procedures may be indicated if complications (which are rare) arise, or if the hysterectomy was performed to treat cancer.

Complications

For instance, short-term complications, like a pelvic abscess formation (a collection of infected fluid) may require surgical drainage, in addition to antibiotic administration.

Other complications that may require surgical repair include:

• Injury to the intestines or bladder
• Formation of a fistula (an abnormal connection between two tissues)
• Pelvic organ prolapse
• Vaginal cuff dehiscence

With vaginal cuff dehiscence, the vaginal cuff—the incision site where the vagina was once connected to the cervix and uterus, which was sutured closed during a hysterectomy—separates. This type of complication, while very rare, is more common with a laparoscopic hysterectomy than an open procedure. 

Gynecological Cancer

If a woman undergoes a hysterectomy for cancer, such as uterine or ovarian cancer, she may need to have another surgery to check for cancer in the lymph nodes within the pelvis. This type of surgical procedure is called a lymph node dissection.

Lifestyle Adjustments

In order to move forward with your life after a hysterectomy, there are a few lifestyle adjustments you may need to undergo.

Menopause Symptoms

If you have not already gone through menopause naturally and your ovaries are also removed when you have your hysterectomy, your body goes through what is known as surgical menopause.

As a result, you will no longer menstruate and will experience symptoms of menopause, such as:

• Hot flashes
• Night sweats
• Insomnia
• Vaginal dryness
• Skin thinning

Due to the loss of estrogen production from your ovaries, you will be at a higher risk for developing bone loss (osteoporosis). This means that you are at a higher risk for developing a bone break (fracture). You are also at an increased risk of heart disease, which affects all post-menopausal women.

To ease symptoms of surgical menopause and to lower your risk for developing osteoporosis, your healthcare provider may recommend hormone therapy.

Emotional Well-Being

Women who have undergone a hysterectomy (regardless if their ovaries were removed or not) are at a higher risk for developing depression. In addition to depression, some women may grieve their loss of fertility. This feeling of loss is normal, can be profound, and should not be discounted.

If you are experiencing symptoms of depression, like feeling sad most days and/or losing interest in activities you once enjoyed, be sure to see your healthcare provider. You may benefit from seeing a therapist, taking a medication for depression, or a combination of the two.

Sex Drive and Functioning

Research shows that a woman's sex drive after a hysterectomy tends to actually be the same or better, perhaps due to a reduction in symptoms like pain or bleeding. Every woman is different, however, and some women do notice a reduced libido after surgery.

Besides a change in sex drive, some women experience physical changes that affect their sexual functioning, such as:

• Difficulty reaching orgasm
• Decreased vaginal sensation
• Vaginal shortening
• Loss of vaginal lubrication

If you are experiencing a loss of sexual desire or functioning after your hysterectomy, be sure to reach out to your healthcare provider for a proper evaluation and treatment plan. Your healthcare provider can discuss several therapies with you, including non-medication and medication options like:

• Sexual education and partner involvement
• Pelvic floor physical therapy
• Vaginal lubricants and moisturizers
• Sex therapy
• Local estrogen therapy, like Estrace (estradiol vaginal cream) or Estring (estradiol vaginal ring)
• Osphena (ospemifene), a prescription oral medication used to treat pain during sexual intercourse in post-menopausal women

A Word From Verywell

Most women are happy with and do very well after their hysterectomy. That said, if you are worried about your long-term recovery, have questions, or are currently experiencing undesirable side effects, please do not hesitate to reach out to your treatment team.