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The disadvantages of hysterectomy THE DISADVANTAGES OF HYSTERECTOMY
Although a safer procedure than, for example, removal of the appendix, hysterectomy is not without risk. For every 2000 abdominal hysterectomies performed, between one and four women die within a month of surgery (the variation in figures depends on which study is consulted). Death rates may be less for vaginal and laparoscopically assisted hysterectomies.
In addition, reports suggest that between 25 and 50% of all women who have a hysterectomy encounter one or more complications. In the case of abdominal hysterectomy, 1-3% of women experience a major complication such as significant post-operative bleeding, the formation of a blood clot in the lungs, or damage to the ureter, the bowel or the bladder, all of which may require further surgery. Vaginal prolapse and sexual problems may also occur with any type of hysterectomy because there is reduced support for the upper part of the vagina from other pelvic structures. To minimise this risk, the ligaments supporting the bladder, bowel and vagina are stitched together after the uterus is removed.
Other complications include infections of the surgical wound and urinary tract, weight gain, abdominal or back pain, constipation, fatigue and frequent urination. Some of these, for example urinary tract infections, usually clear quickly provided antibiotic therapy is administered promptly. In some women, however, they become a persistent source of unsettling symptoms requiring treatment. For Rita, the biggest surprise following her hysterectomy was the kilos she suddenly gained. An enthusiast for keeping in shape, she couldn't understand why she had put on weight, given that she was just as careful about what she ate after her hysterectomy as before. 'My doctor thought it might have something to do with changes in my sex hormones, but when I asked about hormone replacement therapy he said this might cause even more weight gain/ Rita embarked on a vigorous schedule of physical activity which, at last report, had helped her weight to plateau. She is not alone in experiencing this complication of hysterectomy. Some studies report that weight problems occur in nearly a quarter of women after the operation. It seems that women who want to maintain their weight at pre-hysterectomy levels need to be prepared to reduce their calorie intake somewhat in the two to six weeks after surgery in line with their reduced activity levels.
Psychological disturbances have been widely reported in women who have had hysterectomies, with depression, mood change, anxiety and irritability often cited. Other studies have, however, raised the possibility that it is not hysterectomy itself that triggers these disturbances. Rather, they may reflect psychological states which developed during the period of stress and ill-health preceding the operation.
For pre-menopausal women, hysterectomy may lead to an early menopause and distressing menopausal symptoms such as hot flushes and vaginal dryness if the ovaries are removed along with the uterus. This may also occur in women whose ovaries are saved, but less frequently, particularly if the surgeon who does the operation is skilful and experienced. An uncertain factor in all this is the state of the ovaries before surgery. It may be that women who resort to hysterectomy have a higher incidence of problems with their ovaries than women who do not, and that even if they were able to avoid surgery, their ovaries might not function particularly well. What can now be said with some certainty is that women who have had a hysterectomy are much more likely than average to embark on hormone therapy. The Melbourne Women's Midlife Health Project, which questioned 2000 randomly selected women aged forty-five to fifty-five years, found that half the women who had both ovaries removed at the time of hysterectomy were on hormone therapy, as were a third who had a hysterectomy but retained their ovaries. In contrast about one in six women who had not had a hysterectomy was on hormone therapy. In a comparable group of US women, the rate was about the same in the surgical menopause group and significantly lower in the natural menopause group. Rates seem to vary widely across Western Europe, but there is not enough information to enable a valid comparison.
Other long-term complications, which stem in part from the early menopause that sometimes occurs after hysterectomy, are an increased risk of heart disease and of the bone thinning disorder, osteoporosis. In order to reduce these risks, as well as to resolve menopausal symptoms, hormone therapy containing oestrogen is often prescribed after a hysterectomy.
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