Did you know that 33 percent of American women will have had a hysterectomy by age 60? (It’s the second most common surgery among women after cesarean-section deliveries.) While it’s rarer to need a hysterectomy after age 60, it’s still possible. Since it can take such a toll on a woman’s body and emotionally too, it’s a good idea to understand what to expect in the recovery stage. When women over age 60 need hysterectomies, the most common reasons are:
- Uterine prolapse – This occurs when the uterus protrudes out of the vagina due to weakened pelvic floor muscles and ligaments. It’s common in postmenopausal women who have had one or more vaginal deliveries. A surgeon may recommend a hysterectomy if non-surgical treatments have not been successful.
- Cancer – Since the risk for cancer increases with age, a hysterectomy may be needed if a woman has cancer of the uterus, ovaries, cervix or endometrium.
- Persistent fibroid tumors – A surgeon may recommend a hysterectomy as a precaution in case the reappearing tumors are precancerous, but this would be a rare circumstance.
What is a hysterectomy, and what are its long-term effects? A hysterectomy involves the removal of all or part of a woman’s uterus, or the “womb,” and it may or may not include the removal of the cervix, ovaries and fallopian tubes. It’s important to have a thorough conversation with your doctor about all available treatment options (both surgical and nonsurgical) and the implications of each. One important question to ask your physician is whether your ovaries will be removed. You have likely already gone through menopause, but some surgeons believe the ovaries still produce a small amount of estrogen even after menopause ends, which can help with sexual function. What happens after a hysterectomy? Immediately after your surgery, you will have some pain that will be managed with medication. You will be encouraged to get up and walk as soon as you’re able to help prevent blood clots in your legs. You will likely have to urinate through a catheter. Initially, you may experience symptoms such as:
- Temporary problems urinating
- Bloody vaginal draining that could last several weeks (This should not be as heavy as a regular period.)
- Depression or feeling a sense of loss
When you can go home will depend upon what kind of surgery you had.
- Abdominal hysterectomy – This procedure has the greatest risk for complications. You will likely be in the hospital for two to three days, and it can take up to four to six weeks to fully recover.
- Vaginal hysterectomy – With this procedure, women may spend one night in the hospital or even go home the same day. It can take three to four weeks to recover.
- Laparoscopic or robotic hysterectomy – This procedure is the least invasive option and can take two to four weeks to recover.
Once home, it’s important to keep watch for signs of infection, which can include:
- Fever or chills
- Heavy bleeding
- Severe pain
- Redness or discharge from the incision site
- Urination or bowel movement issues
- Shortness of breath or chest pain.
You will need to avoid heavy lifting and sex for the first six weeks to allow your body time to recover. Talk to your gynecologist If you’re experiencing heavy bleeding, abdominal pain or other worrying symptoms, talk to your gynecologist about your concerns and treatment options. With the proper treatment, whether surgical or non-surgical, women typically go on to live happy, pain-free lives.
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It is worth noting the United Kingdom’s National Institute of Clinical Excellence (NICE) guidelines recommend second generation over first generation techniques for heavy menstrual bleeding (20). A review compared the efficacy, safety and acceptability of both techniques and found second generation techniques had shorter procedure times, used local anaesthesia more frequently as opposed to general anaesthesia and had fewer incidences of serious complications (21).
Other options for uterine prolapse
A uterine prolapse occurs when weakened pelvic floor muscles, ligaments or vaginal walls cause the uterus to drop from its pelvic cavity position into the vagina. Other pelvic organs like the bladder or bowel will often also prolapse when the uterus drops. A mild prolapse can be helped with regular pelvic floor exercises. Pelvic floor exercises involve strengthening the pelvic floor muscles by actively tightening and lifting them at timed intervals.
A mild to moderate prolapse may be treated with a ring pessary, which is a silicon device fitted into the vagina to physically support the uterus. Pessaries may be suitable for women who do not wish to have surgery or are unsuitable candidates, such as elderly women or women with medical conditions that make surgery high-risk. A pessary needs to be inserted by a health professional and replaced every three to four months.
A number of surgical procedures including different types of reconstructive surgery and vaginal repair work are available which correct uterine prolapse without hysterectomy. The purpose of these procedures is to correct anatomical defects, maintain or restore bladder and bowel function and maintain sexual function (22).
For further information on uterine prolapse see our Genital prolapse fact sheet.
Other options for endometriosis and adenomyosis
Endometriosis is a condition in which endometrial tissue that normally lines the uterus grows in other parts of the body, usually in the pelvis. Adenomyosis occurs when the endometrial tissue grows into the muscle wall of the uterus. Treatment for endometriosis and adenomyosis includes a range of hormonal drugs such as progestogens, danazol and GnRH analogues. Alternatively, the endometrial tissue can be surgically removed. Women experiencing heavy bleeding as the main symptom of adenomyosis may find the Mirena IUS brings relief.
For further information on endometriosis see the Women’s Health Endometriosis fact sheet.
- Endometriosis fact sheet
- Genital prolapse fact sheet
- Alternatives to HRT fact sheet
- Gynaecological health Women’s Health library booklist
- Hysterectomy – Better Health Channel
- Hysterectomy – Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Pap smears following a hysterectomy (PDF) – SA Cervix Screening Program
- What women should know about hysterectomy (18 languages) – Health Translations
- National Collaborating Centre for Women’s and Children’s Health 2007. Heavy menstrual bleeding Clinical Guideline . National Institute for Health and Clinical Excellence. London: RCOG Press. accessed May 5, 2010
- Ovarian Cancer Australia. Awareness . http://www.ovariancancer.net.au/awareness accessed May 6, 2010
- Australian Institute of Health and Welfare & National Breast and Ovarian Cancer Centre 2010. Ovarian cancer in Australia: an overview, 2010. Cancer series 52:6. Canberra. Accessed May 5, 2010
- AIHW 2010: Ibid: 6
- Monash University , Womens’ Health Program 2005. Androgens in Women. http://med.monash.edu.au/sphpm/womenshealth/docs/androgens-in-women.pdf accessed May 5, 2010
- Monash University 2005, Ibid:1
- Monash University 2005, Ibid:3
- Speroff T et al 1991. A risk-benefit analysis of elective bilateral oophorectomy: Effect of changes in compliance with estrogen therapy on outcome. American Journal of Obstetrics & Gynaecology;164 (1):165-174
- Dennerstein L, Wood C and Westmore A 1998. Hysterectomy. Oxford University Press, 2 nd edition: 148.
- Johnson N et al 2005. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database System Review 5 (1) : CD003677
- Haslett S, Jennings M, Walsgrove H and Weatheritt W 1984. Hysterectomy, Vaginal Repair and Surgery for Stress Incontinence. Beaconsfield Publishers Ltd, Beaconsfield. 6 th edition, 2010:12
- Haslett, S 2010 Ibid: 12
- Haslett, S 2010 Ibid: 37
- Haslett, S 2010 Ibid: 38
- Haslett, S 2010 Ibid: 42
- American College of Surgeons, Surgical removal of the uterus or womb. www.facs.org, accessed May 4, 2010
- Queensland Health. Cervical Screening Program https://www.health.qld.gov.au/cervicalscreening/ accessed May 5, 2010
- Hickey M and Hammond I 2008. What is the place of uterine artery embolisation in the management of symptomatic uterine fibroids?Australia and New Zealand Journal of Obstetrics & Gynaecology; 48(4): 360-8
- Hurskainen R & Paavonen J 2004. Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding. Current Opinion in Obstetrics and Gynecology; 16 (6) : 487-90
- Jones S E, Gurawadayarhalli B, Vyjayanthi S 2007. Surgical and interventional management of abnormal uterine bleeding. Journal of Reproductive Fertility; 6:77-81. Gynaecology Forum, Medical Forum International, Vol. 12 (2): 24
- Jones, S E 2007 op. cit: 24
- Haslett, S 2010 op. cit: 14
For help understanding this fact sheet or further information on hysterectomy, women in Queensland can call the Health Information Line on 3216 0376 (within Brisbane) or 1800 017 676 (toll free outside Brisbane).
Last updated: March 2011 Currently Under Review 2018
© Women’s Health Queensland Wide Inc. This fact sheet was revised by Lorraine Pacey and the Women’s Health Queensland Wide (Women’s Health) Editorial Committee in 2011.
Aging and Hysterectomy
Q1. I have been told that I need to have a hysterectomy, but I am 74 years of age. Is this possible at my age? Is there an age after which you shouldn’t get one? Are there any greater concerns for this procedure as you get older?
There are several reasons that a doctor may recommend a hysterectomy for someone your age — the most important step is to just ask him or her why the hysterectomy is recommended. About 10 percent of hysterectomies are performed for cancer, and the rest are done for benign conditions. In the absence of cancer, the decision to have a hysterectomy should be carefully considered. Some reasons for having a hysterectomy include:
- Cancer of the endometrium. Endometrial cancer is a cancer of the lining of the uterus. It is the most common gynecologic cancer. The median age at diagnosis is 60 years old, so your age does not make it impossible for you to have this cancer.
- Cancer of the cervix. Although the median age at diagnosis of cervical cancer is 50, 10 percent of cervical cancer cases are diagnosed in women over 70. A hysterectomy may be an appropriate treatment, depending on the stage of the cancer.
- Abnormal bleeding after menopause. Bleeding after menopause is not normal and may indicate cancer. You may have had an endometrial biopsy and/or a D&C (dilation and curettage) that had suspicious cells or precancerous cells, for which a hysterectomy would now be a reasonable next step.
- Persistent uterine fibroids. Fibroids are benign growths in the muscle of the uterus. Typically, fibroids get smaller after menopause. If you still have a large fibroid at age 74, your doctor may be recommending the hysterectomy to be sure that the growth is not a cancer of the uterus, such as leiomyosarcoma or endometrial stromal sarcoma. Although these cancers are more typically found in somewhat younger women, they will occasionally be diagnosed in women over 70.
- Uterine prolapse. Uterine prolapse is a benign condition in which weakening of the pelvic floor muscles allows the uterus to slip down into the vagina. This can be uncomfortable. Sometimes nonsurgical interventions can help support the uterus (for example, hormone treatments or the insertion of a ring called a pessary into the vagina to provide extra support), but if the prolapse is severe and is causing problems, a hysterectomy may be recommended.
- Persistent pelvic pain. If the only problem is pelvic pain and evaluations to find the cause of pain have all been negative, you should carefully consider with your doctor whether a hysterectomy is likely to relieve the pain.
Your doctor should be able to answers your questions about why a hysterectomy is being recommended for you, as well as discuss the associated risks of the procedure. You can ask for some details, such as whether your surgeon will use an “open” procedure (called a total abdominal hysterectomy), a procedure using a laparoscope to help remove the uterus through the vagina (called a laparoscopically assisted vaginal hysterectomy or LAVH), or if the procedure can be done completely through the vagina (a vaginal hysterectomy). Another question to ask is whether he or she recommends that your ovaries and fallopian tubes also be removed at the same time.
If you do choose to have a hysterectomy, your doctor will likely do a few tests beforehand to make sure that your heart and lungs are generally fit enough to have general anesthesia. If you are worried about risks associated with the surgery, know that most surgeries to remove the uterus are fairly low risk. However, there is some risk of bleeding and a low risk of infection and injury to other organs located in your pelvis — your bladder and parts of your intestines — during the surgery. There’s also a low risk of decreased ability to control your urine (incontinence). You should be told to expect some degree of postsurgery pain, but this should not be long-lasting. Finally, if you have an open procedure you will likely also be counseled about the possibility of poor wound healing for the open incision in your abdomen. Most incisions heal easily; poor healing and infection is more common in women who are overweight. All women are watched carefully after abdominal and pelvic surgery for evidence of blood clots in the legs, which are a fairly common and potentially serious complication of surgery. They are more common in women whose surgery is being done for cancer. These clots generally form during the short period of time when patients are not yet out of bed after surgery. You can decrease your risk for these clots by being motivated to get moving as soon as your surgeon tells you that it is safe for you to get out of bed. Finally, many women debate whether or not to also get their ovaries removed at the same time as their uterus. Since you are already past menopause, you are not highly likely to have menopause-like symptoms (hot flashes, vaginal dryness, etc.) after surgery, even if your ovaries are removed. However, there has been declining interest in removing the ovaries at the time of a hysterectomy if the surgery is being done for a benign condition. The ovaries do produce a small amount of estrogen and testosterone after menopause, and some doctors and women believe that the removal of the ovaries, even after menopause, may negatively impact sexual function.
Q2. I have always had pain-free Pap tests , but my last experience was the most painful and traumatic experience of my life. I cried out in pain during the whole speculum portion of the exam. The doctor did not stop the procedure. Is the pain a side effect of menopause? And what can a doctor do to avoid causing this pain? Is there anything I can do to avoid having a similar experience in the future? Will there be a time I no longer need a speculum and Pap tests? Thanks.
This is a great question that really asks about two issues: Why was your Pap so uncomfortable, and what are the recommendations for Pap tests in the menopausal woman? It is likely that your Pap was painful because of a condition the medical profession calls vaginal atrophy (I prefer PMV, or postmenopausal vagina). This condition is the consequence of low estrogen levels and involves thinning of vaginal skin and decreased lubrication, among other things. It is responsible for more urinary tract infections and painful intercourse in postmenopausal women. This condition can successfully be treated with local estrogen in a variety of preparations (creams, tablets and a silastic ring which is inserted in the vagina and changed every three months). It may not be necessary to use these products if your only difficulty is the Pap test. Next time, be sure to warn your physician that it can be uncomfortable for you and he/she can use a small speculum and be gentle!
There are several other vulvo-vaginal conditions that can make Pap tests uncomfortable, but these are way less common than PMV. For more information, see Elizabeth Stewart’s wonderful book called, The V Book.
As for how often a postmenopausal woman needs a Pap test, there are several opinions, and it partly depends on your risk for cervical cancer (which is what a Pap test is looking for). Risk factors include having multiple or new sexual partners, previous abnormal Pap smears, being immune-compromised (such as undergoing chemotherapy or being HIV positive), being positive for a high-risk human papilloma virus type, or having been exposed to the drug DES (diethylstilbestrol) in utero.
The U.S. Preventive Services Task Force recommends stopping Pap tests at age 65, while the American Cancer Society recommends age 70 in low-risk women. The American College of Obstetricians and Gynecologists does not set an age. In addition, many people are not aware that if a woman is older than 30, is at low risk for cervical cancer and has had three negative yearly Paps, she can space out her Paps to every two to three years.
Q3. Do I still need a yearly Pap smear even though I’ve had a hysterectomy and partial removal of my cervix? If so, how will this test work now? Can I still get cervical cancer?
Whether you will continue to need a Pap smear after a hysterectomy depends on whether you have had your entire cervix removed. This is something your doctor will tell you. Many professional organizations are now taking the stance that a woman who has had her entire cervix removed does not need to continue to get Pap smears. The purpose of a Pap smear is to screen the cervix for cervical cancer, a risk that will not affect a woman who had had her entire cervix removed. Other women will have a hysterectomy in which the cervix is left intact, and these patients do need to continue getting Pap smears. If even a portion of your cervix is retained after a hysterectomy, as it seems is the case for you, then you need to continue getting Pap smears. You should discuss this issue with the doctor who performed your hysterectomy or with your current doctor so that you can be sure you understand exactly what the procedure involved.
Another aspect to consider — regardless of whether your cervix was removed — is whether you’ve had your ovaries removed. If your ovaries were left intact, then you should continue to receive a manual examination of your ovaries (a pelvic exam). A pelvic exam can help detect ovarian cancer, a major health threat for women, although it’s not a perfect screening test. In many cases, having a hysterectomy doesn’t mean your ovaries are also removed; if this is true for you, you should be sure to get a pelvic exam done regularly, even if your doctor clears you to stop getting Pap smears.
Q4. What can you tell me about life after a hysterectomy? I still have one ovary, so how come I’m still hot all the time? What other changes can I expect now that I’ve had a hysterectomy?
Since you still have one ovary, you are probably making some estrogen and you could be going through menopause. I don’t know your age, but the hot flashes could be related to menopause.
The first thing you should do is find out if you’re menopausal, especially if the hot flashes are disrupting your sleep. Since you’ve had a hysterectomy, you may need an FSH test, which measures the level of follicle-stimulating hormone in your blood, to confirm whether or not you’re in menopause.
If you are in fact in menopause it’s hard to say exactly what you, as an individual, can expect. Menopausal women have a very wide range of experiences — some women sail through menopause and don’t have substantial symptoms that impair their quality of life, while other women have distressing symptoms. Around 70 percent of women in menopause have some hot flashes and night sweats, though only 20 percent of women have symptoms that are moderate to severe, or distressing enough to require hormone therapy. A larger percentage of women who have their ovaries removed have symptoms, due to the rapid decline in estrogen levels. Night sweats can disrupt sleep, and lead to fatigue, loss of concentration, and difficulty with daily activities.
If your symptoms are impairing your quality of life, there are treatment options available. Hormone therapy is the best way to treat these symptoms and its benefits and risks appear well balanced in younger, recently menopausal women who have moderate to severe hot flashes and night sweats. There are also other ways to get relief if you’re not a candidate for hormone therapy, such as the SSRI (selective serotonin reuptake inhibitor) type of antidepressants, an anti-seizure drug gabapentin, black cohosh, soy, and lifestyle changes (such as avoiding caffeine, alcohol, and spicy foods).
Many women also gain weight after menopause, but this isn’t inevitable. To avoid weight gain you should watch your calorie intake, be physically active regularly, and do some strength training and weight-bearing exercises (see above response). There can also be some bone loss after menopause, so this fitness routine may help counter that. Be sure to also get enough calcium (1,200 mg a day) and vitamin D (600 to 800 IU). Finally, a woman’s risk of heart disease and stroke increases after menopause, so in addition to being physically active and following a healthy diet, it’s important to have regular medical exams, and get your blood pressure, cholesterol, and blood sugar checked.
For a more detailed discussion on what to expect, you may find my book Hot Flashes, Hormones & Your Health (McGraw-Hill) to be of interest.
Q5. In 2002 at the age of 41, I had a hysterectomy (ovaries left intact) due to a prolapsed uterus. How does this affect menopause? I feel like I’m having symptoms now, but I’m not positive. When should menopause begin after my type of hysterectomy, and how long should I expect it to last? Thank you for your insight!
The average age of natural menopause is 51, although the range is from 40-60. It is now thought that a hysterectomy causes a woman to go through the menopause transition an average of one to two years earlier than she would otherwise. This might be due to the effects of the surgery on the blood supply to the ovary.
The absence of menstrual periods after a hysterectomy makes it hard to be sure where you are in the menopause transition. But if you are having typical symptoms such as night sweats and hot flashes, you probably are there. An FSH test could confirm this. Even if the results are normal, you could still be in perimenopause, the years of hormonal ups and downs before menopause when a woman’s ovaries stop making estrogen almost completely.
Perimenopause can last up to eight years, and a woman can have symptoms related to menopause for years more. If your symptoms are very bothersome, I suggest you talk to your healthcare provider.
Learn more in the Everyday Health Menopause Center.