Article: Surgical Menopause and Hysterectomy Recovery

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Article: Surgical Menopause and Hysterectomy Recovery
I am scheduled for a TAH/BSO and I'm wondering how hard my recovery will be compared to having a vaginal hysterectomy. Also, will I need to take HRT afterwards? If so, what kind should I take?

There is a difference in a vaginal versus abdominal hysterectomy in that the healing period is typically more extensive and intense for a woman whose abdomen has been cut open. However, the post-op restrictions including lifting limits, as well as fatigue issues and general healing time for the two types of surgeries are about the same.

The TAH patient will have to deal with greater muscle fatigue after surgery because her abdominal muscles have been cut and spread apart, but the threat of infection for both surgeries is essentially equal. The abdominal cut makes the patient more likely to get a pot belly effect after surgery, while the woman who has a vaginal surgery which includes the excision of endometriosis may have residual problems with endometriosis which was left behind due to inadequate visuals from a vaginal entrance.

It seems that, the longer the actual healing time from surgery, the more in menopausal "limbo" a woman may find herself.

During the early recovery period, it is often difficult to tell if you're feeling bad because of lack of hormones, or because of typical post-op recovery issues. The longer the surgery takes in hours, the longer it usually takes to recover, and residual surgical depression is more likely to occur -- probably due to prolonged exposure to the anesthesia. Also, the more that surgeons had to lift, separate, trim and snip inside, the longer it takes to completely heal. Irritable bowels and bladders which have been bruised can be traumatized quite a bit. And that's true regardless of whether the surgery was vaginal or abdominal.

Obviously, women who require transfusions during surgery are going to take longer to recover as well. Loss of blood during surgery effects post-surgical energy, depression, and immunity. Also, the sicker the patient is prior to surgery the more likely she is to experience a slower recovery due to depleted immune system responses, excessive fatigue prior to surgery, and perhaps anemia due to excessive menstrual blood loss.

The first six months post-op is a surgical healing time. And for someone who was very ill prior to surgery, it may be a year before they feel totally revived physically and comfortable with their post-surgical selves.

Patients who have their ovaries removed will, at some point, experience surgical menopause. Most women have a store of estrone (one of the three types of estrogens which the body produces) in their fat tissues, and it can take 6-12 weeks for this estrogenic layer of fat to completely deplete itself. Therefore, immediately after having an oophorectomy, many women may not feel menopausal for up to four months. Other women with a smaller supply of estrone may have their first hot flash in the recovery room! It all depends on the individual woman.

The first real symptoms of menopause often go undiagnosed after a hysterectomy with oophorectomy because the surgery can be so traumatic and healing time so extended that the woman doesn't know which symptoms are due to post-surgical stress versus lack of hormones.

Her healing body feels so different that trying to figure out what the new “her” feels like can be very difficult. She may say, "Well, in a few more weeks I'll be better able to tell." This is especially true for the woman who does not receive Hormone Replacement Therapy right after surgery. (For example, women who have had endometriosis removed and have to stay off hormones to make sure it doesn't grow back.. This could involve a 6-month waiting time without HRT.)

For most women, healing from a hysterectomy/BSO (uterus and tubes and ovaries all removed) takes about nine months, and at that point she can really begin working on the hormone restoration phase which may take another year to figure out as she tries new combinations of HRT and/or a variety of delivery methods..

Many women find that during the first year or two post-hysterectomy they bounce from one HRT regimen to another in their quest for hormonal balance. They may try one form and dosage of estrogen and will feel fine for a couple of months and then menopause symptoms will begin to reappear. At that point they return to their doctor and try a different medication, often repeating this scenario a number of times.

It's during this phase that the woman gets herself a few books on menopause (which she finally accepts that she now has!) and starts educating herself on hormone replacement. But then she might start feeling left out because many books on HRT deal with natural menopause that gradually takes over a woman's body, rather than the abrupt surgical menopause that she experienced.

Usually, the younger the woman, the more pronounced the surgical menopause. Also, the more sexually-focused she is, the more drastically she may feel the loss of her uterus and hormones in contrast to her formerly full and satisfying sex life.

In order of symptoms, the loss of hormones due to the removal of ovaries often transpires as follows:

Hot flashes, varying in quantity and intensity, sometimes accompanied by sweating. Some women get warm, while others get soaking wet and have to change clothes!
Loss of sleep....she either can’t fall asleep, or she wakes up in the middle of the night and can't go back to sleep. This continual insomnia leaves her brain fuddled, makes her jumpy and irritable, and often leads to mild depression that worsens if not corrected.

Around this time "menofog" may set in, too. That includes short term memory problems, forgetting people's names, difficulty expressing oneself verbally, stammering, etc. Lack of estrogen starves the verbal processors in the brain so consequently, messed-up speech and addled thought processes often indicate hormonal deprivation.
Reduced libido. This might be a very distinct loss for a highly-sexual woman, and less so for the woman who didn't have much libido to begin with. This often manifests itself initially as an incomplete orgasmic experience. It may also involve a weak orgasmic response, or the inability to achieve orgasm at all despite she and her partner working at it.
Vaginal dryness and irritation during intercourse.
Urinary tract infection symptoms -- experiencing a sensation of fullness in the bladder like she ought to urinate but cannot. This is a direct link between the estrogen and her pelvic area. With proper estrogen replacement, this feeling will go away.
Lack of affect. Translated, this means lack of mood; dullness; apathy; mild emotional response to anger, joy, etc. This is often the beginning stage of estrogen-depletion related depression. Once the estrogen is restored, the cloud lifts. Lack of affect can also be a result of the trauma some women experience under anesthesia and narcotic pain medication. Is it lack of hormones or is the body still processing the anesthesia drugs? The farther you get from surgery the easier it is to figure this one out!
Rapid/irregular heartbeat, panic attacks (shortness of breath, sudden irrational feeling of fear, especially when lying down). Many women experience their first panic attack at about ten weeks post-op. The cause may be a severe drop in progesterone.
Fatigue. No energy to get up and do anything when they had been energetic before....is it menopause, or is it still an effect of the surgery itself? A year after their oophorectomy, many women begin to figure out that it's hormone related.
Hair and skin changes. Hair starts thinning, or changing color. Skin becomes dry, and sores and cuts don't heal as fast for some reason. Sunburns happen quickly when she didn't used to be sun-sensitive.

Once your surgical healing time is over and your surgeon releases you to resume activities, it's time to find a doctor to help you with hormone replacement.

Most surgeons are not hormone specialists. A surgically menopausal woman should seek a doctor who is willing to spend time with her exploring the various HRT products available in order to determine what is best for her to use. For most women, this medical provider is a family physician or internist. Doctors in these specialties are accustomed to having their patients “try on” medicines to see how they fit, and they are more likely to view the patient as a partner in her health care, rather than as a surgical patient who just refuses to feel better.

You can also locate a gynecologist who specializes in menopause, but it's usually best in the long run to avoid utilizing the services of an OB/GYN whose primary practice is delivering babies, or a reproductive endocrinologist whose primary practice is fertility issues. Do yourself a favor and find a doctor who will walk with you into menopause, and beyond, as a partner.

There is no single HRT product that has been proven to be the "best" for all patients. It would be easier if HRT were "one size fits all" but that, unfortunately, is not the case. Many options are available, however, and new products are continually being developed, tested, and approved for use. Smart women will make it a point to keep abreast of news and developments about HRT. Staying aware and informed on this topic can serve to benefit your health now and in the future.

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.