Removal of the uterus during the menopause

Many women hope to avoid menopause by having their uterus removed. However, this is not the case. On the contrary, removal of the uterus can lead to premature menopause, especially if the ovaries are also removed during the procedure.

This is also known as surgical postmenopause, as in this case the onset of menopause is triggered by the surgical removal of the ovaries. The ovaries are largely responsible for the production of sex hormones and thus control the female menstrual cycle. When hormone production ceases, the typical menopausal symptoms such as hot flushes, mood swings and sleeping problems set in.

Even if the ovaries are left in the body during hysterectomy, there is often a premature loss of their function, so that women enter the menopause earlier in this case as well (on average four years earlier than women without hysterectomy). The resulting menopausal symptoms can be treated with hormone therapy, for example. This involves replacing the body’s own female sex hormones (estrogens).

However, postmenopausal hormone therapy is not risk-free. In addition to the positive influence on menopausal symptoms and the protective effect against osteoporosis, the risk of developing malignant diseases (especially breast cancer) is also greatly increased. The occurrence of leg vein thrombosis and pulmonary embolism is also significantly increased.

The decision to undergo hormonal therapy should therefore only be made after careful consideration and detailed consultation with a doctor. Nowadays, removal of the uterus is a frequently performed procedure with which most gynaecological surgeons are well acquainted. Nevertheless, complications can occur during the operation.

The removal of the uterus, like any other operation, involves general surgical risks. These include bleeding during and after the operation, wound healing disorders, infections of the surgical wound, and injury to neighboring organs, nerves and blood vessels. Moderate bleeding for a few days after the operation is normal.

However, if there is a heavy bleeding or if there are other symptoms such as fever, an infection must be assumed. In addition, a blood clot may form after the operation (thrombosis), which can come loose and shoot into the lung (pulmonary embolism). This is a potentially life-threatening condition.

To prevent this, however, every patient admitted to hospital receives thrombosis prophylaxis in the form of heparin injections and thrombosis stockings. In general, the risks of hysterectomy also depend on the type of hysterectomy. If the uterus is removed through the vagina, possible risks are postoperative narrowing of the vagina and/or ureter, the development of postoperative bleeding or bruising (haematomas), and pain during sexual intercourse.

On the other hand, if the uterus is removed through the abdominal wall, the risks are more likely to include injury to the bladder or intestine, infection of the surgical wound and adhesions. Scar fractures are also described. In both procedures, the blindly closed vaginal stump can descend over time, so that sexual intercourse can be painful.

Sexual desire and sexual excitability may also decrease with the removal of the uterus, but opposite cases have also been described. Overall, complications occur more frequently with removal of the uterus through the abdominal wall than with vaginal hysterectomy. After the hysterectomy, women often feel pain for several weeks, which can be managed with adequate pain medication.

Some women also report prolonged inactivity, fatigue and weakness. However, this is controversial, as many women are more likely to experience a positive effect on their general condition following uterus removal. Removal of the uterus increases the risk of urinary incontinence (bladder weakness with inability to hold urine).

This is manifested by spontaneous urine leakage when laughing, coughing or lifting heavy objects.In women whose uterus is removed before menopause, the ovaries are usually left in the body. However, there is evidence that the removal of the uterus causes the ovaries to cease functioning earlier, so that an early onset of the menopause (up to 4 years earlier) is possible. Of course, these women no longer have menstrual periods after the operation and cannot become pregnant.

Uterus – uterus
Cervix – Fundus uteri
Endometrium – tunica mucosa
Uterine cavity – Cavitas uteri
Peritoneal cover – Tunica serosa
Cervix – Ostium uteri
Uterine body – Corpus uteri
Uterine constriction – Isthmus uteri
Vagina – Vagina
Pubic symphysis pubica
Urinary bladder – Vesica urinaria
Rectum – rectum