Long-term Effects of Hysterectomy

A Focus on the Aging Patient

Catharina Forsgren; Daniel Altman

Disclosures

Aging Health. 2013;9(2):179-187. 

In This Article

Abstract and Introduction

Abstract

Hysterectomy is the second most common major surgical procedure performed in women worldwide and almost one in three women in the USA have undergone a hysterectomy by the age of 60 years. The vast majority of hysterectomies are performed on benign indications to improve quality of life, and the surgical procedure is generally associated with few complications. In recent years, an increasing number of studies have shown long-term adverse effects of hysterectomy on the pelvic floor and some studies have demonstrated unwanted effects on other health aspects. Long-term effects of hysterectomy on the pelvic floor that should be considered in surgical decision-making are: pelvic organ prolapse, urinary incontinence, bowel dysfunction, sexual function and pelvic organ fistula formation. These outcomes are particularly relevant as life expectancy has increased and sequela may occur a long time after the surgical procedure and severely impair quality of life.

Introduction

For many women, deciding on having their uterus removed is an important and emotionally difficult decision. Nevertheless, hysterectomy is the second most common major surgical procedure in women worldwide and almost one in three women in the USA have undergone a hysterectomy by the age of 60 years.[1] The vast majority of hysterectomies are performed on benign indications to improve quality of life,[2] and the surgical procedure is generally associated with few complications.[3] In recent years, an increasing number of studies have shown adverse effects of hysterectomy on the pelvic floor and some studies describe unwanted effects also with regard to other health aspects. These long-term effects are particularly relevant as they may occur a long time after the surgical procedure and may severely impair quality of life; for example, there is a persistent risk of stress urinary incontinence surgery 10 years after hysterectomy.[4] As life expectancy augments, more women will live more of their lives after the menopause. Pelvic floor dysfunction can be related to age and postmenopausal degenerative changes of pelvic floor supportive tissues.

Consequently, an increased number of women will present with pelvic floor dysfunction, such as urinary incontinence and pelvic organ prolapse, and women with previous hysterectomy seem to be at particular risk.

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