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Pregnancy After Hysterectomy: Odds, Risks, And Complications

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Hysterectomy is a surgical procedure to remove the womb or uterus for various health reasons. It may also involve removing one or both ovaries, the fallopian tubes, or the cervix based on the medical requirement. Data suggest that more than one-third of women in the US have had a hysterectomy by the age of 60 years (1).

In this MomJunction post, we help you understand why this procedure is done, what it holds, and the chances of becoming pregnant after hysterectomy.

Why Do You Need A Hysterectomy?

Hysterectomy is a medically necessary procedure to treat health problems affecting the female reproductive system. You might need one if you have any of the following conditions:

  • Heavy or unusual bleeding: Fluctuation in hormonal levels, vaginal infections, fibroids, or cancers can cause excessive and prolonged bleeding (2).
  • Uterine fibroids: These non-cancerous tumors report on the uterine wall and may lead to heavy menstrual bleeding and pain (3).
  • Endometriosis: It is a condition wherein the tissue lining the uterus grows outside of the uterus and on other areas such as the ovaries, fallopian tubes, and outer uterine surface. Symptoms can include spotting or bleeding between menstrual periods, digestive problems, and different kinds of severe pain (4).
  • Uterine prolapse: It occurs when the uterus slips down and presses into the vagina. It is likely to happen in women who had prior vaginal births and may also develop due to obesity or aging. It could lead to abnormal vaginal bleeding or discharge and bowel and urinary problems (5).
  • Adenomyosis: It is the thickening of the uterine walls wherein the tissue lining grows into the muscular walls of the uterus. It leads to heavy bleeding and severe pain (6).
  • Cancer of uterus, cervix, ovary, or endometrium: Hysterectomy could be the option if other treatment procedures such as radiation therapy, hormone therapy, and chemotherapy do not work (7).
  • Obstetric hysterectomy. In the case of heavy hemorrhage due to uterus atony or placenta accreta, hysterectomy is the definitive method of controlling postpartum hemorrhage. This procedure saves undoubtedly mother’s life.

Having a hysterectomy will end your ability to get pregnant. If you plan to become pregnant and cannot go for this procedure, you should consult your doctor for alternatives. For some conditions such as endometriosis, uterine prolapse, and fibroids, there may be less invasive options.

Types Of Hysterectomy

You may require a specific type of hysterectomy depending on why you need it, and how well your reproductive system can sustain it (8).

  1. Total hysterectomy: It removes the uterus and cervix and is a commonly preferred option.
  1. Subtotal hysterectomy (also called partial or supracervical): It removes only the upper part of the uterus and leaves the cervix. The ovaries may or may not be removed.
  1. Total hysterectomy with bilateral salpingo-oophorectomy: It removes the uterus, cervix, fallopian tubes, and ovaries.
  1. Radical hysterectomy: It is used to treat cancers. It removes uterus, fallopian tubes, ovaries, the upper part of the vagina, lymph glands, and fatty tissue in the pelvic region.

How Is A Hysterectomy Performed?

A hysterectomy is performed in several ways—through the vagina, abdomen, or by using laparoscopy. The method depends on your health history and the reason for the surgery (9).

1. Vaginal hysterectomy: A small incision is made near the vagina, and the uterus (or other parts) is removed through it. It is preferred in pelvic relaxation. It takes less time and results in faster recovery. Most women are likely to resume their work or activities sooner than if they had abdominal surgery.

2. Abdominal hysterectomy: It is performed through a regular incision in your lower abdomen, similar to C-section incision. The opening gives a clear view of the pelvic organs. It takes a long time to recover and could lead to complications such as bleeding, wound infection, nerve and tissue damage, and blood clots.

3. Laparoscopic hysterectomy: It is performed by making some tiny incisions in your abdomen. A laparoscope is inserted to view the pelvic organs. Both the procedure and recovery take less time.

4. Robot-assisted laparoscopic hysterectomy: In this procedure, the surgeon controls a robotic machine to perform the surgery through a small incision in the lower abdomen.

Risks And Complications Of Hysterectomy

As with any surgery, hysterectomy may also lead to some risks and long-term complications (10).

Some of the possible risks with the procedure could be:

  • Blood clots
  • Bladder or bowel injury
  • Infection
  • Blood loss that may require transfusion
  • Problems while giving anesthesia

Following hysterectomy, you are likely to have some long-term complications too, including:

  • Feelings of diminished or lost femininity
  • A decrease in sex drive (with the removal of both ovaries)
  • Pain during sex (in case of partial vaginal removal)
  • Pelvic weakness
  • Vaginal dryness (due to low estrogen levels upon removal of ovaries)
  • Risk of osteoporosis (when ovaries are removed)

Can You Get Pregnant After Total Hysterectomy?

You can no longer have menstrual periods and cannot become pregnant after a hysterectomy because the womb (or the uterus) where the baby grows is removed. In this procedure, the whole uterus, including the ovaries and fallopian tubes, are removed (9).

Do You Still Ovulate After A Partial Hysterectomy?

A partial hysterectomy that retains the ovaries and fallopian tubes could help you ovulate. You may also get pregnant, but the chances that the embryo could survive are rare as it will not have a uterus to implant itself, and this may increase the risk of ectopic pregnancy (11) and an emerge situation for woman’s life.

Ectopic Pregnancy After Hysterectomy

Ectopic pregnancy, also known as tubal pregnancy, develops when a fertilized egg implants and grows outside the main uterine cavity, especially in the fallopian tubes. Ovulation and fertilization occur, but there is no chance for the embryo to develop further. This situation is rare and may be happen when the hysterectomy is performed in luteal phase of cycle without a measurement of bHCG in the blood before surgery. It is not possible to carry it to term without a uterus to support its growth. Ectopic pregnancy could be life-threatening and is associated with the following symptoms that may help your doctor diagnose the condition.

  • Vaginal bleeding if hysterectomy is partial
  • Hemorrhage in the case of rupture of internal tissues
  • Severe abdominal pain
  • Nausea and vomiting
  • Pain in the rectal region, neck, and shoulder
  • Extreme fatigue and dizziness
  • Shock from the lost blood inside the peritoneal cavity

Your doctor may usually prescribe methotrexate to remove the fetal tissue. If that does not work, it is surgically removed through laparoscopy or open is it is immerge (12).

Is It Possible To Have A Child After Hysterectomy?

There is a way to have a child through surrogacy wherein someone else carries the baby for you. In this option, your eggs could be harvested for fertilization and implanted into a surrogate who can carry the baby.

Another option is to adopt a child if you do not want to consider surrogacy (13).

Frequently Asked Questions

1. Can a uterus grow back after a hysterectomy?

Once the uterus is removed through a hysterectomy, it does not grow back.

2. Where do your eggs go after a hysterectomy?

When the ovaries release eggs, they are likely to float in the pelvic or abdominal cavities where they dissolve and get reabsorbed by the body. It is also possible to harvest them in a lab if you want to consider surrogacy. A fertility specialist can help you in making this decision.

3. Does a hysterectomy shorten your life?

Hysterectomy is likely to enhance the quality of your life as it relieves you from symptoms of serious medical problems. You may enjoy an improved sense of well-being.

Hysterectomy is a major surgery that results in life-changing circumstances. Counseling is necessary before surgery and in follow ups. Patient is necessary to know the cause of hysterotomy and the quality of life after hysterectomy.

While some women are relieved, some may feel a sense of loss and experience depression and grief as they lose fertility. Getting pregnant after hysterectomy—ectopic or abdominal pregnancy—could be fatal too. While a viable pregnancy after a hysterectomy is not possible, surrogacy or adoption may be the possible alternatives. It is also a good idea to see your doctor and get routine health check-ups for your well-being.

References:

1. Margaret A. Olsen, et al.; Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy; Washington University School of Medicine Digital Commons@Becker (2009).
2. Heavy periods; NHS
3. Uterine fibroids; Office on Women’s Health
4. Endometriosis; Office on Women’s Health
5. Uterine prolapse; U.S. Department of Health and Human Services National Institutes of Health
6. Adenomyosis; U.S. Department of Health and Human Services National Institutes of Health
7. Uterine Cancer; U.S. Department of Health and Human Services National Institutes of Health
8. Hysterectomy; New York State – Department of Health
9. Hysterectomy; American College of Obstetricians and Gynecologists
10. Complications – Hysterectomy; NHS
11. Fylstra DL; Ectopic pregnancy after hysterectomy: a review and insight into etiology and prevention; Fertil Steril (2010).
12. Ectopic Pregnancy; University of Rochester Medical Center
13. Preserving Fertility in Women With Cancer; American Cancer Society

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