What Causes Pelvic Pain And Cramps Years After Hysterectomy?

The reproductive system of a human female is a complex and intricate structure where each element plays an important part in making sure everything functions the way it is supposed to. Historically, it was believed that the only purpose of the uterus was to provide a place to nurture and facilitate the growth of a baby. This led to the incorrect assumption that once the woman no longer wished to have children, she no longer needed her uterus.

In the U.S., over 600,000 hysterectomies are performed every year as a treatment for benign uterine conditions such as fibroids, cysts, and adenomyosis. Through the years, medical research has uncovered numerous women’s health issues that are tied to the uterus.

Hysterectomy surgery and the removal of the uterus can have life-long consequences that are rarely fully disclosed when the surgery is discussed as a treatment option. The removal of the uterus can pose risks of heart disease, memory issues, personality changes, incontinence, and sexual dysfunction, just to name a few.

Today we are going to talk about another long-term, chronic consequence of the surgery that many women are not aware of. It can cause pelvic pain years after a hysterectomy, menstrual-like cramps, and other serious life-altering issues.

How Common Is Pelvic Pain After A Hysterectomy?

Women who undergo a hysterectomy to relieve unpleasant symptoms are often just trading some painful symptoms for others once their uterus has been removed. Among patients who took part in a survey conducted nationwide about pain after hysterectomy, almost 12% were experiencing pelvic pain that persisted even after six months, and that number rose to over 32% after a year.

What Causes Pelvic Pain Years After A Hysterectomy?

There can be a few causes of pelvic pain years after a hysterectomy, and some of the ones identified include:

ROS, or Residual Ovarian Syndrome
This can occur if one or both ovaries are left in place during the hysterectomy. ROS causes symptoms of chronic pelvic pain and the formation of a mass, and it can also cause pain during sexual intercourse. As many as 50% of patients who experience ROS end up having additional surgery within five years to alleviate their symptoms, and around 75% experience pelvic pain 10 years after a hysterectomy and require surgery. About 77% of patients with ROS have ongoing abdominal pain, with almost 70% experiencing dyspareunia (pain during intercourse).

A typical case of ROS was reported after a 35-year-old woman had a vaginal hysterectomy to ease heavy bleeding and other symptoms due to adenomyosis, but her normal, healthy-looking ovaries were left in place. Within two years, she began experiencing persistent pain in the lower left portion of her abdomen and sought additional treatment. Imaging scans revealed a cyst-like mass that was about 4 cm in diameter, and she was diagnosed with ROS with treatment consisting of painkillers and observation. After three months and chronic pain, surgery was performed to remove both the cyst and the left ovary and fallopian tube.

Ovarian Remnant Syndrome
Another less common cause of pelvic pain and cramps years after a hysterectomy is a condition called ovarian remnant syndrome. This can occur after the removal of both ovaries, where a small amount of tissue from the ovary remains behind and remains somewhat functional. This can result in the formation of cysts and ongoing pain in the abdominal or pelvic area.
Scar Tissue
The development of scar tissue can also be the underlying cause of ongoing menstrual-like cramps years after a hysterectomy or frequent pelvic pain. Some women have reported that the pain they experience after their surgery is worse than what they had dealt with beforehand.
Hormone Fluctuations
Abdominal cramps years after hysterectomy that feel like PMS are prompted by a fluctuation in hormones. If the ovaries are left intact, they can still produce and release these hormones and cause cramping, bloating, and other PMS symptoms even though the uterus has been removed.

Some women who feel menstrual-like cramps years after total hysterectomy are confused because they no longer have ovaries. Although the ovaries are the main hormone-producing source that drives PMS-type side effects such as cramping, other organs, such as the thyroid, produce hormones that may also prompt symptoms like depression, bloating, and irritability.

Pre Existing Conditions
Pelvic inflammatory disease (PID) or endometriosis that existed before the surgical removal of the uterus may continue to cause discomfort and chronic pain in the lower abdominal or pelvic region. Additionally, the pain caused by these conditions can be exacerbated by the formation of scar tissue resulting from the surgery.

What Other Conditions Can Occur Besides Chronic Pelvic Pain After A Hysterectomy?

Pelvic Floor Dysfunction
This can cause long-running pain in the pelvic region as well as urinary incontinence and can also create pain or difficulty during sexual intercourse.
Prolapse
Pelvic organs can drop down, becoming displaced from their intended location after the removal of the uterus. It can cause vaginal tissue to protrude outside of the vagina or affect the bladder or bowels.
Increased Risk Factor For Many Serious Conditions
While removing the ovaries can reduce the risk of ovarian cancer by almost 90% and a hysterectomy can relieve some debilitating symptoms, there are also many potential negative long-term side effects.

Hysterectomy Risk For Future Complications (With Removal of Ovaries Before 50 Years of Age)

Condition Percentage of elevated risk
Lung Cancer 45%
Heart Disease 33%
Memory Issues 60%
Stroke 62%
Parkinson’s 80%
Osteoporosis 50%
Sexual Dysfunction Over 40%

Why You Should Consider UAE Instead of Hysterectomy

Years of research have shown that the uterus plays a bigger role in a woman’s total picture of health than once believed. It also became common practice to retain the ovaries when the uterus was removed to prolong the onset of menopause and hormone issues. What has been discovered is that when the uterus is removed and the ovaries retained, a host of other issues can occur.

A study was conducted in over 4,000 women that determined that the risks for high blood pressure, irregular heart rate, and higher cholesterol levels were significantly greater, and women who no longer had these reproductive organs were also more likely to experience heart disease or become obese. The risks were substantially greater for women who had their uterus removed before the age of 35.

If uterine fibroids or adenomyosis are the underlying cause of heavy bleeding and other painful symptoms, uterine artery embolization (UAE) is a safe and effective treatment. This non-surgical procedure can eliminate the side effects of these conditions without removing the uterus or causing serious, long-lasting health issues.

The UAE procedure should be done by a specially trained interventional radiologist like Dr. John Lipman or Dr. Mitchell Ermentrout at the Atlanta Fibroid Center and is done as an outpatient procedure. The procedure itself usually takes less than an hour and does not require a stay in the hospital. UAE is 80% effective in eliminating symptoms related to adenomyosis and 90% effective in getting rid of fibroid-related symptoms.

Atlanta Fibroid Center Can Help

If you have been diagnosed with either of these chronic health conditions, please reach out to the Atlanta Fibroid Center to learn more about how UAE can eliminate your pain and symptoms without creating more issues through the surgical removal of the uterus. Call us today to set up your appointment.

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