From the Research
Gynecological complications in hypermobile Ehlers-Danlos Syndrome (hEDS) patients require special surgical considerations during hysterectomy, and the most recent evidence suggests that prophylactic tranexamic acid can reduce bleeding complications in benign hysterectomy 1. Common gynecological issues in hEDS include pelvic organ prolapse, dysmenorrhea, menorrhagia, and dyspareunia due to connective tissue laxity. For a 39-year-old hEDS patient undergoing hysterectomy, several key considerations are essential:
- Surgical planning should include extended recovery time, as hEDS patients heal more slowly and have increased bleeding risk.
- The anesthesiologist should be informed about potential autonomic dysfunction and medication sensitivities.
- Tissue fragility necessitates gentle handling techniques and potentially additional sutures.
- Prophylactic antibiotics should be administered to prevent infection in this high-risk population.
- Postoperatively, pain management may require multimodal approaches including NSAIDs, acetaminophen, and carefully titrated opioids, with awareness that hEDS patients may metabolize medications differently.
- Physical therapy should begin early but progress gradually to prevent complications.
- Hormone replacement therapy should be considered to prevent early menopause symptoms, using estradiol 1-2mg daily with cyclic or continuous progesterone if the uterus is retained.
- Long-term follow-up should monitor for prolapse of other pelvic organs and address potential psychological impacts. These precautions address the specific challenges of connective tissue disorders, where standard surgical approaches may need modification due to tissue fragility, delayed healing, and autonomic dysfunction common in hEDS patients. Additionally, the use of tranexamic acid has been shown to reduce bleeding complications in benign hysterectomy, which is relevant for hEDS patients who are at increased risk of bleeding due to their condition 1. It is also important to consider the patient's individual needs and preferences when making decisions about hysterectomy, as well as the potential risks and benefits of the procedure, as outlined in the SOGC clinical guidelines 2. Overall, a comprehensive approach to care is necessary to ensure the best possible outcomes for hEDS patients undergoing hysterectomy.