What symptoms can a postmenopausal woman expect after a total hysterectomy and bilateral oophorectomy (surgical removal of ovaries)?

Expected Symptoms After Total Hysterectomy and Bilateral Oophorectomy in a Postmenopausal Woman

A postmenopausal 61-year-old woman who undergoes a total hysterectomy with bilateral oophorectomy will likely experience minimal additional hormonal symptoms beyond what she may already experience, but may develop significant sexual dysfunction, anatomical changes, and potential pelvic pain.

Hormonal Impact

• Since the woman is already postmenopausal (7+ years past menopause), she will experience minimal additional hormonal symptoms as her ovaries have already significantly decreased hormone production 1
• No new hot flashes or night sweats would be expected beyond what she may already experience, as these symptoms primarily relate to the initial drop in estrogen that occurred years ago 1
• However, even postmenopausal ovaries continue to produce small amounts of hormones, particularly androgens (testosterone), which when removed can affect sexual function and sense of well-being 2

Sexual Function Changes

• Sexual dysfunction affects at least 50% of women after hysterectomy with bilateral oophorectomy, which may be particularly pronounced in this scenario 3, 1
• Specific sexual issues may include:
  • Decreased vaginal lubrication and expansion on stimulation 1
  • Dyspareunia (painful intercourse) 3
  • Reduced genital sensation 1
  • Difficulty with orgasm 3
  • Decreased libido, which can be more pronounced following surgical removal of the ovaries compared to natural menopause 4

Vaginal and Urogenital Symptoms

• Atrophic vaginitis symptoms may worsen after bilateral oophorectomy, including:
  • Vaginal dryness, discomfort, and pruritis 3
  • Dyspareunia 3
  • Urinary tract infections and urinary urgency 3
• Unlike vasomotor symptoms that tend to resolve over time, vaginal atrophy symptoms may persist indefinitely and even increase over time 3
• Removal of the ovaries eliminates the small amount of estrogen still being produced, which can exacerbate existing vaginal atrophy 3, 1

Anatomical and Structural Changes

• Vaginal scarring may develop, potentially causing shortening of the vagina 1
• Blood flow to the vagina and vulva may be impaired after pelvic surgery 1
• Vestibular glands may be affected, contributing to vaginal dryness 1
• Removal of parts of the vulva and vagina during radical hysterectomy may reduce sensation 1

Pelvic Pain

• Subacute or chronic pelvic pain may occur related to:
  • Intraperitoneal adhesions 1
  • Pelvic floor dysfunction 1
  • Vaginal cuff complications 1
  • Myofascial pain 1

Long-Term Health Considerations

• Bilateral oophorectomy in postmenopausal women has been associated with increased risks of:
  • Cardiovascular disease 1, 5
  • Osteoporosis and bone fractures 1, 5
  • Cognitive impairment 5
  • Depression and anxiety 5

Management Approaches

• For sexual dysfunction:
  • Lubricants and vaginal moisturizers should be first-line treatments for vaginal dryness 3
  • For persistent symptoms, low-dose vaginal estrogen can be considered if not contraindicated 3
  • Lidocaine can be offered for persistent introital pain and dyspareunia 3
• For pelvic pain:
  • Pelvic floor physical therapy may help address pelvic pain and urinary symptoms 1
• For overall well-being:
  • Annual assessment of symptoms is recommended to address ongoing issues 1
  • Sexual counseling may be beneficial as sexual function and satisfaction are important aspects of quality of life 1

Common Pitfalls to Avoid

• Assuming all symptoms are solely due to the hysterectomy when they may be related to pre-existing menopausal changes 1
• Overlooking the psychological impact of surgery on body image and sexual function 1
• Failing to assess all domains of sexual functioning including desire, arousal, lubrication, orgasm, satisfaction, and pain 1
• Neglecting to consider that even postmenopausal ovaries produce small amounts of hormones that affect quality of life 2, 6