What vitamins, supplements, or herbs should I avoid after a total hysterectomy?

Supplements to Avoid After Total Hysterectomy

At 2 days post-hysterectomy, you should continue to avoid all supplements that increase bleeding risk, which should have been stopped 2 weeks before surgery, and you should not restart them until your surgeon confirms adequate wound healing and minimal bleeding risk.

Critical Supplements to Continue Avoiding

Bleeding Risk Supplements (Hold Until Cleared by Surgeon)

The following supplements significantly increase bleeding risk and should remain discontinued until your surgical team confirms it's safe to restart 1:

• Ginkgo - Displaces platelet-activating factor, decreasing coagulation and interacts with warfarin 1
• Ginger - Inhibits thromboxane synthetase with decreased platelet aggregation 1
• Garlic - Has antiplatelet effects and may increase bleeding 1
• Turmeric - Inhibits platelet aggregation via thromboxane metabolism and calcium channel inhibition, also inhibits thrombin and factor Xa 1
• Vitamin E - Has antiplatelet effects related to protein kinase C inhibition, worsened when taken with aspirin 1
• Fish oil/Omega-3 - Exception: Can be continued as they do not increase perioperative bleeding risk according to SPAQI guidelines 2

Additional bleeding-risk supplements to avoid 1:

• Bromelain (from pineapple)
• Dong quai
• Feverfew
• Saw palmetto
• Horse chestnut
• Policosanol
• Danshen
• Devil's claw
• Cat's claw

Blood Pressure and Cardiovascular Effects

• Licorice root - Causes mineralocorticoid effects, hypokalemia, and fluid retention 1
• Yohimbine - Alpha-2 adrenergic blockade associated with both hypotension and hypertension 1
• Horny goat weed - Causes vasodilation through calcium channel blockade 1

Central Nervous System Depression (Interaction with Pain Medications)

Since you're likely taking opioid pain medications post-hysterectomy, avoid supplements that potentiate CNS depression 1:

• Kava - Acts additively with opiates and benzodiazepines causing excessive sedation 1
• Lemon balm - May result in additive CNS depression with sedatives 1

Drug Interaction Concerns

• St. John's wort - Potent inducer of CYP3A4, reduces plasma concentrations of many medications including pain medications 1, 3
• Goldenseal - High potential for drug interactions through CYP3A4 and CYP2D6 systems 1
• Grapefruit extract - Interacts with multiple medications 1

Absolutely Contraindicated

• Kratom - Has opioid-like properties and is explicitly not recommended by SPAQI; FDA warns against use 1
• Marijuana/Cannabis - Inhibits platelet aggregation and has multiple drug interactions 1

Safe Supplements to Continue

The following can be safely continued in the immediate postoperative period 1:

• Melatonin - Safe perioperatively, may reduce anxiety and delirium 1
• German chamomile - Reduces anxiety without CNS interference 1
• Passionflower - Anxiolytic with good safety profile 1
• Lavender - Safe for anxiety without anesthetic potentiation 1
• Valerian - Safe and may protect against cognitive dysfunction 1
• Omega-3/Fish oil - Explicitly safe to continue, may support recovery 2

When to Restart Held Supplements

The general principle is that supplements impairing coagulation should only be restarted once the risk of postoperative bleeding is minimal 1. For hysterectomy, this typically means:

• Wait until vaginal bleeding has stopped or is minimal
• Confirm with your surgeon at your postoperative visit (typically 2-6 weeks post-surgery)
• Consider that vaginal cuff dehiscence risk is highest in the first few weeks, occurring at a rate of 0.39% overall 4

Critical Pitfalls to Avoid

• Do not assume "natural" means safe - Many herbs have potent pharmacological effects that increase surgical complications 1
• Bleeding complications after hysterectomy range from 238-660 mL blood loss, and supplements that impair coagulation worsen this risk 4
• Infectious complications are most common after hysterectomy (9-13%), so avoid supplements that might interact with antibiotics if prescribed 4
• Always disclose supplement use to your surgical team, as lack of standardization in supplements creates unpredictability 3