Post-Hysterectomy Symptoms: Menstrual Changes and Pain

Hysterectomy

Hello Dr.
Chen: I have been suffering from anemia and menstrual pain for several years.
It has been confirmed that I have adenomyosis and a 3 cm uterine fibroid (causing continuous bleeding), as well as a chocolate cyst on one ovary.
I decided to undergo a hysterectomy in early October 2022, where only the uterus was removed.
My menstrual flow has significantly decreased, but I still have periods.
Is this reduction in menstruation normal, or should I not be having any periods at all? This is my first question.

I have been having regular periods each month, but there are always small blood clots.
Starting from July 2023, I have experienced severe anal pain three days before my period, which I had not experienced before.
I took painkillers, which helped alleviate the pain.
Then, the day before my period in August 2023, I started having headaches and anal spasms.
I took another painkiller, which provided some relief.
This is my second question.

After the hysterectomy, why am I still experiencing anal spasms? Is this a complication from the surgery or could it be due to other reasons? I am a bit worried.
Thank you, doctor!

makiwo01, 40~49 year old female. Ask Date: 2023/08/25

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Indications and advantages/disadvantages of subtotal hysterectomy should be discussed prior to the procedure to allow for proper evaluation.
This includes information about potential postoperative outcomes such as the continuation of menstruation and a reduction in menstrual flow.
It is essential to follow up according to medical advice after the surgery, and if any other discomfort arises, please return for a consultation promptly.
Thank you.

Reply Date: 2023/08/25

More Info

After a hysterectomy, it is common for patients to experience a variety of symptoms, including changes in menstrual patterns and pain. In your case, it seems that you have undergone a hysterectomy due to conditions such as adenomyosis, uterine fibroids, and an endometrioma (chocolate cyst) on one ovary. Let’s address your concerns regarding menstrual changes and the pain you are experiencing.

Menstrual Changes Post-Hysterectomy
1. Menstrual Flow: You mentioned that you are still experiencing menstrual bleeding, albeit reduced, after your hysterectomy. This can be surprising, as many patients expect their periods to cease entirely after the removal of the uterus. However, if the ovaries are still intact, they continue to produce hormones, which can lead to ongoing menstrual-like symptoms. It is possible to have some bleeding due to hormonal fluctuations or residual endometrial tissue if any was left behind during the surgery.
2. Blood Clots: The presence of small blood clots during your menstrual cycle can also be attributed to hormonal changes or the body’s adjustment post-surgery. If the bleeding is light and manageable, it may not be a cause for concern. However, if you notice an increase in the volume of bleeding or the size of the clots, it is advisable to consult your healthcare provider.

Pain Symptoms Post-Hysterectomy
1. Rectal Pain: The new onset of rectal pain before your menstrual cycle could be related to several factors. It may be due to changes in pelvic anatomy after the removal of the uterus, which can affect surrounding structures, including the rectum. Additionally, if there was any manipulation or trauma to the surrounding tissues during surgery, it could lead to pain in that area.

2. Headaches and Pain Relief: The headaches you experience before your menstrual cycle could be related to hormonal changes as well. Many women experience migraines or tension headaches that correlate with their menstrual cycle due to fluctuations in estrogen and progesterone levels. The use of pain relief medications, such as NSAIDs, can help alleviate these symptoms, but it’s essential to use them as directed and consult your doctor if you find yourself needing them frequently.

Potential Complications
While some pain and changes in menstrual patterns can be expected after a hysterectomy, it is crucial to monitor your symptoms closely. If the rectal pain persists or worsens, or if you experience any other concerning symptoms such as fever, significant changes in bowel habits, or severe abdominal pain, it is important to seek medical attention. These could indicate complications such as infection, adhesions, or other issues that may require further evaluation.

Conclusion
In summary, experiencing reduced menstrual bleeding and new pain symptoms after a hysterectomy can be normal, especially if the ovaries remain intact. However, it is essential to keep an open line of communication with your healthcare provider to ensure that any concerning symptoms are addressed promptly. Regular follow-ups can help manage your symptoms effectively and provide reassurance as your body adjusts to the changes following surgery. If you have further questions or if your symptoms change, do not hesitate to reach out to your doctor for personalized advice and treatment options.

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