So you’ve had a hysterectomy, now what?

Many women think that they are done with pelvic exams and women’s health doctors once they have had a hysterectomy, especially a complete hysterectomy with removal of the ovaries as well as the uterus and cervix. Well.. not so.  There are many other variables to take into consideration, though your visits may not be as frequent as they once were.

Remember, you still need to have annual check-ups for your health. You should have a general physical every year which would include monitoring your blood pressure and possibly lab work.

Breast Exams: You should have a clinical breast exam at least once a year, depending on your personal and family history.  You should also be doing self-breast exams on a monthly basis. Ask your primary care or women’s health provider if you need clarification on this. Up to 40% of breast cancers are found on self-exam, so it is important you know how to do these quick exams at home, and what to look for.

If you are over 40, you should have a mammogram scheduled every one to two years.

Pelvic Exams: If you still have your ovaries, you need a pelvic check every year.

You definitely need to be seen by your primary care or women’s health provider if you are having any problems with bleeding after hysterectomy.  This is abnormal.

If you had abnormal paps or a positive HPV test in the past, you may continue to have Pap testing but that will be determined by your women’s health specialist given your unique medical history.  The HPV virus can cause changes that lead to cancer.  If you had HPV on your cervix before you had your hysterectomy, there is the potential to have changes in your vaginal tissue. This is not common but does happen.

Hormone Therapy: If you are on hormones you will need to check in with your doctor at least once a year as studies and recommendations may change, and it is important to discuss with your doctor whether or not you should continue taking your hormones.  Stopping hormones completely can cause vaginal dryness, hot flashes, low libido, anxiety, insomnia and many other problems.   Providers who specialize in women’s health are used to discussing these problems and treating them.  It is tricky to restart a woman on hormones after she has been off of them for a few years.  It is often best to stay on them at a reduced dose unless you wish to completely discontinue taking them.  So, before you stop your hormones consult first with the doctor who put you on them.

Urinary and bladder infections are not uncommon after menopause. Often applying estrogen to the tissue will help prevent recurring UTI’s and keep the tissue healthy.  I see a number of women post hysterectomy for vaginal infections or painful intercourse due to vaginal atrophy.  Also, vaginal infections after menopause may not cause the same discharge that you had in your premenopausal years. So any discomfort or irritation needs to be checked out.

If you develop a “lump or bump” or a discoloration in your genital area, you should come to see your provider. Often these are benign but occasionally biopsy is warranted.

STI screenings: Don’t forget that sexually transmitted infections can happen to women of all ages. Many women feel embarrassed to ask for STI screening, please don’t.  It is important for your health and the health of your partner/s.  I admire patient’s being proactive and responsible.

As a primary care provider, I also provide general health counseling about preventive health measures in relation to chronic conditions such as cardiovascular disease, blood sugar abnormalities, osteoporosis and more.