Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, characterized by hormonal imbalances, irregular periods, and ovarian cysts. Many women with PCOS struggle with weight management, leading them to explore various treatment options. A hysterectomy, the surgical removal of the uterus, is sometimes considered, but its role in managing PCOS, particularly in relation to weight loss, requires careful consideration. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy.
Understanding Hysterectomy
A hysterectomy involves removing the uterus and may include the removal of the ovaries and fallopian tubes. It is a relatively common procedure, especially for women between 40 and 50 years old, and can be the best treatment for chronic pain or disease.
Reasons for Hysterectomy
Several conditions may necessitate a hysterectomy:
- Uterine fibroids: Noncancerous growths in the uterus can cause heavy periods, prolonged bleeding, and pelvic pain.
- Endometriosis: Uterine tissue grows outside the uterus, causing pain and menstrual irregularities.
- Uterine prolapse: The uterus slips down into or protrudes out of the vagina.
- Cancer: Hysterectomy is a common treatment for cancers of the uterus, cervix, ovaries, or fallopian tubes.
Hysterectomy and Weight Changes
While some women may experience weight loss after a hysterectomy, it is not a direct result of the operation itself. Removing the uterus and alleviating pain may lead to a decrease in appetite, resulting in weight loss. Nausea after a hysterectomy is also sometimes a side effect, and many women have a hard time keeping food down in the days following the procedure. You may also experience a loss of appetite during the healing process. If you aren’t able to eat or are constantly vomiting, however, you should consult with your doctor. The process of throwing up may cause more pain and affect the healing of your hysterectomy. If you aren't able to eat, you may not be getting the nutrients your body needs to heal.
Conversely, some women may gain weight after a hysterectomy. For women who had a loss of appetite and nausea before their hysterectomy as a side effect of their medical condition, removing the uterus may alleviate nausea and increase their appetite. These women may be able to eat more or may find eating more pleasurable now that they aren’t experiencing chronic pain or discomfort. Women who were used to an active lifestyle may gain weight after a hysterectomy, especially if the procedure was performed as an abdominal surgery rather than a vaginal hysterectomy. Regardless of the circumstances, if your activity level has decreased, but you’re eating the same number of calories, you will likely gain weight. If you notice you’re gaining weight, keep a close eye on the calories you consume, focusing on whole, healthy foods, especially lean meats and colorful fruits and vegetables. These foods also have plenty of nutrients to help your body heal.
Read also: Guide to PCOS Exercise
The Link Between PCOS and Weight
PCOS is often associated with insulin resistance, a condition where the body does not effectively use insulin. This can lead to increased blood sugar levels and weight gain. More than 50% of females with this syndrome are obese. Obesity in women of childbearing age is associated with anovulation, infertility, pregnancy loss, pregnancy-associated complications such as preeclampsia and gestational diabetes, and postpartum complications including hemorrhage as well as higher rates of infant mortality and congenital defects. Obesity in patients with PCOS is also associated with delayed or failed response to fertility treatments including clomiphene citrate, gonadotropins, and assisted insemination.
Weight management is a common concern for women with PCOS, and losing even a little weight has been shown to improve PCOS symptoms.
Hysterectomy: Not a Cure for PCOS
It is a large myth that a hysterectomy is a cure for the millions of women suffering from polycystic ovary syndrome (PCOS). As the name implies, PCOS does involve the ovaries, a source of excess androgens and the frustrating and unwanted symptoms that go with it.It would then seem likely that removal of the ovaries would cure PCOS. However so much more is known about PCOS beyond the ovaries and how it changes with age.
Having a hysterectomy results in what’s called surgical menopause. Your periods stop immediately. Hormone levels drop quickly as compared with the natural and gradual decline seen in menopause. Women who have had a hysterectomy but still have their ovaries, will see a decline in hormone levels and reach menopause earlier. Women who have their ovaries also removed during a hysterectomy will experience greater losses in estrogen and progesterone, which are hormones produced by the ovaries.
Androgens are still being produced. For women with PCOS who have had a hysterectomy and her ovaries removed, she will still experience the long-term effects of having elevated androgens (male sex hormones like testosterone). The adrenal glands also produce testosterone and may be stressed to produce more to keep up with the loss of ovarian production. This means a woman may still suffer from excess hair growth, hair loss or balding, or even acne.
Read also: PCOS Diet Recipe Guide
Metabolic problems persist. While PCOS is a reproductive disorder, it’s also an endocrine disorder. Most women with PCOS have higher levels of insulin and inflammation than women without PCOS. If not well managed, excessive levels of insulin and inflammation can lead to prediabetes or type 2 diabetes and increase the risk for cardiovascular diseases such as high blood pressure, high cholesterol, and fatty liver disease. A quick loss of estrogen also increases the risk for these complications.
A hysterectomy will not cure these complications but rather an antioxidant rich whole foods based eating style, regular exercise, good sleep, and stress management will. The right supplements can also help.
A hysterectomy is not a cure for PCOS because it does not address the underlying hormonal imbalances and metabolic issues associated with the syndrome. While a hysterectomy may alleviate symptoms like heavy periods, it will not resolve other PCOS-related problems, such as:
- Excess androgen production: Androgens are still being produced. For women with PCOS who have had a hysterectomy and her ovaries removed, she will still experience the long-term effects of having elevated androgens (male sex hormones like testosterone). The adrenal glands also produce testosterone and may be stressed to produce more to keep up with the loss of ovarian production. This means a woman may still suffer from excess hair growth, hair loss or balding, or even acne.
- Insulin resistance: Women with PCOS are likely to suffer from insulin resistance and high blood sugar. Women with PCOS also have an increased risk of inflammation in the body, putting them at risk of other health conditions. A hysterectomy would not address these issues, and the accelerated loss of estrogen associated with hysterectomy could actually make them worse.
- Metabolic complications: Metabolic problems persist. While PCOS is a reproductive disorder, it’s also an endocrine disorder. Most women with PCOS have higher levels of insulin and inflammation than women without PCOS. If not well managed, excessive levels of insulin and inflammation can lead to prediabetes or type 2 diabetes and increase the risk for cardiovascular diseases such as high blood pressure, high cholesterol, and fatty liver disease. A quick loss of estrogen also increases the risk for these complications.
Managing PCOS After Hysterectomy
Even after a hysterectomy, managing PCOS symptoms remains crucial. Treatment options include:
- Lifestyle changes: A change in diet and activity. symptoms. A change in diet and activity. symptoms.
- Diet: Boost your diet with plenty of anti-inflammatory foods. This will help to reduce insulin and inflammation and help to prevent diabetes and cardiovascular disease. Insulin resistance is associated with blood sugar spikes, which can worsen your symptoms. Eat a low-glycemic diet to avoid blood sugar spikes. Eat a diet rich in fresh fruit and vegetables, whole grains, lean proteins, and healthy fats.
- Exercise: Exercise regularly for body and mind. Physical activity is beneficial for women with PCOS and can alleviate symptoms. Cardio and strength training exercises are great ones to start with.
- Stress management: PCOS puts the body under a lot of stress. Many women suffer emotional stress as a result of the symptoms of PCOS. Managing your stress levels can help to alleviate symptoms. Mindfulness, yoga, and cognitive behavioral therapy (CBT) can help you manage stress. You may also find added health benefits from meditation or other stress-management techniques.
- Medications:
- Hormone therapy: Your doctor may prescribe hormone therapy to balance your hormones and manage your symptoms. Speak to your doctor to see what hormone treatments may be right for you. Oral contraceptive pills can help regulate hormones, which can reduce irregular periods and excess hair growth.
- Diabetes medicine: to lower insulin resistance in PCOS. Patients with PCOS are often at a higher risk of developing prediabetes, which can turn into type 2 diabetes if left untreated. If your blood sugar is high, your doctor might recommend medication to help combat insulin resistance.
- Weight management medication: The FDA has approved several different drugs to help people lose weight in combination with a healthy diet.
- Supplements:
- Consider Ovasitol, an inositol supplement proven to reduce insulin levels and to help manage carbohydrate cravings
- Consider Berberine as an aggressive way to reduce cholesterol and fatty liver as well as help reduce insulin and possibly body fat
- Resveratrol is a powerful antioxidant to support immune health and to lower cholesterol and insulin. Found in the grapes of red wine, Resveratrol helps combat the effects of aging.
- Zinc can help reduce hair loss
- Fish oil can help reduce androgens, inflammation, and triglycerides
- Calcium is needed to prevent bone loss
- Vitamin D is important to help with mood, prevent bone loss and fight inflammation
- Magnesium can promote better sleep, help reduce anxiety and even pain
- According to a 2022 article published in Endocrine Regulations, Omega-3 supplements can help to balance hormones and reduce insulin resistance. A study published in Cureus found that inositol supplementation lowers insulin resistance in women with PCOS.
Bariatric Surgery as an Alternative
Bariatric surgery is the most durable and effective treatment for morbid obesity and also results in the improvement of the metabolic syndrome. With the safety of the laparoscopic approach and improved understanding of the metabolic changes occurring in bariatric patients postoperatively, morbidly obese women with infertility secondary to PCOS have resorted to bariatric surgery [13]. Historically, epidemiological studies have suggested that the rapid weight loss in the first year or two after bariatric surgery may increase women's chance of conception. While the incidence of PCOS decreases significantly after surgery [14], there are very few studies assessing fertility before and after bariatric operations.
Read also: Natural Ways to Reduce PCOS Facial Hair
Bariatric surgery results in improvement of menstrual irregularities and hirsutism and amelioration of the metabolic profile. Observational studies suggest that female fertility improves following bariatric procedures and weight loss.
Lifestyle Tips After Hysterectomy
Your physician will recommend good lifestyle habits to follow to ensure a healthy recovery from a hysterectomy and reduce long- and short-term side effects. In general, these will include following a healthy diet, including whole foods, and avoiding refined sugar and processed foods. If you aren’t sure how to lose weight after a hysterectomy, ask your doctor or a dietitian to help you with meal plans.
In addition to lean meats and fresh fruits and vegetables, include whole grains and make sure to get plenty of calcium. Women who enter menopause, and those who have completed menopause, are at a higher risk of osteoporosis. Good exercise habits are another component of weight loss after a hysterectomy. Follow your doctor’s orders for physical activity, and begin with lower-impact exercises, such as pool workouts, to avoid straining your body as it heals. You may also find added health benefits from meditation or other stress-management techniques.
Finally, some women experience grief and loss after having their uterus removed.
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