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Does MS Get Better or Worse After Hysterectomy?

Posted on May 26, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Maureen McNulty

Some people living with multiple sclerosis (MS) may need to undergo a hysterectomy. During this surgery, the uterus (womb) is removed.

“I just found out that I’ll be having a hysterectomy in March, and my mind is kind of blown,” one MyMSTeam member wrote. Another said, “I have a leaky bladder, which can be caused by my MS or my hysterectomy.”

Hysterectomies are major surgeries, and anyone considering this procedure may want to talk to their doctors about potential benefits and drawbacks. People with MS may also have additional factors to take into account. Surgery is generally safe for those with MS, although infections can cause problems. Additionally, if a person goes into menopause after a hysterectomy, it could positively or negatively affect their MS.

Hysterectomy: The Basics

A hysterectomy involves removal of the uterus. After a hysterectomy, you will no longer be able to become pregnant.

Sometimes, other organs are also removed during this surgical procedure. For example, during a total hysterectomy, the uterus and cervix are removed. Additionally, a hysterectomy plus bilateral salpingectomy includes removal of the uterus and both fallopian tubes. A hysterectomy plus bilateral salpingo-oophorectomy involves taking out the uterus, both fallopian tubes, and both ovaries.

Hysterectomies and related procedures are used to treat certain conditions that affect the reproductive system, such as:

  • Cancer of the uterus, ovaries, or cervix
  • Uterine fibroids (noncancerous tumors in the uterus)
  • Uterine prolapse (a condition in which the uterus slips down into the vagina)
  • Endometriosis (a condition in which uterine tissue grows outside of the uterus)
  • Other conditions that affect the uterus

People with severe menstrual symptoms, such as very heavy bleeding or severe pelvic pain, may also undergo a hysterectomy when other treatment options don’t work.

Having Surgery While Living With MS

Surgery and anesthesia (medications that put you to sleep and numb pain) can sometimes have side effects. Minor side effects, such as nausea, soreness, constipation, and sleeping problems, don’t usually last long. Any surgery comes with the risk of potentially more serious complications (conditions that occur after a treatment), such as losing too much blood, developing blood clots, or experiencing an allergic reaction to anesthesia. However, these issues are rare.

Anyone who undergoes surgery always has some risk of developing side effects, and people with MS don’t have a higher risk of complications after a procedure. Additionally, surgery doesn’t typically affect MS symptoms. At least one study has found that individuals with multiple sclerosis are not more likely to experience a relapse after surgery.

Surgery is typically safe for people with MS. According to the National Multiple Sclerosis Society, “MS is generally not a reason to avoid having surgery.”

Potential Problems After Surgery

Infection is always possible after surgery, and an infection could worsen your MS symptoms. If you are having a hysterectomy, ask your doctor how to prepare before surgery. Your doctor may recommend washing with a disinfecting soap beforehand. Quitting smoking also helps because people who smoke are more likely to develop infections after surgery.

Once your surgery is over, make sure you understand how to take care of your surgical wounds. Avoid touching the incision, and don’t remove bandages until your doctor tells you to. Contact your health care team if you notice signs of infection, including redness, pain, or heat near the wound, or if you develop a fever.

Some people with advanced MS also have breathing problems that may increase their chances of experiencing complications. Tell your surgeon and anesthesiologist (a doctor who gives you anesthesia) if you have any respiratory problems as a result of your MS.

Hysterectomies and Menopause

Consider the effects of menopause if you are thinking about undergoing a hysterectomy. Menopause is a condition that occurs when menstrual periods stop.

Menopause can develop if the ovaries are removed during a hysterectomy. The ovaries produce estrogen and progesterone (hormones that help control sexual development, menstruation, and fertility). Most often, the ovaries stop making these hormones during a person’s late 40s or early 50s, which triggers menopause. However, if the ovaries are surgically removed before this point, you will go into menopause early — immediately after surgery.

If you have a hysterectomy but the surgeon leaves your ovaries intact, you most likely won’t go into early menopause. However, there is a small risk that your ovaries will stop working after surgery or that you will start menopause earlier than you normally would have if you hadn’t had a hysterectomy.

The Effects of Menopause on Multiple Sclerosis

Going through menopause may lead to changes in your MS symptoms. Different studies have found different results:

  • Some research has found that MS symptoms tend to be worse after menopause, and other research has found no changes in symptoms.
  • In one small study from European Neurology, researchers found that women were less likely to experience MS relapses after going through menopause.
  • One study in Multiple Sclerosis Journal found that MS disability tended to get worse after menopause.

It’s not yet clear why menopause may lead to MS changes. It’s also hard to tell exactly how menopause will affect your disease course until you go through it. But it is important to know that if you have your ovaries removed during a hysterectomy, you could notice new, worsening, or improved symptoms.

Once menopause begins, some of its symptoms may mimic MS symptoms. You may experience hot flashes, night sweats, bladder problems, mood swings, sleeping problems, and vaginal dryness during menopause. It may be hard to differentiate some of these symptoms from MS-related issues. Additionally, menopause symptoms like hot flashes can sometimes make MS symptoms worse.

Menopause Treatments and MS

Some people going through menopause use hormone replacement therapy (HRT) to relieve menopause symptoms and improve their quality of life. HRT involves taking medication containing estrogen, progesterone, or both.

HRT may have some benefits for people with MS. Some women report that taking these drugs improves their MS symptoms. Researchers have also found that HRT can lead to better physical function for postmenopausal women with MS. In one clinical trial, people living with MS who took estriol (a form of estrogen) in addition to a disease-modifying therapy had lower MS relapse rates.

Hormone therapy can also help improve bone strength. People with MS are more likely to have osteoporosis (a condition leading to weaker bones), and menopause also increases a person’s chances of developing this bone disease. However, HRT can help prevent these problems and reduce the risk of breaking a bone.

If you are interested in trying HRT, you may want to ask your gynecologist about the risks and benefits. HRT may help prevent some of the health problems that could occur after early menopause, but this treatment can also lead to an increased risk of developing other conditions, such as blood clots, breast cancer, and strokes.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 186,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you had a hysterectomy while living with MS? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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