Our Summary

This study is a detailed analysis of past cases where women experienced an ectopic pregnancy after undergoing a hysterectomy, a surgery where the uterus is removed. This review looked at two different types of hysterectomies: total and supracervical. Total hysterectomy involves removing the entire uterus and cervix, while supracervical (also known as subtotal) hysterectomy involves removing only part of the uterus, leaving the cervix in place.

The researchers studied 108 cases, where 34 women had supracervical and 74 had total hysterectomies. They found no differences in factors like age, symptoms, or health status between the two groups when they presented for treatment.

However, they did discover that women who had a supracervical hysterectomy were less likely to experience an ectopic pregnancy around the time of their surgery. On the other hand, they were more likely to have a possible ectopic pregnancy diagnosis before surgery.

The researchers recommend that doctors keep in mind that ectopic pregnancies after a supracervical hysterectomy may occur well after the surgery. Therefore, they should consider ectopic pregnancy as a possible cause when women who have had any type of hysterectomy present with abdominal or pelvic pain.

Ectopic pregnancy is a medical emergency where a fertilized egg implants outside the uterus, usually in a fallopian tube, which can cause life-threatening complications if not treated promptly.

FAQs

  1. What is the difference between a total hysterectomy and a supracervical hysterectomy?
  2. Are women who have had a supracervical hysterectomy more likely to experience an ectopic pregnancy?
  3. What should doctors consider when a woman who has had a hysterectomy presents with abdominal or pelvic pain?

Doctor’s Tip

Doctors may advise patients who have had a hysterectomy to be aware of the signs and symptoms of ectopic pregnancy, such as abdominal or pelvic pain, vaginal bleeding, shoulder pain, and dizziness. Patients should seek immediate medical attention if they experience any of these symptoms, as early detection and treatment are crucial in preventing serious complications. Additionally, patients should continue to attend regular gynecological check-ups and follow-up appointments to monitor their overall health and well-being.

Suitable For

Patients who are typically recommended hysterectomy include those with:

  1. Uterine fibroids: Noncancerous growths in the uterus that can cause heavy menstrual bleeding, pelvic pressure, and pain.
  2. Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, causing pain and infertility.
  3. Uterine prolapse: A condition where the uterus slips down into the vaginal canal due to weakened pelvic floor muscles.
  4. Adenomyosis: A condition where the tissue that normally lines the uterus grows into the muscular wall of the uterus, causing heavy menstrual bleeding and pain.
  5. Gynecologic cancers: Including cancer of the uterus, cervix, or ovaries.
  6. Chronic pelvic pain: Unexplained and persistent pain in the pelvic region that does not respond to other treatments.
  7. Abnormal vaginal bleeding: Including heavy periods, irregular periods, or bleeding between periods that does not respond to other treatments.

It is important for patients to discuss their individual medical history and symptoms with their healthcare provider to determine if a hysterectomy is the best treatment option for them.

Timeline

Before hysterectomy:

  • Patient consults with their healthcare provider regarding symptoms such as heavy menstrual bleeding, pelvic pain, or other gynecological issues.
  • Patient undergoes various diagnostic tests such as ultrasound, MRI, or biopsy to confirm the need for a hysterectomy.
  • Patient discusses the different types of hysterectomy with their healthcare provider and decides on the best option for them.
  • Patient undergoes pre-operative preparations such as blood tests, imaging scans, and medication adjustments.
  • Patient undergoes the hysterectomy surgery, either total or supracervical, depending on the recommendation of their healthcare provider.

After hysterectomy:

  • Patient stays in the hospital for a few days to recover from the surgery.
  • Patient may experience pain, discomfort, and fatigue following the surgery.
  • Patient follows post-operative instructions provided by their healthcare provider, such as taking prescribed medications, avoiding heavy lifting, and attending follow-up appointments.
  • Patient may experience emotional and psychological changes due to the removal of the uterus, such as feelings of loss or changes in body image.
  • Patient gradually resumes normal activities and may notice improvements in symptoms that prompted the hysterectomy, such as relief from heavy bleeding or pelvic pain.
  • Patient may need to adjust to changes in their menstrual cycle or hormone levels, depending on whether the cervix was removed during the hysterectomy.
  • In rare cases, patients may experience complications such as infection, blood clots, or, as mentioned in the study, an ectopic pregnancy.

What to Ask Your Doctor

  1. What are the risks of developing an ectopic pregnancy after a hysterectomy?
  2. Are there any specific symptoms I should watch out for that may indicate an ectopic pregnancy?
  3. How soon after a hysterectomy can I potentially experience an ectopic pregnancy?
  4. What steps can I take to reduce my risk of developing an ectopic pregnancy after a hysterectomy?
  5. If I experience abdominal or pelvic pain after a hysterectomy, should I be concerned about the possibility of an ectopic pregnancy?
  6. How is an ectopic pregnancy diagnosed and treated in someone who has had a hysterectomy?
  7. Are there any long-term implications or complications associated with experiencing an ectopic pregnancy after a hysterectomy?
  8. Is there anything I should discuss with my gynecologist or healthcare provider if I am concerned about the possibility of an ectopic pregnancy post-hysterectomy?

Reference

Authors: Awonuga A, Agboroko S, Moussa D, Hsu R, Fee M, Shah J, Das S, Nnaji C, Camp OG, Diamond M. Journal: J Obstet Gynaecol Res. 2025 Apr;51(4):e16268. doi: 10.1111/jog.16268. PMID: 40150941