PCOS After Hysterectomy: Outcome and Treatment Options

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. According to the AMA, PCOS affects 6-12% of women of reproductive age in the United States​ 

It is characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries. A hysterectomy involves the surgical removal of the uterus and, in some cases, the ovaries and fallopian tubes.

A hysterectomy is a common surgical procedure among women; 1 in 3 women in the United States have a hysterectomy by age 60 as per ASA. It can affect the ovaries and hormone production depending on whether the ovaries are removed.

Removing the uterus itself does not eliminate PCOS because the syndrome is primarily related to ovarian function and hormonal imbalance. Scientific findings suggest that PCOS can persist after a hysterectomy if the ovaries are not removed. Medical opinions indicate that while some symptoms may lessen, others can continue, requiring ongoing management.

Yes, it is possible to have Polycystic Ovary Syndrome (PCOS) after a hysterectomy, but it depends on the type of hysterectomy performed. Here’s a more detailed explanation:

Types of Hysterectomy

1. Total Hysterectomy: Removal of the uterus and cervix.
2. Subtotal (Partial) Hysterectomy: Removal of the uterus, leaving the cervix in place.
3. Total Hysterectomy with Bilateral Salpingo-Oophorectomy: Removal of the uterus, cervix, both ovaries, and fallopian tubes.

Impact on PCOS

• Ovaries Retained: If the ovaries are retained (as in a total or subtotal hysterectomy without removal of the ovaries), the person can still have PCOS. This is because PCOS is primarily a condition involving the ovaries, where they produce an excess of androgens (male hormones) and may have cysts.
• Ovaries Removed: If the ovaries are removed (as in a total hysterectomy with bilateral salpingo-oophorectomy), the person cannot have PCOS anymore, since the condition directly involves the ovaries. However, they might experience symptoms related to hormonal imbalances or other conditions that mimic PCOS symptoms.

A partial hysterectomy involves the removal of the uterus while leaving one or both ovaries intact. This means that hormone production continues, which can sustain PCOS symptoms. Typical PCOS symptoms include:

• irregular menstrual cycles
• excessive hair growth
• acne
• weight gain.

After a partial hysterectomy, these symptoms may persist because the hormonal imbalance associated with PCOS remains. However, the absence of the uterus means that menstrual irregularities might present differently. For instance, without a uterus, you won't have menstrual periods, but the underlying hormonal issues can still cause other symptoms like acne, weight gain and excess hair growth.

Treatment goals for managing PCOS post-hysterectomy focus on controlling symptoms and maintaining hormonal balance. Here are some key strategies:

Lifestyle Changes:

• Follow a balanced diet rich in whole foods and low in processed sugars to help manage weight and improve insulin sensitivity.
• Engage in regular physical activity, including both cardio and strength training exercises.

Medical Treatments:

• Hormone therapy to balance androgen levels (consult a healthcare provider for specific recommendations).
• Regular medical check-ups to monitor hormone levels and adjust treatments as necessary.

Alternative Therapies and Supplements:

• Consider supplements such as vitamin D and omega-3 fatty acids to support overall health.
• Explore alternative therapies like acupuncture or herbal remedies under the guidance of a healthcare provider.