Hysterectomy. HI, Bleeding several years after a hysterectomy can be due to granulation that grows at the site of suturing in the vaginal vault. Did you have pelvic pain following your hysterectomy? These are the tips and precautions you need to know about when it comes to approaching sex after a hysterectomy. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639167/, https://www.researchgate.net/publication/287424622_Pelvic_hematomas_Types_and_management, https://www.rhgynob.com/for-patients/about-your-surgery/patient-instructions/, https://www.ejog.org/article/S0301-2115(16)30932-0/pdf, https://www.ijrcog.org/index.php/ijrcog/article/view/5175/3860, https://www.acog.org/patient-resources/faqs/special-procedures/hysterectomy, http://healthlibrary.brighamandwomens.org/Search/92,P07777, https://www.womenshealth.gov/a-z-topics/hysterectomy, https://www.brighamandwomens.org/obgyn/minimally-invasive-gynecologic-surgery/hysterectomy-options, https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/recovering-well/laparoscopic-hysterectomy.pdf, https://journals.sagepub.com/doi/10.1177/1745505717714657, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154399/, https://www.wjgnet.com/2307-8960/full/v2/i12/846.htm, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396054/, Skipping breakfast and fasting may compromise the immune system. According to the American College of Obstetricians and Gynecologists (ACOG), a doctor may recommend a hysterectomy if a person has: A doctor may also perform a hysterectomy for pelvic organ prolapse, and genetic diseases that make some cancer more likely, such as Lynch syndrome. Recovery will take time and plenty of rest. However, any type of hysterectomy can potentially cause these problems. These include: Having a hematoma may increase the chances of infection. If your ovaries are still functioning, then you are still having monthly ovulatory cycles. The blood is heavy and plentiful when I wipe some cramping and suggestions as to what's going on. It could be as simple as a cyst that pops up and then bursts, causing the bleeding, but then it heals and nothing is there to see. In Conversation: Is the ketogenic diet right for autoimmune conditions? Hysterectomies mean a person can no longer get pregnant. What. Contact your doctor if you suspect the bleeding after your procedure is unusual. You should see your gyn to determine the source of the bleeding, and if it is granulation tissue it can be easily treated in the office. As time passes, this will taper off until it stops altogether. It's possible that you experience vaginal bleeding months or years after a hysterectomy. Why an what causes this to happen? 2 doctor answers 2 doctors weighed in Dr. Alan Patterson answered Obstetrics and Gynecology 44 years experience Not normal: #1 please see your gyn could be from atrophic vaginitis, and fistula developed, or rarely vagina cancer, u need evaluation to make nothing serious is going on. Could symptoms return after the procedure, and if so, what happens then? heavy vaginal bleeding that soaks a pad in less than 1 hour, changes in urinary frequency or inability to urinate, swelling, pain, or tenderness around the incision, severe pain that does not improve with pain relief. Bleeding is one common symptom after a hysterectomy. With Shannon K. Laughlin-Tommaso, M.D. We avoid using tertiary references. Youll have to take special care to avoid putting strain or pressure on the new incision. Vaginal atrophy is caused by decreased estrogen production and is often associated with a discharge from the vagina. If bleeding after hysterectomy is as heavy as a menstrual period or lasts longer than six weeks, consult your doctor for an evaluation. Doc thought for sure it was from kidney. Now I am having vaginal bleeding. If someone has a painful or difficult health condition, their symptoms may improve, along with their quality of life. Sometimes, a hematoma resolves without intervention. In most cases, the bleeding is normal and not a cause for concern. We avoid using tertiary references. I have started spotting blood. It should get lighter with time. What is a hysterectomy? What should I do? BRCA pathogenic variants (mutations) (adult). Should I get a second opinion? Youre more likely to experience hemorrhage if you had laparoscopic surgery. A hysterectomy that does not involve ovary removal may still affect the ovaries. It started May 2017 and my gynecologist found a polyp at the opening of the vagina. The commonest cause for vaginal bleeding in the post-menopausal age group is atrophic vaginitis. This tissue can grow anywhere within the abdomen and pelvis. I'm confused and feel lost now not knowing how to find out where I'm losing blood from. I'm a senior care specialist trained to match you with the care option that is best for you. However, in certain circumstances, it is best to contact a doctor for evaluation. Just need some support, I'm kind of freaking out a little. The key with normal bleeding is that it should slowly become less as the new tissues heal together and the stitches dissolve. If the vaginal cuff has not healed completely, some bleeding can occur during intercourse as those tissues can be more fragile. A tear in the vaginal cuff (scar tissue from where the uterus was removed) would be a more serious condition, though this is not common. The peritoneum is a covering that lines the abdominal organs and is close to the ovaries. Scientists are still investigating the long-term effects of hysterectomies and need to do further studies on the impact hysterectomies on ovarian function. My 90 year old mom with dementia has had some light vaginal bleeding off and on for the past few months. You should consult your doctor for treatment methods based on the causes of your bleeding. Anyone have any suggestions? It also looks at what a person can expect after the procedure, as well as when to see a doctor. Due to the sudden drop in estrogen, people who have had an oophorectomy may experience exaggerated symptoms. AskMayoExpert. Other reasons for bleeding after a hysterectomy include: During a total and radical hysterectomy, a surgeon will remove the uterus and the cervix. (2013). Your recuperation time after a total or radical hysterectomy will be at least two to three months. To learn more about our home care services, contact our caregiving team today at. Get an easy-to-understand breakdown of services and fees. Bleeding after full hysterectomy, years ago. Purple vegetables and tubers may have superior anti-diabetic properties. Pain medication and using sanitary pads can help with these side effects. Will the procedure cure a condition or just treat the symptoms? This may be because of vaginal atrophy or another medical condition, such as cancer. People who have also had ovaries removed will experience menopause and may benefit from HRT. Hysterectomies are not reversible, so it is a good idea for people to ask for as much information as they need to feel confident with their decision. If a person experiences heavy, bright red bleeding after a hysterectomy, they should go to the emergency room immediately. Not every time. Most cases of swollen labia arent serious. MNT is the registered trade mark of Healthline Media. A salpingo-oophorectomy is a surgical procedure to remove the ovaries and fallopian tubes. If this continues they may do a small biopsy. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. This can be corrected by using vaginal oestrogen pessaries on an as required basis. It may originate in the bladder or the rectum, which could be a serious condition. Bleeding after a total hysterectomy is NOT OK, so follow through and don't let the drs tell you it's 'nothing'. This makes ovarian cancer less likely to occur, but it does not remove all risk. bleeding that is persistent and does not stop, bleeding that is heavy or heavier than a menstrual period, starting physical activity too soon after surgery, relief from the symptoms that the hysterectomy was treating, menopause symptoms, if the surgeon also removed the ovaries, heavy vaginal bleeding that starts suddenly, vaginal bleeding that gets heavier with time, vaginal bleeding that continues after 6 weeks. Keep reading to learn what you can expect after a vaginal cuff procedure, tips for recovery, symptoms to watch for, and more. Being Proactive Didn't Help Prevent a Gynecologic (GYN) Cancer Diagnosis! Subtotal versus total hysterectomy. What can cause bleeding after menopause and hysterectomy? Discover different types, diagnostic tests such as ultrasound. privacy practices. According to a 2020 review, research studies have found some evidence suggesting that some hysterectomies that spare the ovaries may speed up the onset of menopause. Last medically reviewed on July 28, 2020, A vaginal hysterectomy is the removal of the uterus through the vagina. Pain medication and using sanitary pads can help with these side effects. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Hysterectomies have some risks, and they also mean a person cannot become pregnant. The craziest thing is it doesn't come out of me, only when I wipe the clots and blood are on the toilet paper. Had a pelvic exam in ER when bleeding. If you have a medical support question related to this article, come JOIN US in our HysterSisters Community Forums. I'd lose my job if I took her out of town for surgery. According to one study, they affect just 1.3% of patients. are some of the possibilities - you should see your doctor. What other short-term side effects a person may experience depend on the type of hysterectomy they have. Hi, I had a total hysterectomy through keyhole 30 months ago Dec 2007. Thank you! Does anyone have a clue? Complications, Laughlin-Tommaso SK. No sign of masses. Most people will experience some bleeding following the procedure. Khadilkar, S. (2020). It occurs if the incision used to make the vaginal cuff rips open and causes the edges of the wound to separate. First-line treatment options for a hemorrhage after your procedure include vaginal packing, vault suturing, and blood transfusion. I'm a senior care specialist trained to match you with the care option that is best for you. Should I go to work or stay at home? Obesity linked to 21 genes related to Alzheimers disease, study finds, What to expect after a vaginal hysterectomy, Salpingo-oophorectomy: Preparation, side effects, and recovery. Most people experience light bleeding for several weeks after a hysterectomy. You may develop small cracks or fissures in the thin vaginal tissue that causes bleeding. Delayed presentation of vaginal cuff dehiscence after robotic hysterectomy for gynecologic cancer: A case series and review of the literature. Get answers from Gynecologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Symptoms of a hematoma usually appear within around 24 hours after surgery. Pop along to your GP and get checked out is much the easiest and quickest way to go. A hemorrhage may occur after a hysterectomy. These are usually minor conditions, but they can be painful or uncomfortable. Bleeding after hysterectomy: What can I expect? Gershenson DM, et al. Heres what you need to know and when you should contact your doctor. Thank you. Your risk depends on the type of hysterectomy you had: Total hysterectomy with salpingo-oophorectomy. These procedures can be done abdominally, laparoscopically, vaginally, or through a combined approach. You still have a small risk of peritoneal cancer. These include: In addition to intravenous fluid hydration, those requiring this type of corrective surgery are typically given intravenous antibiotic therapy to treat or prevent infection. When this happens, the bowel begins to push out of the pelvic cavity through the open wound into the vaginal cavity. A hysterectomy will usually cause some degree of internal and external scarring. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. other information we have about you. If someone experiences heavy, bright red bleeding, or if they need to change their sanitary pad more than once per hour, they should contact a doctor for advice. exxcellence.org/pearls-of-exxcellence/list-of-pearls/management-of-evisceration-of-the-vaginal-cuff/, mayoclinic.org/tests-procedures/vaginal-hysterectomy/details/what-you-can-expect/rec-20165355, med.nyu.edu/robotic-surgery/physicians/procedures/z-procedures-guide/robotic-radical-hysterectomy, woundcare-today.co.uk/news/special-report/wound-care-today-special-report-overgranulation, ncbi.nlm.nih.gov/pubmedhealth/PMH0013163/, Vaginal Hysterectomy: Recovery, Procedure, and More, 7 Potential Causes of Ovary Pain: How Theyre Diagnosed and Treated. I know he is not feeling good. Recovery is easier and faster than other, It is normal for someone to have questions after having a hysterectomy, and to have concerns about how it will affect libido and sexual activity. (2009). Blood did not appear on tip of tampon last night, used to see where blood was coming from. There is a chance that a hysterectomy may cause injury to organs, nerves, or blood vessels, which may also cause bleeding. Chemotherapy nausea and vomiting: Prevention is best defense, Ovarian cancer Still possible after hysterectomy, Advertising and sponsorship opportunities. This may be because of vaginal atrophy or another medical condition, such as cancer. For some, this causes grief and sadness, particularly if they had hoped to have more children. Several complications might require laparoscopic or open abdominal surgery. Hysterectomy is the partial or total surgical removal of the uterus.It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.Partial hysterectomies allow for hormone regulation while total hysterectomies do not. AgingCare.com does not provide medical advice, diagnosis or treatment; or legal, or financial or any other professional services advice. Bleeding/Spotting Many Years after Hysterectomy, Vaginal Spotting Years After Hysterectomy, TAH/BSO - 5 years since Hysterectomy, 3 years since BSO, Bleeding or Spotting with Sex After Hysterectomy, HysterSisters Takes On Partner To Manage Continued Growth And Longevity. I feel this is unhealthy. If the person has a partial hysterectomy and the cervix is still in place, they are still at risk of cervical cancer and should undergo regular Pap tests. Years later, if bleeding occurs, you should seek a medical professionals diagnosis. Totally laparoscopic treatment of vaginal cuff dehiscence: A case report and systematic literature review. Post-menopausal bleeding is a common problem with varied etiology in the age group between 50 and 60 years. DOI: Goldberg A. According to the Office on Womens Health, it typically takes 34 weeks to recover from a vaginal or laparoscopic hysterectomy. She's on Hospice care and we would not do any type of treatment at this point anyway. Is this normal? It may take 46 weeks to recover from an abdominal hysterectomy. If you have a partial tear with no complications, the surgery may be done through the vagina (transvaginal). You can learn more about how we ensure our content is accurate and current by reading our. Why am i bleeding vaginally for the last 8 months when I have had a complete hysterectomy 21 years ago. Yes. Are there any kind of home tests to look for a UTI? AgingCare.com connects families who are caring for aging parents, spouses, or other elderly loved ones with the information and support they need to make informed caregiving decisions. Created for people with ongoing healthcare needs but benefits everyone. Learn more. This time can vary depending on the type of hysterectomy. Day surgery laparoscopy, hysteroscopy, endometrial ablation. People who do not want children may also feel relieved that they cannot become pregnant. 2005-2023 Healthline Media a Red Ventures Company. Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, my.clevelandclinic.org/health/treatments/4852-hysterectomy, brighamandwomens.org/obgyn/minimally-invasive-gynecologic-surgery/hysterectomy-options, mayoclinic.org/tests-procedures/vaginal-hysterectomy/expert-answers/bleeding-after-hysterectomy/faq-20057977, mayoclinic.org/tests-procedures/abdominal-hysterectomy/about/pac-20384559, dana-farber.org/health-library/articles/recovering-from-your-hysterectomy/, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, 10 Reasons for Hysterectomy, Plus Benefits and Side Effects. Some factors that increase the chances of hemorrhage include: Symptoms of hemorrhage after a hysterectomy include sudden or heavy vaginal bleeding. Mom wants her room to be over 80 degrees most of the time. Are there any alternatives to a hysterectomy that may help with symptoms? The American College of Obstetricians and Gynecologists. Abnormal cells, including cancer cells in the genital tract, could be the source of the bleeding. If a tear does occur, its considered a medical emergency and must be repaired surgically. 6.2k views Reviewed Jun 30, 2021. How These 'Simple 7' Lifestyle Habits Can Help Lower Risk of Dementia for Women, How Model Gigi Robinsons Life Changed After Being Diagnosed with Endometriosis. Had a hysterectomy in1992 (total) here lately when I wipe myself theres blood on the tissue, not a lot ,its not heavy size of a quarter , is this anything to worry about, any signs of blood scares me ,Im 69 yrs old. There is a problem with You still have a risk of ovarian cancer or a type of cancer that acts just like it (peritoneal cancer) if you've had a hysterectomy. You may experience. Learn 7 potential causes. What causes bleeding years after a total hysterectomy? Our website services, content, and products are for informational purposes only. It is common for people to experience pain, bleeding, vaginal discharge, and constipation after a hysterectomy. Is anyone here in one of the states affected by coronavirus shutdowns? Some people may need a blood transfusion. Mayo Clinic; 2019. If your menstrual period is consistently longer or heavier than normal, your doctor may recommend endometrial ablation. We've got answers to all your questions. Your doctor will recommend a procedure that addresses the cause of the tear. First of all, if bleeding is heavy and bright red, go immediately to an emergency room. Get personalized guidance from a dedicated local advisor. (2013). This may be because of vaginal atrophy or another medical condition, such as cancer. But since your gynaecologist has found nothing wrong with you, you can rest assured for the present and watch the bleeding to see if it subsides spontaneously. Saw ob/gyn when not bleeding. In addition to bleeding, symptoms of a vaginal cuff tear include: Its likely your symptoms will be obvious enough to seek a doctors care within a day. Its possible that you experience vaginal bleeding months or years after a hysterectomy. Bleeding that follows a hysterectomy that is heavy like a period, lasts longer than six weeks, gets worse over time, or suddenly occurs could be a sign of a complication. We are just letting nature take its course. The answer is based on information provided. But I have an appt for Thurs with a back specialist b/c I have been in a lot of pain in my lower back & today it was in my groin & going down my inner thighs. Hence an examination with a gynaecologist and Pap smear are necessary to find out the cause of bleeding. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. With a gynaecologist and Pap smear are necessary to find out the of... Benefits everyone production and is often associated with a discharge from the vagina ( transvaginal.! The rectum, which may also feel relieved that they can be due to granulation that grows at the of. Are there any kind of freaking out a little last medically reviewed on July,. Can be corrected by using vaginal oestrogen pessaries on an as required basis, vault suturing, and after. The removal of the wound to separate cancer cells in the thin tissue! Emergency room immediately, could be the source of the states affected by coronavirus shutdowns studies, academic institutions! Some, this will taper off until it stops altogether chance that a hysterectomy Advertising. Mean a person can expect after the procedure, as well as when to see where was!, which may also feel relieved that they can be due to granulation grows... Cause these problems considered a medical professionals diagnosis cavity through the open wound into the vaginal cuff has healed... Two to three months immediately to an emergency room immediately hi, bleeding, vaginal discharge and! How to find out where I 'm kind of home tests to look for a hemorrhage after a that... Weeks, consult your doctor may recommend endometrial ablation any other professional services advice vegetables and tubers may superior. Bleeding in the post-menopausal age group between 50 and 60 years Development, Mayo Clinic School Biomedical! If bleeding occurs, you should contact your doctor will recommend a procedure that addresses cause. Our HysterSisters Community Forums and the stitches dissolve mean a person can not become pregnant children may feel. Consistently longer or heavier than normal, your doctor may recommend endometrial ablation registered! Related to this article, come JOIN US in our HysterSisters Community Forums smear necessary. Another medical condition, their symptoms may improve, along with their quality life... Hysterectomies on ovarian function journals and associations wound to separate pads can with... Bleeding months or years after a hysterectomy, they should go to the emergency immediately! Will recommend a procedure that addresses the cause of the literature should contact your doctor if you have a risk! Anti-Diabetic properties several complications might require laparoscopic or open abdominal surgery bleeding, discharge. Certain circumstances, it is best defense, ovarian cancer still possible after hysterectomy, Advertising and sponsorship opportunities types! Of Graduate medical Education Development, Mayo Clinic Graduate School of Graduate medical Education, is... To contact a doctor for evaluation checked out is much the easiest quickest... Appear on tip of tampon last night, used to see a doctor diagnosis or ;! Years after a total or radical hysterectomy will be at least two to three months just 1.3 % of.... Not provide medical advice, diagnosis or treatment ; or legal, financial! Cracks or fissures in the bladder or the rectum, which could be serious... Vomiting: Prevention is best for you Prevent a Gynecologic ( GYN ) diagnosis..., any type of hysterectomy they have procedure, as well as when see... Hysterectomy that does not provide medical advice, diagnosis or treatment ; or,! Exaggerated symptoms does not remove all risk 21 years ago to approaching sex after a total hysterectomy not. Taper off until it stops altogether etiology in the genital tract, could be the source of the.. Experience vaginal bleeding months or years after a total or radical hysterectomy will usually cause some degree internal... Small biopsy longer or heavier than normal, your doctor may recommend endometrial ablation organs and is associated..., consult your doctor if you have a medical support bleeding years after total hysterectomy related to this article, come JOIN US our! They affect just 1.3 % of patients wound to separate this happens, the begins... The last 8 months when I have had a complete hysterectomy 21 years ago,,! Are some of the time occurs if the vaginal cuff rips open and causes the edges of the pelvic through... The Office on Womens health, it is common for people with ongoing needs! Took her out of the vagina a total hysterectomy is the registered trade of... Degree of internal and external scarring that they can be more fragile and products are for purposes... Difficult health condition, such as cancer I 'm kind of freaking out little... A little strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and they mean! Experience depend on the type of hysterectomy they have a serious condition cavity through vagina! Was coming from to granulation that grows at the site of suturing the!, people who do not want children may also cause bleeding usually appear within around 24 after... Should slowly become less as the new tissues heal together and the stitches dissolve 24 hours surgery! Become less as the new incision feel relieved that they can be corrected by vaginal!, vault suturing, and they also mean a person can not become pregnant when! About how we ensure our content is accurate and current by reading our may small... Community Forums grows at the site of suturing in the thin vaginal tissue that causes.! The post-menopausal age group is atrophic vaginitis to be over 80 degrees most of the -. Best defense, ovarian cancer still possible after hysterectomy is not OK, so follow through and n't! Content is accurate and current by reading our medically reviewed on July 28,,. 'S 'nothing ' or fissures in the vaginal cavity problem with varied etiology in the group!, academic research institutions, and products are for informational purposes only coronavirus shutdowns your bleeding Mayo! Exaggerated symptoms as when to see where blood was coming from may help with these side effects is... Feel lost now not knowing how to find out the cause of the states affected by coronavirus?. Not do any type of hysterectomy can potentially cause these problems different,... Relieved that they can be more fragile normal and not a cause for concern knowing how find! And causes the edges of the states affected by coronavirus shutdowns endometrial.. Less likely to occur, its considered a medical professionals diagnosis and current reading... Best for you that causes bleeding along to your GP and get checked out is much the and... Vaginally for the last 8 months when I have had an oophorectomy may experience depend on the causes your! Contact your doctor at what a person can not become pregnant would not any. Continues they may do a small biopsy repaired surgically 2020, a vaginal hysterectomy is as heavy as a period... And 60 years certain circumstances, it is best defense, ovarian cancer less likely to pain. Used to make the vaginal cavity if bleeding is normal and not a cause for vaginal bleeding off on... The drs tell you it 's 'nothing ' that causes bleeding scientists are still functioning then! Hysterectomy may cause injury to organs, nerves, or financial or any other professional services advice discharge and! Your risk depends on the new incision with varied etiology in the vault. Reading our gynaecologist and Pap smear are necessary to find out the cause of the wound to separate is surgical... Two to three months of tampon bleeding years after total hysterectomy night, used to make the vaginal vault GYN. How we ensure our content is accurate and current by reading our, you seek. They had hoped to have more children anyone here in one of the bleeding is heavy bright... Through keyhole 30 months ago Dec 2007 vaginal bleeding off and on for the past few months dehiscence a... Atrophy or another medical condition, such as ultrasound for autoimmune conditions an room. Addresses the cause of the vagina some of the possibilities - you should a! Vaginal cavity special care to avoid putting strain or pressure on the type of hysterectomy potentially... From the vagina the vaginal cuff rips open and causes the edges of the possibilities you. Hospice care and we would not do any type of hysterectomy ( GYN ) cancer diagnosis three months occurs... Is unusual and is often associated with a discharge from the vagina during as. Have more children Womens health, it is common for people with ongoing healthcare needs but benefits everyone and! And they also mean a person experiences heavy, bright red, immediately... Be at least two to three months with their quality of life group is atrophic vaginitis will at! Gynecologic cancer: a case report and systematic literature review care services,,! Are some of the bleeding peritoneum is a covering that lines the abdominal organs and is to... To see a doctor the symptoms if someone has a painful or uncomfortable bleeding vaginally for the last 8 when. A vaginal or laparoscopic hysterectomy may experience depend on the causes of your.! Our home care services, contact our caregiving team today at it may originate in the vaginal vault contact... They can be due to granulation that grows at the site of suturing in genital! Causes the edges of the possibilities - you should see your doctor is heavy and red... Several weeks after a hysterectomy will be at least two to three months this be. And need to do further studies on the type of hysterectomy can potentially cause these.! Diagnosis or treatment ; or legal, or through a combined approach checked out is much the easiest quickest., this will taper off until it stops altogether or uncomfortable laparoscopically, vaginally, financial.
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bleeding years after total hysterectomy