Joint Pain After Hysterectomy
Written by Dr. Jewel Alfoure, ND
Hormone Regulation is Key
Hormones are important chemical messenger molecules that keep the body balanced and functioning properly. When hormones become unbalanced, many physiological functions are affected. Menopause and andropause (the male equivalent of menopause) are the most well-known reasons for hormonal decline (1). However, hormones can decline for many other reasons, including toxin exposure, adrenal fatigue, and unhealthy aging. Well-known symptoms of hormone decline include low libido, fatigue, weight gain, sleep problems, low mood, and brain fog. Hormone imbalance can also occur due to medical procedures, including hysterectomy (2). It was discovered that after medical procedures, including hysterectomy, women can experience a significant decline in hormones. The decline in hormones puts the woman in sudden, early menopause which can lead to various health problems, including joint inflammation. Therefore, it is important to be aware of the potential for hormone decline in order to maintain optimal health (3).
So what is a hysterectomy anyway?
Unfortunately, over the past few decades, a hysterectomy became a common procedure. This is because of its capacity to offer complete disease control for some female conditions.
A hysterectomy is a female health procedure in which the uterus is surgically removed. Removal of the uterus can be done for a variety of reasons, including cancer, fibroids, endometriosis, and pelvic prolapse (4).
Although a hysterectomy can have many positive outcomes, it also results in the loss of fertility and can cause side effects such as menopause-like symptoms including vaginal dryness, and urinary incontinence. In addition, a hysterectomy can put extra strain on the joints due to the sharp decrease in estrogen. A drop in hormone levels can eventually lead to joint problems such as arthritis. Therefore, it is important for women to weigh the risks and benefits of a hysterectomy before making a decision (5).
No! The Uterus is NOT a Reproductive Pouch!
In some cases, a hysterectomy can also lead to sexual difficulties. This is because the placement of the uterus affects the vaginal opening. When the cervix is removed, the vaginal canal may become shorter, which can make sex less comfortable (5). In addition, some women may feel a loss of nerve sensation in their vagina after a hysterectomy. This loss of sexual feeling is due to the removal of the nerves that supply sensation to the vagina (6).
Many people and clinicians regard the uterus as a reproductive organ, forgetting its endocrine role. Due to the fact that the uterus is an important organ for the maintenance of good health, different forms of hysterectomy were developed to remove as few of the functional structures of the body as possible.
There are several types of hysterectomy, and the invasiveness of the procedure is determined depending on the individual medical situation.
Total hysterectomy: The removal of the uterus and the cervix
Subtotal hysterectomy: Removal of the uterus but leaving the cervix in place
Radical hysterectomy: Removal of the uterus, cervix, ovaries, fallopian tubes, and nearby lymph nodes (6).
If it was just a pouch, then no one would need the hormones
Hormone therapy may be recommended for some patients who undergo a hysterectomy, especially those who have their ovaries removed at the same time. This therapy can help to reduce menopausal symptoms and maintain bone density. In addition, some women may require hormone replacement therapy if their ovaries are removed but they have not yet reached menopause (7).
Long story short, the uterus is important for many things outside of just being a reproductive pouch!
Hormones and Joint Health
Joint pain is a common problem among older adults, especially those who are approaching or going through menopause. There are a number of reasons why joint pain, joint stiffness and menopause may be linked. One possibility is that the changing hormone levels associated with menopause can cause changes in the capacity to synthesize cartilage and collagen that make up the joints. This can lead to pain and inflammation of the joints (8).
Additionally, declining levels of the hormone estrogen can lead to an increase in inflammation throughout the body. This inflammation can contribute to the development of conditions such as osteoarthritis. As a result, it is important to be aware of the potential relationship between hormone decline and inflammation.
The Effect of Hormones on Bones is Well Recognized
The risk of osteoporosis is known to significantly increase in post-menopausal women. In older women, the use of oral estrogen was related to a lower incidence of hip osteoarthritis.
A positive correlation was found between a clinical diagnosis of osteoarthritis and serum estrogen levels in premenopausal women with mild knee osteoarthritis (9).
Menopause can also cause changes in bone strength and density, which can increase the likelihood of developing osteoarthritis, a condition characterized by joint pain and stiffness.
While joint pain can be frustrating and debilitating, there are a number of treatments available that can help to ease the symptoms. Exercise, weight management, and pain medication can all be effective in managing joint pain (10).
Estrogen Therapy and Joints
Estrogen has an anti-inflammatory impact on women's bodies. A drop in estrogen levels encourages inflammation in both perimenopausal women and postmenopausal women. It is widely accepted that osteoarthritis increases at or shortly after menopause and that women who have lower hormone levels are at significant risk of bone density loss and bone fractures (11).
Progesterone and Joints
According to Dr. John Lee MD, progesterone is a natural hormone that gets very little press due to the fact that little profit can be made through its sale. The symptoms of progesterone deficiency include irregular periods, mood swings, headaches, exhaustion, and joint pain (12).
Due to the fact that progesterone interacts directly with bone-building cells called osteoblasts, ailments such as osteoporosis and arthritis might develop when the body is deficient in progesterone. Some clinicians note that progesterone replacement therapy considerably reduces pain and other symptoms in individuals with bone and joint disorders (13).
Cortisol and Joints
Cortisol levels increase significantly during periods of prolonged stress. This increase leads to weight gain, mood swings, and blood sugar imbalances. Such an increase is usually paid with an increase in inflammation. All those factors play a role in stressing the joints (14).
Cortisol does alter the body's pain and inflammation response. Several previously published studies found a relationship between cortisol levels and the occurrence of chronic pain in illnesses such as rheumatoid arthritis, low back pain, or physical discomfort (15).
Women with low serum levels of endogenous estradiol, progesterone, and testosterone are associated with increased risk of knee swelling, synovitis, and possibly other osteoarthritis-related structural changes.
Hysterectomy and Joint Pain—Hormone Replacement May Not Be The Complete Answer
In a large study, A total of 10,739 postmenopausal women who had undergone hysterectomy were randomly assigned to receive a daily oral dose of conjugated natural estrogens. Joint pain and swelling were evaluated with a questionnaire.
The study followed the women for a total of six years and compared them to a placebo. At the beginning of the research, joint discomfort and edema were equivalent across the estrogen and placebo groups.
After one year, joint pain frequency and intensity were significantly reduced with estrogen-alone. The improvement was consistent until the third year. Upon ending the study it was concluded that the use of estrogen alone in postmenopausal women reduces the frequency of joint pain in a small but persistent manner. Interestingly, estrogen alone might exacerbate joint edema (16, 17).
The Estrogen Bias
In a world would there is a huge bias that makes medical practitioners think of estrogens way before they consider natural progesterone, medical hormone regulation is a hard goal to achieve. Additionally, hormone testing with regular bloodwork has many limitations. Salivary testing and dry urine hormone testing are best for getting more accurate results (18). Before considering any hormone replacement, it is important to keep in mind that hormone replacement therapy, if not done correctly may increase the risk of breast cancer and endometrial cancer. It is important to consider the possible benefits and the risk factors.
The Quick Answer is to Address Inflammation
Serrapeptase is a protein-digesting enzyme that has been used for decades in Europe and Asia for the treatment of a wide variety of conditions. While serrapeptase is most commonly used to treat inflammation and pain, some recent studies have suggested that it may also have benefits for female health (19).
One potential use of serrapeptase is after surgical procedures like a hysterectomy. Post-surgical use of serrapeptase has been shown to reduce inflammation and pain, as well as improve healing time. Additionally, it has been shown to reduce the formation of scar tissue. As a result, serrapeptase may help to reduce recovery time and improve outcomes after surgery (20).
Additionally, serrapeptase is generally well tolerated, with few reported side effects. Therefore, it may be an effective option for reducing symptoms during recovery and improving outcomes after this surgery.
Please note that postoperative use of serrapeptase can only be done safely under the care of a primary care physician and any personal prescription maybe lead to significant side effects.
Addressing Hormonal Inflammation Before Regulating The Hormones
Serrapeptase is a powerful anti-inflammatory enzyme that has been shown to be effective in the treatment of various conditions associated with inflammation. In joints, for example, serrapeptase can help to reduce inflammation and cartilage breakdown, both of which are major contributors to the development of arthritis (21).
Furthermore, serrapeptase has also been shown to be effective in the treatment of respiratory conditions such as bronchitis and sinusitis, both of which are characterized by inflammation of the airways (22).
In addition, serrapeptase has also been shown to be helpful in the healing of wounds and the reduction of scar tissue formation. Overall, serrapeptase is a potent anti-inflammatory agent that can be effectively used in the treatment of a variety of conditions associated with inflammation.
Moving with physical activity and having a diet rich in healthy fats and cruciferous vegetables may be one of the best ways to start a healthy hormone regulation journey.
Reduce built-up inflammation by breaking down inflammatory markers
Use a proteolytic enzyme to physically breakdown inflammation
Start moving and exercising to encourage hormonal changes
Understand that if you have undergone surgical menopause, you need hormone support
Natural menopause can sometimes also improve with minimal hormone replacement therapy
Estrogen, natural progesterone and testosterone should all be considered for hormone replacement
Ask a healthcare provider about the possibility of having a higher risk of breast and endometrial cancer
Don't rely on blood tests when you are on hormone replacement therapy, they may not be accurate
Hot flashes, weight loss, discomfort in the pelvic area, and lower back pain are common symptoms experienced after menopause and hysterectomy, report them to your doctor
Keep physical therapy, like pelvic floor therapy in mind
Know that regular exercise is your friend!