Why Some Women Bleed Years After A Hysterectomy

The uterus plays a critical role in orchestrating hormonal experiences unique to the female reproductive system, like menstruation and pregnancy. In certain cases, a person may undergo a hysterectomy in order to have their uterus removed. Around 500,000 hysterectomies are carried out each year in the United States, making it the second most common surgery for American women, as reported by Yale Medicine. A total hysterectomy involves the complete removal of the uterus and cervix, while the cervix is preserved in a supracervical hysterectomy. During a radical hysterectomy, the uterus, cervix, and some neighboring tissues are removed. 

A hysterectomy may be recommended for someone who has uterine, ovarian, cervical, or endometrial cancer, according to Johns Hopkins Medicine. The need for a hysterectomy can also arise if someone has been experiencing abnormal bleeding, endometriosis, or heavy or prolonged menstruation. In addition, some transgender males and individuals who are nonbinary may opt to have a hysterectomy to affirm their gender.

Following the removal of such a major reproductive organ, the body will no longer be able to menstruate or become pregnant. After a hysterectomy, some people may experience emotional distress or depression as they grieve their ability to have children, while others may feel a sense of relief. Other potential side effects of a hysterectomy include blood clots, pain, constipation, or trouble emptying the bladder. 

A person may notice bleeding shortly after surgery, and others can experience bleeding months or even years after their surgery. Let's dive into why this may happen. 

Why would someone bleed long after a hysterectomy?

Vaginal bleeding in the aftermath of a hysterectomy may seem scary and uncomfortable, but it's considered a common side effect of the surgery. In fact, The American College of Obstetricians and Gynecologists explained that it's normal for women to experience bleeding and vaginal discharge in the weeks following a hysterectomy. The bleeding can last for up to six weeks as the body needs time to heal and dissolve the surgical stitches, according to Healthline

For individuals who received a supracervical hysterectomy where their cervix is still intact, light periods may occur after their surgery due to the endometrial lining still being present in the cervix. Still having functioning ovaries can make it possible to continue ovulating monthly, according to Sutter Health. Women who have had their uterus and cervix completely removed by a radical or total hysterectomy shouldn't expect to have periods again, and bleeding long after the average healing time could be considered abnormal. 

Scar tissue can develop at the top of the vagina after a hysterectomy. The tissue is known as granulation tissue, and it can contribute to bleeding years after the surgery, according to MedicalNewsToday. Medical conditions like cancer or vaginal atrophy can also result in bleeding long after a hysterectomy. Vaginal atrophy occurs when a deficiency in the estrogen hormone leads to the lining of the vagina becoming drier and thinner, as reported by the Cleveland Clinic

When to see a doctor about post-operative bleeding

While a certain amount of bleeding is normal after a hysterectomy, you should seek the guidance of a medical professional if there's anything unusual about your bleeding. Excessive bleeding after a hysterectomy can be a sign of certain health complications, so it's important to monitor bleeding after surgery and be aware of what constitutes abnormal bleeding.

In rare cases, a hemorrhage, or bleeding from a damaged blood vessel, can occur after a hysterectomy (per Healthline). In a 2014 article published in the Journal of The Society of Laparoscopic & Robotic Surgeons, it was estimated that 1.3% of the hysterectomy patients who were studied experienced a secondary hemorrhage. Nevertheless, a hemorrhage can be life-threatening, so it's imperative to head to the emergency room when experiencing heavy amounts of bright-red bleeding after the procedure. Anyone with a high fever, breathing problems, or chest pain after their hysterectomy should also go to the emergency room.

Abnormal bleeding after the procedure can sometimes be an indication of organ injury, according to MedicalNewsToday. Although rare, a hysterectomy can damage the organs close to the uterus, like the bowel and bladder. In some cases, pelvic hematomas and vaginal cuff tears can also occur after a hysterectomy. A person should contact their doctor if their bleeding continues after six weeks, becomes heavier with time, and becomes darker in color. Bloody urine or bleeding from the rectum should also be reported to a doctor.