Women’s Health

Women may face several different gender-specific surgeries throughout their lifetime ranging from a Caesarean section (C-section) to breast reconstruction. Whether your surgery is a medical necessity or choice, it’s important to have an educated discussion with your doctor about how to manage pain after your procedure. These conversations are especially critical in light of new research that proves women are more likely than men to become persistent opioid users following surgery.

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To ensure patients and caregivers know what to expect, let’s explore these procedures in greater detail.

Caesarean Section

A Caesarean section, also known as a C-section, is a type of surgery used to deliver a baby. By making an incision through the lower abdomen and uterus, a doctor can safely remove a baby in a matter of minutes — which can be ideal if there are unforeseen complications or other delivery-related considerations. If it’s a planned C-section, most doctors will wait until you’re at least 39 weeks to ensure the baby is fully developed.

Following a C-section, you can expect to spend 2-3 days in the hospital. It’s a major surgery and takes longer to recover than from a vaginal birth. There have been studies that show that the use of injectable non-opioid options during C-sections can provide long-lasting pain relief with fewer or no opioids, decreased complications after surgery, and a shorter hospital stay as a result of better pain control and enhanced recovery.

Once you return home, rest when you can and try not to lift anything heavier than your baby for the first few weeks. You’ll also want to keep your incision clean and alert your doctor at any sign of infection, such as fever, discharge or severe pain.

Although more than half of women undergoing a C-section are prescribed opioids, many are concerned about the side effects from these drugs, including the potential impact on breastfeeding and the ability to feel “fully present” in the days following birth. There are effective non-opioids available that can manage pain following a C-section, without some of the bothersome side effects such as constipation and dizziness.

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Hysterectomy

A hysterectomy removes part or all of the uterus (also known as the womb), ultimately ending a woman’s menstruation and her ability to become pregnant.

and will affect more than a quarter of all women in the United States by age 60. A dropped bladder and cancers of the reproductive system — such as the uterus, ovaries and cervix — are the most common reasons to have a hysterectomy. However, younger women may also face a hysterectomy due to other medical conditions including chronic pain, endometriosis or fibroids.

Recovery time varies by patient and the type of hysterectomy performed. With a minimally invasive procedure, you may be sent home the next day; however, if a large surgical incision is made in the abdomen or if your hysterectomy is related to cancer, you may need to stay in the hospital for a few days. Once you are home, its common to be tired and experience pain for an average of 4-8 weeks after surgery. To avoid any complications as you heal, do not attempt strenuous activity until your doctor provides you with medical clearance.

A hysterectomy can be a complicated journey for a woman, as removing these reproductive organs adjusts the hormone levels in the body and brings on uncomfortable menopause symptoms such as hot flashes and mood swings. Don’t forget to talk to your doctor about managing these symptoms and pain following a hysterectomy. Research shows that more than 7 percent of hysterectomy patients will become persistent opioid users, but there are effective non-opioid options that can administered during surgery that can reduce or eliminate the need for opioids following a hysterectomy.

Fibroids

Fibroids are non-cancerous, abnormal growths that develop in or on a uterus and are frequently found during a routine pelvic exam. Also referred to as uterine myomas, leiomyomas or fibromas, most fibroids (80 percent) develop by the age of 50, and several factors may influence their development including weight, age, family history and ethnic origin. Women approaching menopause are at risk for fibroids based on their exposure to high levels of estrogen. You may need to have fibroids surgically removed if you have large or multiple growths, or you develop severe symptoms such as prolonged bleeding, back and stomach pain, heavy periods and increased urination.

It will be important to discuss your treatment choices with your doctor, as options can range from minimally invasive procedures such as a laparoscopic or robotic myomectomy to a hysterectomy.

The length of your recovery will depend on the type of procedure and number of fibroids that were removed. For example, an abdominal myomectomy involves a larger incision as it provides full access to the uterus, allowing your surgeon to remove larger, multiple or more complex fibroids, that may have grown deep into the uterine wall. Since this is an invasive procedure, patients will stay in the hospital for a few days and may take 4-6 weeks to fully recover. Alternatively, if your fibroids are smaller, your doctor may suggest a minimally invasive myomectomy, which involves small incisions in your abdominal area and may even be a same-day procedure.

When discussing what treatment option is best, be sure to also ask your doctor how your pain will be managed following surgery. It’s common to be sore, feel weak and have spotting, but restricting your activities and getting plenty of rest is important. Keep in mind women ages 40-59 are being prescribed more opioids than any other age group, so ask your doctor about available non-opioid options to manage pain after surgery.

Breast Reconstruction

Breast reconstruction is a surgery that allows a woman’s breast(s) to be rebuilt following a mastectomy (entire removal of the breast(s) to treat or prevent breast cancer) or lumpectomy (removal of a lump from the breast). The surgery may occur at the time of mastectomy/lumpectomy or be delayed until a later date. Conducted by a plastic surgeon, there are 2 primary ways a breast can be reconstructed: implant-based where an implant made of saline or silicone is used to shape the breast; or flap reconstruction, where a surgeon takes tissue from another area of the patient’s body to create a new breast. Breast reconstruction accounted for 1.9 percent of all reconstructive procedures, with more than half of all procedures conducted among women between the ages of 40-54 .

The length of your recovery will depend on the type of breast reconstruction you have. The average hospital stay for an implant is 1-2 days, but patients undergoing flap reconstruction may be kept in the hospital for 5-6 days. Since soreness, swelling and bruising are common the first few weeks following surgery, you may be sent home with a pain medication. In addition, you will likely be discharged with a small tube that will drain fluid from the surgical site.

Taking care of yourself during the recovery period will help you get back on your feet faster, including the ability to resume normal physical activity. Ask your doctor about pain management options prior to surgery. You might find that a long acting non-opioid injected during surgery is an option for you to manage pain with limited or no exposure to opioids.