Post-Hysterectomy Supplement Management

Supplements to Avoid

• The American College of Surgeons and Mayo Clinic Proceedings recommend avoiding Ginkgo, as it displaces platelet-activating factor, decreasing coagulation and interacts with warfarin 1, 3
• The Mayo Clinic advises against Ginger, as it inhibits thromboxane synthetase with decreased platelet aggregation 1, 3, 4
• Garlic has antiplatelet effects and may increase bleeding, according to the Mayo Clinic Proceedings 1, 2
• Turmeric inhibits platelet aggregation via thromboxane metabolism and calcium channel inhibition, also inhibiting thrombin and factor Xa, as reported by the Mayo Clinic Proceedings 5, 6
• Vitamin E has antiplatelet effects related to protein kinase C inhibition, worsened when taken with aspirin, according to the Mayo Clinic Proceedings 5, 6, 7
• The Mayo Clinic Proceedings warns against the use of Bromelain, as it increases bleeding risk 1
• Policosanol may increase bleeding risk, as reported by the Mayo Clinic Proceedings 2
• Licorice root causes mineralocorticoid effects, hypokalemia, and fluid retention, according to the Mayo Clinic Proceedings 2, 3
• Yohimbine is associated with both hypotension and hypertension due to alpha-2 adrenergic blockade, as reported by the Mayo Clinic Proceedings 5, 6, 7
• Horny goat weed causes vasodilation through calcium channel blockade, according to the Mayo Clinic Proceedings 2, 3, 4
• Kava acts additively with opiates and benzodiazepines, causing excessive sedation, as warned by the Mayo Clinic Proceedings 2, 3, 4
• Lemon balm may result in additive CNS depression with sedatives, according to the Mayo Clinic Proceedings 2, 3
• St. John's wort is a potent inducer of CYP3A4, reducing plasma concentrations of many medications, including pain medications, as reported by the Mayo Clinic Proceedings 6, 9, 7
• Goldenseal has a high potential for drug interactions through CYP3A4 and CYP2D6 systems, according to the Mayo Clinic Proceedings 1, 3, 4
• Grapefruit extract interacts with multiple medications, as reported by the Mayo Clinic Proceedings 1, 3, 4
• Kratom has opioid-like properties and is explicitly not recommended by SPAQI, with the FDA warning against its use 2, 3, 4, 9, 7
• Marijuana/Cannabis inhibits platelet aggregation and has multiple drug interactions, according to the Mayo Clinic Proceedings 2, 3, 9

Safe Supplements to Continue

• Melatonin is safe perioperatively and may reduce anxiety and delirium, as reported by the Mayo Clinic Proceedings 2, 6, 9, 7
• German chamomile reduces anxiety without CNS interference, according to the Mayo Clinic Proceedings 1, 3, 4, 6, 9
• Passionflower has anxiolytic effects with a good safety profile, as reported by the Mayo Clinic Proceedings 2, 6, 9
• Lavender is safe for anxiety without anesthetic potentiation, according to the Mayo Clinic Proceedings 2, 6, 9
• Valerian is safe and may protect against cognitive dysfunction, as reported by the Mayo Clinic Proceedings 5, 6, 9, 7
• Omega-3/Fish oil is explicitly safe to continue and may support recovery, as stated by the SPAQI guidelines 8

General Principles

• The general principle is that supplements impairing coagulation should only be restarted once the risk of postoperative bleeding is minimal, as reported by the Mayo Clinic Proceedings 5, 6, 9
• Patients should always disclose supplement use to their surgical team, as lack of standardization in supplements creates unpredictability, according to Praxis Medical Insights 10