| When
is hysterectomy necessary?
Lianne McNeil wrote:
I originally posted this on Oct. 24, 1996. It is drawn from: THE
NEW OUR BODIES, OURSELVES, by the Boston Woman's Health Book Collective;
Touchstone, Simon & Schuster; c. 1992.
Now
I want to make some comments:
FIRST GROUP
A number of
life-threatening conditions may REQUIRE hysterectomy, including:
-
Invasive cancer of the
uterus, cervix, vagina, fallopian tubes and/or ovaries.
-
Severe, uncontrollable
infection (PID) Better antibiotics need to be developed,
to prevent this from making a hysterectomy necessary.
-
Severe, uncontrollable
bleeding. Surely there are surgical techniques available
now that would stop the hemorrhaging?!
-
Life-threatening blockage
of the bladder or intestines by the uterus or growth in the uterus.I
believe that a careful surgeon could repair this without having to remove
the entire organ.
-
Conditions associated
with rare but serious complications during childbirth, including rupture
of the uterus. I don't think this mandates a hysterectomy any more.
I have read stories about veterinarians repairing similar uterine emergencies
in animals -- why can't people doctors do it, too? Uterine rupture
can be repaired. It may not be possible to have any further pregnancies
after such, but since the uterus provides beta-endorphines and other valuable
functions, it seems like a good idea to retain the uterus whenever
possible.
>>>>>Rupture
can be repaired but there is at least one uterine injury that still mandates
immediate emergency hysterectomy - placenta accreta(?sp) when the placenta
has grown into the muscle fibers of the uterus and cannot be separated
from it, even if the abdomen and the uterus are opened. I know about this
one because it happened to my sister-in-law after her daughter was
born four years ago. It's rare but it does happen. (Tetje)
SECOND GROUP
Some conditions
that are not life-threatening but may JUSTIFY hysterectomy, including:
-
Precancerous changes
of the endometrium (hyperplasia).Haven't effective
non-hysterectomy treatments of this condition been developed yet?
If not, why not?
>>>(sarcasm
follows) Because, Lianne, "endometrial cancer is easily cured with hysterectomy."
That's the argument used when the carcinogenic properties of estrogen are
pointed out. Hysterectomy is a "nothing" surgery - no side effects, no
problems, just benefits. You thought your uterus was important ? served
a purpose beyond a place to carry a baby ? silly you. The money which might
have been used on this silly research is better spent on finding cures
for male baldness, or ways to keep men operating at their sexual peak when
they're 60. (Ever wondered about the logic of feeding women drugs to increase
their libido, so you have to feed men drugs to increase *their* libido
and potency so that they can keep up with their chemically enhanced partners?
-
Severe, recurring pelvic
infections. Ditto for this one.
-
Extensive endometriosis,
causing debilitating pain and/or involving other organs.
-
Fibroid tumors that
are extensive, large, involve other organs or cause debilitating
bleeding. In most cases those can be removed without
having to take out the uterus. I think the reason, in most cases,
that they aren't are that surgeons are lazy, or unskilled.
-
Pelvic relaxation (uterine
prolapse).From what I've read, doing a hysterectomy
for this may cause or worsen cystoceles and rectoceles. So I'm not
convinced that removal of the uterus is the best remedy. In most
cases, a skillful surgeon should be able to tack it back up.
THIRD GROUP
Hysterectomies
are frequently performed UNNECESSARILY for the following reasons:
-
Small fibroids that
are not causing problems.
-
Abortion (during the
first and second trimesters).
-
Sterilization
-
Cervicitis
-
Mild dysfunctional uterine
bleeding. I have a friend who has had a hysterectomy
recommended for what I believe is this reason. Perhaps when
her test results come back we'll know more about what is causing
her excessive bleeding.I'm going to recommend that she read Dr. Goldfarb's
book, _The No Hysterectomy Option_ by Herbert A. Goldfarb, MD (c.
1990) pub. by John Wiley & Sons 605 Third Ave. New York, NY 10158-0012;
ISBN 0-471-53232-0, before she agrees to a hysterectomy.
-
Pelvic congestion (menstrual
irregularities and low back pain.)
Yes,
I know -- who am I to be suggesting what doctors SHOULD be doing, especially
since I'm not one and not able to do those things myself? Even so, I do
believe that we need to have the expectation that our uteruses are important
even after childbearing, and need to be preserved, not removed just because
it's easier than fixing them.
Lianne |
>before
I had my TAH/BSO, I was:
:
> 1) Bleeding 2/3 of each month, on 20 mg. Provera, 10 days/mo.;
:
> 2) In considerable pain;
:
> 3) Anemic.
:
I'd just like to
interject an observation here: I, too, had the above symptoms. In
fact, I was bleeding constantly and, at one point, went almost three
straight months without much relief. What I'd like to repeat, just
for general information's sake, is that, though my symptoms were
indeed horrific, *they went away with full menopause*. In
other words, I waited it out, and here I am a year later with no
bleeding, still have all body parts and take no drugs of any sort. I
repeat...horrible symptoms, but *they were temporary* and went away
once my hormone levels had settled down. I tried provera and estrogen
plus provera, but they never stopped the bleeding. Things got gradually
better after I completely got off of the hormones; improved my diet
and brought the anemia under control and began an exercise program.
Bottom line: you may not need any surgery, much less the full TAH/BSO
if you have severe bleeding/flooding problems - even as bad as mine
were.
The only caveat,
of course, is the ability to hang in there may vary with your job
and personal circumstances. I'm fortunate to be an academic with
a flexible schedule and was able to take it easy for 2 months to
get myself straightened out. I'm lucky because I now feel better
than I have since my 30's - my personal measure of feeling great
since I was extremely active at that time with 2 little kids, a full-time
student and running 40-50 miles/week.
A couple more thoughts
I had with respect to the TAH/BSO as a cure for bleeding: It sure
seems extreme to remove healthy body parts. In my case there was
*nothing wrong with these organs themselves,* I was having
hormone swings from peri that were exacerbated by the drugs, making
the bleeding even worse.
Secondly, the
doctor assumed I would be taking pills for the rest of my life if I'd had
this surgery. I was not at all comfortable with this prospect, and have
had my fears substantiated in the case of my mother-in-law.
Recently, my mother
in law, who had a TAH/BSO over 25 years ago, has developed problems
connected with processing the estrogen pills. She took premarin for
many years and ogen for the last 5-6 years. Recently, she's had problems
with severe mood swings, hot flashes and general malaise associated
with perimenopause.Tests she had indicate her liver is now damaged, so
the hormones aren't being delivered to her system in an even manner.
The doctor wouldn't say for sure, but suspects the oral estrogen
pills caused the damage. (She's a teetotaller, if anyone is interested,
so that cause is out!) She's also had a couple of other hysterectomy/estrogen
problems in the past, including gallbadder and incontinence problems.
Her doctor is reluctant to try to wean her completely off of hormones entirely.
At her age of 76, this might be an undue hardship, so he is going
to have her try a patch. The irony is that her original surgery was
for precisely the same problem I had: severe bleeding at perimenopause.
She asked to have her operation and has always seemed happy about
it, and even tried to talk me into getting one last fall....thanks,
but no thanks! |
My sister had her hysterectomy for cervical cancer and it was the
most extreme solution to the problem. What makes her angry now, since
apparently total hysterectomy wasn't the only solution, is that no one
mentioned a thing to her about the possibility of the many problems she
now faces. It's not just absence of libido, but of something there's
no real word for that underlies joy, energy and creativity. Had she
known any of this in advance, she would never have had the total
hysterectomy. She had such a terrible reaction to the estrogen (both
patch and pill) that she hesitates to try it again...so you're right, she's
between "a rock and a hard place." Too bad no one mentioned these things
to her BEFORE the surgery.
. There are many types of estrogen available these
days. If one did not agree with her perhaps another will. She
should keep trying. I feel almost 98% better now and "normal" again.
An estrogen deprived woman can become almost psychotic!!! I've taken
several types of estrogen before we found 1 that worked best. It's
a real pain but she should not give up. Also for libido she will
need small amounts of testosterone. She should read the book "Hysterectomy
before & after". They never tell you anything before surgery,..
they're afraid they'll scare you off and lose all that $$$ (about $6 to
$7,000 in my area). If they RUIN your life they could care less!
If you ask questions or complain they think of you as a neurotic woman
and suggest a shrink (therapy). It's sickening....
Carol
(another poster)
I am very much like your sister - hysterectomy for
cervical cancer and feel like if I knew then what I know now, I never would
have agreed to it. However, I also am on estrogen now and am grateful for
that. I, too, had to try more than one kind to find one that worked
and didn't mess with my mind. I don't think that she should give up on
trying to find one that works for her just yet
Did
your doctor present other alternatives to hysterectomy?
I'm
ashamed to say, no, he didn't, and I didn't ask as at that time in my life.
I was having other problems emotionally that made it easier for me to just
go along with him. I was having major anxiety problems and just couldn't
deal with it. It was so bad at that time that I even took a
friend with me to the doctor as I knew that I wouldn't be able
to comprehend what he was telling me. Ignorance is definitely
not bliss. I am a much stronger and healthier woman in all
ways 11 years later. However, I no longer have a uterus. |