California State Codes: Health and Safety Code Section 1690-1691

  (a) Prior to the performance of a hysterectomy, physicians and surgeons shall obtain verbal and written informed consent. The informed consent procedure shall ensure that at least all of the following information is given to the patient verbally and in writing. 

1. Advice that the individual is free to withhold  and withdraw consent to the procedure at any time before the hysterectomy without affecting the right to future care or treatment and without loss or withdrawal of any state or federally funded program benefits to which the individual might otherwise be entitled. 

2. A description of the type or types of surgery and other procedures involved in the proposed hysterectomy, and a description of any known available and appropriate alternatives to the hysterectomy itself. 

3. Advice that the hysterectomy procedure is considered irreversible and that infertility will result, except as provided in subdivision (b). 

4. A description of the discomforts and risks that may accompany or follow performing of the procedure, including an explanation of they type and possible effects of any anesthetic to be use. 

5. A description of the benefits or advantages that may be expected as a result of the hysterectomy. 

6. Approximate length of hospital stay. 

7. Approximate length of time for recovery. 

8. Financial cost to the patient of the physician's and surgeon's fees. 

(b) A woman shall sign a written statement prior to the performance of the hysterectomy procedure indicating she has read and understood the written information provided pursuant to subdivison (a) and that this information has been discussed with her by her physician and surgeon, or his or her designee. The statement shall indicate that the patient has been advised by her physician or designee that the  hysterectomy will render he permanently sterile and incapable of having children and shall accompany this claim, unless the patient has previously been sterile or is post menopausal. 

(c) The informed consent procedure shall not pertain when the hysterectomy is performed in a life-threatening emergency situation in which the physician determines prior written informed consent is not possible. In this case, a statement , hand written and signed by the physician, certifying the nature of the emergency, shall accompany the claim. 

Section 1691 
 The failure of a physician and surgeon to inform a patient by means of written consent, in layman's language and in a language understood by the patient of alternative, efficacious methods of treatment which may be medically viable, when a hysterectomy is to be performed, constitutes unprofessional conduct within the meaning of Chapter 5, commencing with Section 2000, of Division 2 of the Business and Professions Code of the State of California 

Only you know how these things make you feel and how they affect your life. The pre-cancerous cells are a serious consideration.  You need to find out more about what this means.  Hysterectomy is major surgery and once done, there's no going back.  The doctor will most likely ask you whether or not to remove the ovaries while he is in there.  This is your decision to make and must be carefully considered by you.  It will help you to decide by thinking of the ovaries as being equivalent to a man's testicles.  They are equivalent and important to your future well-being.  Once removed, you can take ERT, but you will never be the same as if you had kept them.  Some women cannot take ERT because it causes side effects and some have family histories of cancer which makes it contra-indicated for them to have it.

>    I would be glad of any info/advice on 

•  any side effects

Hysterectomy will not give you a flat tummy.  It can result in lost libido and reduced orgasm in about 20% of women.  There is a whole litany of possible side effects from possible vaginal prolapse to punctured bowel or bladder (caused by an unskilled surgeon).  These, I think are rather rare. So far, after my July 96 hysterectomy, I have experienced the lost libido/reduced orgasm side effect and have changed my hormones  probably four times in the past year looking for the right balance.  There are good effects for many women.  The pressure and pain caused by the fibroids will be gone and many women find that their sex lives are better than ever afterward.  If you are able to keep your ovaries, you will have a normal menopause hormone transition only there won't be the bleeding symptoms to tell you it is happening.  You may have this transition earlier than intact women.
 
• Rough cost of procedure, incl Dr, anaesthesia, Hospital stay etc (apparently 3 days).   I am from England, but our insurance here in the US will not give me any idea of total cost - so I have no idea what my 20% co-pay will be.

I can't answer this as I never saw my bill.  It went to the insurance company only.  It seems reasonable that you should be able to get some kind of estimate from the doctor and from the hospital of what the average cost should be so that you can plan.  It will depend on how many days you need the hospital and whether or not there are any complications.
 
• Are most done by cutting thru the abdominal walls  - what about thru the vagina?

This is determined by the surgeon.  If the uterus is very large an abdominal incision is usually favored.  If there is suspected cancer, the abdominal is also preferred.  Otherwise it can be done vaginally by a skilled surgeon.
 
• Period of recuperation - how long not allowed to drive? 

That depends on you and how fast you heal.  It's really individual.  I didn't ask my doctor and he didn't volunteer the info.  Just told me to come into the office at 4 weeks.  I was in a great deal of discomfort still, but was able to drive my son to his summer job after one week.  That was without any pain medications.  You would not want to drive if you were on medications.  I had an abdominal incision.  The vaginal incision is supposed to heal faster.

I had a hysterectomy recently because I was so anemic that I was close to requiring transfusions.  I had fibroids, flooding (Alabama isn't the only "Crimson Tide"), constant pain, and I was really sick.  My biopsy showed the beginning stages of cancer. 

Prolapse, thickening, and enlargement of the uterus are not good things, but there is always a range.  If I were you I would want to consider *how* prolapsed, *how* enlarged, *how* thick.  How serious the conditions are would be an important factor in any decision I made. 

Based on that, if I were in your shoes again and knew what I know now, here's what I'd ask: 
 

1. I'd want a D&C or endometrial biopsy to check for cancer.
2. I'd ask if any alternative procedures would work.  Myomectomy, endometrial ablation, D&C, and progesterone, would all be things I would want to explore (actually, before my hysterectomy I did examine all of these things with two physicians).  I'd want to get the MD's opinion on outcomes, and I'd want numbers that I could compare--50% chance of success, etc.
3. I'd want to know how big the tumor is and if the Lupron shrunk it any. 
4. If a fibroid dies, it's very painful and you get very sick (this from a woman who studied for midterms during labor and has had root canals without anesthetic--I have a very high pain threshold and *I* thought tumor disintegration was unbearably painful).  I don't think the MD can tell without a biopsy if this is happening, but s/he should be able to predict the likelihood that it is, or will soon be, happening based on the size of the tumor.
5. What will happen if you do nothing, i.e., following your problems without treatment?  Your MD should be able to explain the benefits and consequences of doing nothing.
6. If you have tumors and cysts, how many, how large, how much do they threaten your health?
7. If you decide not to have the hysterectomy now, but decide that you want it in a few months, will it still be an option?  If you were taking Lupron to shrink the tumor to allow surgery, if you stop and don't have the surgery, would you have to postpone surgery and go back on Lupron if you decided you wanted the hysterectomy later?
8. How far does the MD think you are from menopause?  How long can you expect to have bleeding problems if the surgery isn't done?
9. How severe is your prolapse and could it be helped with pelvic exercises such as Kegels?
10. If you don't have a hysterectomy but have other surgery (cyst removal, ablation, etc.) will that delay your chance to have a hysterectomy if you decide you want one?

>I can just tell you, from my own perspective, it ain't all in the vagina!

Sorry, I should have been more clear when I said orgasms are vagal in origin.  What I meant was that the vagus nerve is responsible for the sensation of orgasm, according to the article I read.  The vagus nerve is responsible for a whole lot of other sensations too.  And I was tryingto figure if hysterectomy somehow affected the vagus nerve, or if affecting the vagus nerve would be a surgeon's error, while doing a hysterectomy.  Also wondering if changes in sexuality differed. from one patient to another, because of the surgical technique.  eg. vaginal vs. abdominal hysterectomy.

>> Which is only to say,  I am willing to rage against the physicians who made me a statistic in the Hysterectomy Industry , but for the sake of women here who might actually NEED a hysterectomy, I wouldn't want to say sexuality goes into the slop pail with the uterus.  I would first want to have some sense of how many castrated women actually experienced loss of sexuality.  I didn't. You did, I assume.  What would others say? 
> 
>Good assumption....I hope others comment.
> 
>> If some ended up with short vaginas, well there is NO surgery about which you can't find some horror stories.  There are some "butchers" among the ranks of surgeons. 
> 
>Shorter is how a total hyst is done.  There is a technique, Worelling, I believe, which maximizes the length of the vault.   I think short would depend on several factors, like how long it was before the surgery, how much the woman needs to accommodate her mate, as well as the skill of the surgeon.

another poster comments: 
I had a total abdominal hysterectomy/ bilateral salpingo-oophorectomy (TAH/BSO)(horizontal, hairline incision) one year ago.  After my surgery I was somewhat numb below the incision line for probably 6 or 7 months.  My doctor said that this was caused by nerves severed in the surgery.  Both my libido and my sexual response were less to non-existent after the surgery. I have taken 1.25 mg Premarin, tapering to .625 mg. over the year and currently take Estratest HS.  I don't know if it is the passage of time allowing my body to heal the nerves, or the addition of testosterone with the Estratest, but I am now finding some gratifying return of sexual response and desire.  I don't feel as though it will ever be the same as it was before surgery, but it is not totally gone and there is always hope that improvement can continue.  I am also realistic about the fact that I am getting older and it is normal to function differently for that reason.

As to anatomical changes- my doctor says that my vagina is now about three and a half inches deep, but very elastic.  It is adequate for my needs, but the HRT does not stimulate me to lubricate; so artificial lubricants are always needed.  Before surgery, I was heavy with fibroids and everything kind of sagged down.  Now, just as in the article Victoria posted, it all seems to be retracting inward some.  This is actually a relief- much more comfortable than before.  I can run and jump and not feel like something is about to fall out.
 

Yes, I have.  You are not alone.  I have a transverse scar from similar  surgery of July 1996.  If your experience is similar to mine, you should be  able to exercise in any way your energy level will allow after 8 weeks.  I  was able to return to my job of carrying mail at the post office - full  duty- after 8 weeks.  There were no lifting restrictions or hour  limitations.  As for exercise, you should listen to your body.  If you had a  transverse of 'bikini' incision, don't worry about splitting anything open.  The skin is cut across, but I think that the muscles are not cut at all.  They are spread apart for the surgery.  In any case after 8 weeks, you  should be able to do anything you used to do as far as physical limits are  concerned (this is based on my experience with my body).  Energy limits are  something else.  You may not be able to endure the way you could before  surgery.  You may find yourself tiring faster.  That is where you have to  listen to your body and give it a rest or don't push it too far too fast.  You may have to build up your endurance to the former limits- you didn't say  what kind of exercise you are talking about- are we talking power walking  around the block or are we talking Olympic cross country training???  I  found that it took a year for everything to seem healed.  I had the same  numb skin surrounding the incision from the cut nerves.  It took months for  this to mend, but it will eventually start to feel more normal.  I speculate  that nerves are also damaged which affect the sensation of orgasm.  Your  sexual response will possibly also not be where it will be for perhaps a  year.  Be patient with yourself and don't push too hard, but don't be afraid  to try.  You won't break ;-) 
fiona