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To Remove or Not to Remove: Should I Keep My Uterus?
Hysterectomy Explained
In honour of World Ovarian Cancer Day, May 8, 2017, we’re writing about hysterectomy – the surgery to remove the uterus – and explaining the ins and outs, as well as some of the controversies.
By age 60, about 1 in 3 women in the U.S. will have had a hysterectomy and between 20% to 40% of these surgeries may not be needed. There are many reasons why women absolutely need the procedure – and two key ones include a diagnosis of cancer and uterine prolapse. However, particularly during peri-menopause in our 40s, we believe we need to challenge the idea that going straight to a hysterectomy is the right solution for common gynaecological conditions such as fibroids and endometriosis. We agree with Dr. Oz, who calls the hysterectomy the most unnecessary surgery that women are having.
Our 40s represent a time in our lives when hormonal fluctuations lead to increased estrogen and the development of fibroids and endometriosis in many women (studies show between 30% and 60%). For many women, fibroids and endometriosis will resolve after menopause, when our hormones stabilize.
Personal Stories
Perri van Rossem is a yoga therapist who shares her story with us.
In 2015 I had a fibroid my doc found and it was the size of a grapefruit she said. With homeopathic care along with acupuncture and some good old fashioned patience it disappeared. No external interventions were required. I had to do some work which required slowing down, being still and trusting the process of life. I was peri-menopausal at the time. These sorts of changes are apart of natural aging. Knowing we have options and being willing to let your body, mind and soul age naturally may be uncomfortable for a while, but that is life.
Chia Chia also shares her story.
I am 47 and first had a diagnosis of small, pea-sized fibroids at age 43. The most common symptom that I am experiencing is a heavy flow during my periods. This heavy flow is definitely annoying and sometimes even concerning. During the first day of my flow, I may have to change a super tampon and pad every hour or two. This qualifies as “menorraghia” or heavy menstrual bleeding. Is there something wrong with me? The short answer is, “No.” The long answer is, “Yes, I am experiencing many of the common symptoms of peri-menopause.” My gynaecologist advises me that my fibroids will likely resolve and disappear as they do for most women.
I’ve met many women who have been advised to have hysterectomies and then proceeded with other options for management. My advice is, even if you’re in your 30s or 40s, to seek a gynaecologist who is also a menopause practitioner.
What are the options other than hysterectomy that women should consider? They depend on why hysterectomy is being suggested. If your gynaecologic issues are not interfering with your daily life and you can wait for them to resolve, then lifestyle management techniques, such as the ones Perri van Rossem used, can be employed.
| Condition | First treatment to consider | Second treatment | Third treatment |
|---|---|---|---|
| Heavy bleeding from fibroids | Lifestyle management or low dose hormonal pill | For women who can’t take hormones, a drug that blocks progesterone receptors | Less invasive procedures such as uterine fibroid embolization, endometrial ablation or removal via scope (myomectomy) |
| Endometriosis | Hormonal treatment | Endometrial ablation | |
| Pelvic pain | Exercise with a pelvic floor specialist | Mild over the counter pain medication |
For women who do need a hysterectomy, it’s important to understand the types of surgery that are available. They include a partial, complete or radical hysterectomy.
| Removal of: | Uterus | Cervix | Upper Part of Vagina |
|---|---|---|---|
| Partial | ✓ | ||
| Total | ✓ | ✓ | |
| Radical | ✓ | ✓ | ✓ |
A hysterectomy does not involve removal of the ovaries, a procedure that is called an oopherectomy. Sometimes both the uterus and ovaries are removed at the same time. Unless you are over 65 or you have an underlying condition such as cancer or a genetic risk, it is much better for you to keep your ovaries. Studies show improved long term survival when women keep their ovaries until age 65.
If you require a hysterectomy, please ensure that you and your surgeon discuss the three approaches – laparoscopic, open abdominal and vaginal. Know your surgeon’s comfort with each approach and the risks. Discuss your ovaries and understand the risks and benefits of removal versus leaving them in.
Once you and and your doctor have decided on having a hysterectomy, it’s important to understand how it affects your menstrual cycle and future health.
If your ovaries are removed, you will go enter menopause fairly quickly – this occurs once your body has depleted any hormonal stores which is usually within 1 to 2 weeks. You may wish to use hormonal treatment if you are able to. If you are unable to take hormones, then management of menopausal symptoms with exercise and diet is important. A menopause practitioner can provide you with a management strategy.
If you still have your ovaries, you will have menstrual cycles but not a period. Once you reach the age when your menstrual cycle would have naturally ended, you will experience menopause.
After hysterectomy, your surgeon will provide you with exercise and movement recommendations for the first 1 to 8 weeks. Once you are given the green light to exercise, a physiotherapist with pelvic floor training can provide you the information you need to exercise the deep pelvic floor muscles. This will help prevent the muscle opening at the vagina from becoming weak, and may help prevent prolapse.
Once the pelvic floor muscles become weak, you may have trouble with incontinence of urine and rarely, stool. Avoid this by exercising and maintaining a good body weight. Many women find that pain associated with sexual intercourse is improved after hysterectomy. If painful intercourse continues or worsens after hysterectomy, then speak with your surgeon.
We hope that you find this information helpful. For more information, please join Chia Chia Sun during her live coffee chat with www.CelebrateWomanToday.com on Wednesday, May 17th. You can ask her any questions at 10:30 am Eastern time or throughout the day by going onto the website and posting your questions.
References:
Why hysterectomies are unnecessary
Search for North American menopause practitioners
Medical literature overview
Pellicer, Antonio, “Overview of Current Trends in Hysterectomy,” Expert Rev of Obstet Gynecol. 2009;4(6):673-685.
Contributors:
Chia Chia Sun is CEO of Damiva, a women’s health company that develops and sells 100% natural feminine moisturizers, including a vaginal moisturizer, Mae and a labial skin cream, Cleo.
Dr. Rardi van Heest is a General Surgeon at William Osler Health Services. She is a Performance Improvement Expert and specializes in Breast Surgery.
Perri van Rossem is a yoga therapist for whom pelvic floor health is a specialty and personal passion. After 3 vaginal deliveries of children all over 10 lbs, she embarked on an in depth study and practice, and discovered how to rehabilitate her own muscles and restore structural support. For over 10 years she has been guiding her students to discover their journey toward healing and well-being. www.livingstudios.ca.