Hysterectomy: Making a Decision
It is estimated that over 1000 hysterectomies are performed each week in the UK and that number totals more than 11,000 in the US. Hysterectomy is the most commonly performed operation, and it has, over the past decades, been used to 'solve' all manner of female problems. Hysterectomies are rarely performed to save lives, many are unnecessary and the most common reason for a hysterectomy is heavy periods. Frankly, the removal of a fundamental part of a woman's body for this reason is nothing short of scandalous.
It may be that you do need a hysterectomy for legitimate medical reasons, but before you make that decision you need to know what choices are available to you and whether there are other ways of approaching the problem. The majority of hysterectomy operations are not necessary, but many women are unaware that there are viable alternatives. If, in fact, your hysterectomy is necessary, there are still choices to be made. Should you keep your ovaries? Can your cervix be left in place? There are many, many options available to most women, but to make an informed decision, you need to know the facts. All of these points will be covered in detail below and in the rest of this chapter.
Some time ago I was speaking at a seminar on Pre-menstrual Syndrome (PMS). One gynaecologist stood up to outline his solution to the problem, which involved a total hysterectomy, removing the ovaries as well. The logic behind this was that if a woman did not have a cycle, she would not suffer from pre-menstrual symptoms! This 'treatment' was offered even to young women, in the midst of their childbearing years. Certainly the PMS symptoms would be wiped out, but what these women probably would not know is that a radical hysterectomy involving the removal of the womb and the ovaries would plunge them straight into the menopause, with all the its symptoms. So, for example, the irritability of PMS would be traded for hot flushes. The solution to early menopause and its symptoms? HRT (Hormone Replacement Therapy). It doesn't take a rocket scientist to work out that dealing with the PMS symptoms would be a much more viable, and healthy, solution.
It is this sort of radical 'treatment' option that you need to question. Always remember that it is your body, and you will almost always have choices. Educate yourself on the options, and make your decision after seeking a number of different opinions.
What your doctor might tell you
It may be suggested that you should have a hysterectomy for any of the conditions below:
heavy periods
fibroids
endometriosis
prolapse
pelvic inflammatory disease
cancer
All of the conditions mentioned above, apart from cancer, are covered in separate sections on this web site. In each section, I outline the ways to deal with that condition from both a conventional and a natural point of view. In other words, there are a variety of viable treatment options that do not involve hysterectomy.
In every case, hysterectomy should be a last resort, except in the case of cancer where your life may be at stake. The information detailed below relates to any other condition apart from cancer, where you will not have the same choices available to you.
Questions to ask yourself before considering hysterectomy
1. Can I live with the symptoms?
2. Do the symptoms affect my quality of life to the extent that it prevents me from doing things I would like to do?
3. Have I tried all the alternative medical treatments?
4. Have I tried the natural approach?
5. Do I want to have children or to have more children?
If you decide that a hysterectomy is inevitable then you need to ask yourself two questions:
1. What kind of hysterectomy should I have?
2. Should my ovaries be removed at the same time?
Keeping your ovaries
Your ovaries produce the hormones, oestrogen, progesterone and testosterone. If your ovaries are removed, your body will suddenly enter a state of surgical menopause, which can be enormously traumatic both physically and emotionally. When the female hormone supply from the ovaries is cut off, your body literally goes into the menopause overnight. On the other hand, a natural menopause (even if you don't have a womb) can take anywhere from 15 to 20 years, as hormone levels gradually decline.
Premature menopause is normally classed as taking place before the age of 40. If you are younger than 40, and require a hysterectomy with your ovaries removed, you will be pushed into a premature menopause. That means beginning HRT because you cannot risk being without important female hormones for a long period of time. It has serious implications for your bones (see Osteoporosis section), among other things.
A hysterectomy over the age of 50 (the average age of menopause) won't have quite the same implications because you will have a naturally lower level of oestrogen in your body, and will be unlikely to experience a shock as the supply is cut off. It may be enough to use the The New Natural Alternatives to HRT, and to ensure that your bones are regularly monitored for signs of osteoporosis (see Osteoporosis section).
Protocol in some hospitals dictates that whenever the ovaries are removed during a hysterectomy, oestrogen implants are inserted straight after surgery. The pellets that are inserted contain a type of oestrogen that does not dissolve evenly, and it appears that controlled doses are not always maintained, causing overdosing.
When a woman has had a hysterectomy she is given HRT in the form of oestrogen only and not as combined oestrogen and progestogen. If you take HRT after a hysterectomy, you will only be given oestrogen. Normally HRT is a combination of oestrogen and progestogen because if oestrogen is given on its own then there is a risk of womb cancer (because oestrogen will build up the lining of the womb). When the womb is removed progestogen is not needed so only oestrogen is prescribed.
This also raises the issue of whether or not you want to go down the HRT route. If you do decide to try hormone replacement therapy, there are a number of different ways that it can be administered (see Menopause section)
What are your choices?
I have detailed the various options that you have regarding how the surgery is performed in the rest of theHysterectomy e-book at The Natural Health Practicewhich can be downloaded .
Supplements
I would suggest you take a programme of supplements leading up to the operation and start them again after the surgery. The aim is to keep you in good health in order for your body to cope as comfortably as possible with the trauma of the operation.
Multivitamin and Mineral
A good quality multivitamin and mineral would form the foundation of your supplement programme to make sure that you are getting a 'little bit of everything'.
Certain nutrients such as vitamin C, zinc and garlic are included to boost your immune system. I have also included acidophilus which you should take before and after the operation. You will probably be given antibiotics after the surgery, to prevent infection, but these can, unfortunately, upset the balance of bacteria in the gut and give you attack of thrush. There can also be distressing digestive side-effects, such as nausea and diarrhoea. Acidophilus helps to build up the 'healthy' bacteria in the gut, which can minimise later problems.
Vitamin E can be extremely useful to speed up wound healing and to reduce scarring. Get some pure vitamin E oil or buy capsules of vitamin E, which can be broken open and rubbed into the scar. Check with your doctor before trying this.
Vitamin E can be taken by mouth as well after the surgery and this can help post-operative complications caused by blood clots. Once again, however, check with your doctor before taking this vitamin. If you have already been given medication to thin your blood, such as aspirin, you may have too much of a good thing.
Coping with surgery
One of the best things you can do following surgery, and even leading up to the operation itself, is to see a good homeopath for suitable remedies. These can make a big difference to how you feel after surgery, and improve your rate of recovery dramatically.
You want to be as healthy as possible before, during and after the surgery to allow your body to recover quickly and to fight off any infections. Follow the dietary recommendations in the Foundation of Health page. Unless you have an emergency hysterectomy (which is not common, unless cancer has been diagnosed), you will have time to begin eating well long before you go into hospital. This can make a great deal of difference to the healing process.
In particular, it is important that you give up alcohol in the lead-up to the operation. You will be given drugs, anaesthetics, painkillers and many other toxins over the course of the operation and follow-up treatment, and you will need your liver to work efficiently to eliminate these from your system.
Start weaning yourself off tea and coffee and anything else containing caffeine (such as colas, chocolate and others) as soon as possible. It is now known certain postoperative symptoms are not caused by the effects of the anaesthetic, as previously thought, but by caffeine withdrawal. Before a general anaesthetic patients are asked not to eat or drink for a number of hours and by the time they come round from the operation the withdrawal symptoms have already started.
Eat foods that help to boost your immune system. These include plenty of fresh fruits and vegetables. Include fresh garlic in your diet for its immune-boosting properties.
While you are in hospital, do the best you can with the hospital food and choose the healthiest options.
Herbs (see caution below)
Herbs can be taken before you enter hospital, in order to encourage healing and to increase your chances of avoiding postoperative infections.
Echinacea
Echinacea is useful for boosting immune system function as it can increase white blood cell count and activity. This increase can help the body engulf abnormal cells. Echinacea appears to be more effective when taken on and off. Take for 10 days, stop taking it for three, and then take it for another 10 days.
Caution
You should not take any of the above herbs if you are taking, The Pill, Fertillity drugs, HRT or any other hormonal treatment or other medication unless they are recommended by a registered, experienced practitioner.
Your supplement plan
A good multivitamin and mineral tablet
Vitamin C (1000mg per day)
Zinc citrate (30mg per day)
Garlic capsules
Acidophilus
The section above forms part of a larger 8 page chapter on Hysterectomy taken from my book, . In the rest of the chapter you will learn what the medical approaches to hysterectomy are and how to combine them with the natural approach. This is called Integrated Medicine and is the way that healthier of the future is moving towards. Each treatment is then discussed and the pros and cons of the options explained. The Integrated Approach to hysterectomy is considered in some detail so that if appropriate you can know how to combine the best of both conventional and natural medicine.
At the end of the chapter is a practical step by step summary of what you can do to help yourself
Hysterectomy
What is it?
Hysterectomy is the surgical removal of the uterus. The uterus is a pear-shaped organ located at the top of the vagina. A hysterectomy can involve other reproductive organs in addition to the uterus, depending upon the reason for the surgery. A woman who has had a hysterectomy will no longer have a menstrual period each month and will no longer be able to have children.
Who needs this procedure?
A hysterectomy is the usual treatment for women with uterine, ovarian, or cervical cancer; severe endometriosis; fibroid tumors that are causing bleeding and other complications; or heavy, uncontrollable vaginal bleeding. It may be necessary as treatment for prolapsed uterus, in which the uterus protrudes through the vagina; pelvic inflammatory disease; and endometrial hyperplasia, which is a potentially precancerous condition. It has also been used as a permanent sterilization procedure to prevent pregnancy. Hysterectomy is the second most common operation performed in the United States.
How do I prepare for this procedure?
If you and your doctor decide a hysterectomy is the best treatment for you, you will need to sign a release form showing you understand the procedure and giving the doctor permission to perform the operation. Your doctor will order blood and urine tests before the surgery. You’ll meet with the anesthesiologist to talk about the type of anesthesia you will have for the surgery. With a local anesthetic, you will remain awake and only the part of your body where the incision is made will be made numb so you don’t feel any pain. A general anesthetic makes you feel as if you are in a deep sleep so you don’t feel any pain. Follow all instructions provided by your doctor concerning food and drink before your surgery. Generally, you should not eat or drink anything after midnight. If you normally take medications, check with your doctor about how to take them the morning of your surgery. You may need to use a laxative or enema before the surgery to empty your bowels. The day of your surgery, you’ll receive an intravenous (IV) line in your arm for fluids and medications. You may also have a catheter to drain urine from your bladder until you are able to urinate on your own. Both the IV and catheter will be remove within a day or two of your surgery.
How is this procedure performed?
The type of hysterectomy you need depends upon the reason you need the surgery. In a total hysterectomy, the uterus and the cervix are removed. This is the most common kind of hysterectomy, usually performed for uterine and cervical cancer. When the fallopian tubes and ovaries are removed along with the uterus, it is called hysterectomy with bilateral salpingo-oophorectomy. This procedure may be performed to reduce the risk of ovarian cancer. A subtotal, or partial, hysterectomy removes only the uterus and is used to treat fibroids, abnormal bleeding, or pelvic pain. A radical hysterectomy removes the uterus, cervix, ovaries, oviducts, fallopian tubes, top part of the vagina, lymph nodes, and lymph channels. It is performed when cervical or endometrial cancer has spread to the cervix, and has the longest recovery period. Hysterectomies can be performed abdominally or vaginally. The choice depends upon your doctor and the type of hysterectomy you need. With an abdominal hysterectomy, the surgeon makes a cut in the abdomen, similar to a cesarean section, through which he or she removes the uterus and other reproductive organs, if necessary. An abdominal hysterectomy accounts for most of the hysterectomies performed in the United States. It gives the surgeon a good view of the uterus and other reproductive organs, allows the surgeon to remove even large fibroids, and gives the surgeon room to work around and see any adhesions (scarring) from previous surgeries. However, abdominal hysterectomy does leave a scar, has some discomfort associated with the recovery period, and has a longer recovery period than the vaginal hysterectomy. With a vaginal hysterectomy, the incision is made near the top of the vagina. Through this incision, the surgeon can cut and tie off the ligaments, blood vessels, and fallopian tubes. The uterus is then cut free and removed through the vagina. The surgery and hospital stay are shorter than the abdominal hysterectomy and women usually return to normal activities after around four weeks. The vaginal hysterectomy is less painful than the abdominal procedure and leaves no exterior scar. However, if you have large fibroids or need more than just the uterus removed, the vaginal hysterectomy is not possible. Because it is difficult for the surgeon to actually see the uterus and surrounding tissue during the vaginal procedure, he or she may use a laparoscope. This is a slender tube equipped with a tiny camera and is inserted through a small incision below the belly button. The surgeon can then see the uterus on a television monitor. He or she uses small instruments inserted through two other tiny incisions in the abdomen to cut and tie off the blood vessels, fallopian tubes, and ligaments. The uterus is then removed though a small incision at the top of the vagina. The hospital stay is very short, and women generally recover within two weeks. However, only very skilled surgeons are able to perform the laparoscopic-assisted vaginal hysterectomy.
What can I expect after the procedure?
The time you must stay in the hospital and your recovery period depend upon the reason for your surgery, the type of surgery you need, and how the surgery is performed. Your doctor can provide you with these details.
Self-care tips
Follow your doctor’s instructions carefully during your recovery period. Avoid heavy lifting, get plenty of rest, and have regular checkups after the surgery. Always contact your doctor if you experience heavy bleeding, fever, nausea or vomiting, dizziness, pain during urination, a leaking or open incision, or leg pain, swelling, or redness. If you have both ovaries removed, you will benefit from estrogen replacement therapy to reduce the risk of heart disease and osteoporosis (brittle bone disease). Some women experience changes in sex drive and some weight gain after a hysterectomy. Seek support and advice from your doctor on these issues.
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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.