You
know what a hysterectomy is. It's surgical procedure in which a
woman's uterus, sometimes her ovaries, is removed. And you
probably know that a lot of women have the operation and that the
surgery has a reputation for being performed unnecessarily.
But
you may not know what you would do if your doctor said, " you need a
hysterectomy."
A
controversial " Cure "
Hysterectomies
are the second most common operation. From 1988 through 1991, an average
of 564,00 hysterectomy operations were done in the USA. The surgery is
performed most often of women in their early forties.
Controversy
surrounds hysterectomy
Experts say about 25 percent of the operations
are unnecessary. Gary Lipscomb, Assistant professor in the
Department of Gynecology at the University of Temmessee in Memphis, concedes
that hysterectomies are sometimes performed when they're not medically
warranted. In these cases, he says, doctors may err on the side of
surgery in stead of other approaches for a number of reasons.
"
We are trained to be aggressive in managing decease, " says Dr.
Lipscomb, "and doing surgery is an active approach to problems, in
stead of a more passive approach. There's an old adage among
surgeons in general that a chance to cut is a chance to
cure."
Another
reason some hysterectomies are done is that women suffering from heavy
bleeding ask for the procedure as a way to stop it, says Dr. Lipscomb.
Such hysterectomies may be medically unnecessary, but they may be appropriate
as far as the women is conceded, he says.
Also,
some patients want treatment that will give them immediate results, so
even when they are offered less invasive treatments that may take
a while to be effective, they choose hysterectomy, he say.
Finally,
some doctors may not offer alternative reproductive surgeries if they can't
perform them as well, says Philip Brooks, Clinical Professor of
Obstetrics
and Gynecology at the University of California, Los Angeles. "Not all doctors are competent in all
procedures," he says. So if a doctor is better at removing
the uterus than he is at removing fibroids, for example, he may
offer hysterectomy alone.
The
decision to have a hysterectomy is not an easy one . It's major
surgery that involves incisions, a stay in the hospital , anesthesia
and painful days afterward. It can also trigger physical,
psychological and sexual changes, many of which doctors
can't predict. If the ovaries are also removed , the surgery will
cause a women to have sudden, early menopause and then
there's the one definite consequence that's irreversible- the loss
of the ability to bear children.
So
women may wonder " Do I really need this procedure ? Am I doing the
right thing?' Some women don't-
they leave it up to their physician. " For some women who are
having a lot problems, they just wait to get it over , " says
Linda Bernhard, R.N Ph. D, Associate Professor of nursing and women's
studies at Ohio State University in Columbus. " That puts women in
a very vulnerable position to have some nice physician say. Well,
we can fix you all up . We'll just take it all out, and then
everything will be better."
But
women can get involved , take control and make the decision
that's right for them.
Not
All Procedures are Alike
Hysterectomy
is most clearly warranted when a woman has cancer or serious, life
- threatening complications during childbirth . Other
conditions for which doctors might recommend or perform
hysterectomies include fibroids, heavy bleeding, endometriosis
prolapsed uterus, pelvic pain and pelvic inflammatory disease, although when the surgery is necessary
for threes conditions is less clearly defined.
There
are different types of hysterectomies. A total hysterectomy, for
instance. removes the uterus and the cervix, while a partial hysterectomy
removes only the uterus .
There
are also different methods of doing a hysterectomy. In an abdominal
hysterectomy the uterus is removed through an incision in the vagina. The vaginal surgery in less
invasive and
recovery is easier than with the abdominal procedure.
In
the 1990s, new techniques have been developed using laparoscopy. During
the procedure, a laparoscopy, a surgical microscope at the end of a
viewing tube, is inserted through and incision in the
navel, allowing physicians, to view the woman's reproductive area, says
Dr. Lipscomb. They can then determine whether a vaginal procedure would
be likely to be effective.
In
cases where a traditional vaginal hysterectomy might prove difficult to
do, miniature operating instruments can be inserted through other small
openings in the abdomen and the uterus removed vaginally under
laparoscopic guidance. This is known as a laparoscopic assisted
hysterectomy .
In
any of these procedures, doctors may recommend the removal of one or
both ovaries in a procedure called an ophorectomy. Some doctors
advocate removing the ovaries in women who have medical professionals
recommend leaving the ovaries in as long as possible because they
supply estrogen, which plays a role in preventing osteoporosis and heart
disease, as well as gorgon, which influences a woman's sex
drive.
About
the Alternatives
The
thing to remember about hysterectomy is that a lot of times
is not the only possible treatment, says Paula Bernstein, M,D., Ph.D
Attending Physician at Cedars -Sinai Medical center in Los
Angeles. There are Usually other treatment alternatives for fibroids,
heavy bleeding , pelvic pain, endometriosis, prolapsed uterus and pelvic
inflammatory disease.
Fibroids
are the reason for about 30 percent of hysterectomies.
Alternatives include leaving fibroids alone or removing them.
Heavy
bleeding, the problem that leads to 20 percept of hysterectomies, can
often be treated with medication or a procedure called endometrial ablation,
in which the lining of the uterus is removed but the organ is left
intact, Endometriosis can be treated with drugs as well. or the
diseased tissue alone can be removed using laparoscopy.
Fifteen
percent of hysterectomies are performed for prolapsed uterus
, in which the uterus literally starts to fall . Women who
develop a prolapsed uterus can ask their doctors about exercises
which help to strengthen the uterine muscle . They
can also ask about an essay device that is inserted in the
vagina much like a diaphragm to hold the uterus in place.
Obstetrical
compactions, such as hemorrhaging during childbirth and gynecologic
caner, are the reasons for about 11 percent of hysterectomies. For
these conditions , there's usually no alternative " Those are the
life-threatening reasons, " says Susan Haas, M.D, Assistant
Professor of Obstetrics and Gynecology at Harvard Medical School.
In
other cases, though, whether a woman has a hysterectomy is ultimately up
to her, " In my opinion, since the women lives with all
the risks and all the benefits, she's the one who makes
the decision says Dr, Hass. " We should term this elective
hysterectomy that the final decision-making power
lies with the woman. It also implies that she can make
that decision at any " she says.
Even
in the case of cancer, if a woman feels she's not quite ready for
the surgery, it probably can wait a day or two, says Marvel Williamson
R.N; Ph.d. Professor of Nursing and Director of the School of
Nursing in Parkville.
