The Endangered Uterus
By Peg Rosen
If your doctor has recommended a hysterectomy, don't make a decision until you read this startling report on the real risks of surgery and the less-invasive alternatives your ob-gyn may not be mentioning.
A Doctor's Opinion
If someone suggested that you undergo an elective procedure that could keep you out of work -- and in pain -- for six weeks, might leave you incontinent, deep-six your sex life, increase your risk of osteoporosis and heart disease, and possibly shorten your life span, would you do it? Maybe not -- but what if your trusted ob-gyn told you it was a good move?
Chances are you would agree to it. In fact, every day, as often as 11 times every 10 minutes, women in the United States struggling with noncancerous pelvic conditions -- including fibroids, endometriosis, and heavy periods -- agree to resolve the problem by getting rid of their reproductive organs. Ninety percent of hysterectomies in this country are performed for reasons other than cancer treatment, and the vast majority involve major open abdominal surgery. Women between 40 and 54 are most at risk, and not just because the onset of many pelvic disorders occurs during the years leading up to menopause. The hysterectomy rate is so high because many of us take our doctor's word that once we are finished bearing babies, it's no great loss if our problematic uterus, and maybe even our ovaries, are removed. Don't believe it. And don't believe that there are no alternatives to open abdominal surgery. The question is, why isn't your doctor telling you about them?
Why the Uterus Is Worth Keeping
Evidence is growing that our reproductive organs serve a purpose beyond birthing babies. In 2005 a landmark study showed that removing ovaries, which is still done during most hysterectomies to reduce the relatively small risk of ovarian cancer, actually increases the risk of heart disease and osteoporosis, according to study coauthor William Parker, MD, of the UCLA School of Medicine. While the ovaries produce a diminishing level of estrogen after you turn 45, for decades they will continue to produce testosterone and androstenedione, hormones that convert to estrogen when they circulate throughout the body. These provide crucial protection against heart disease and osteoporosis. Testosterone also helps preserve our sex drive, bolster energy levels, and maintain lean body tissue. Even though some women opt to keep their ovaries when they undergo a hysterectomy, Parker says that within four years of the operation about 15 percent will experience postoperative ovarian failure, which triggers premature menopause.
All of this might be acceptable if doctors had no alternatives to offer women suffering from noncancerous pelvic disorders. But that is far from the case. Over the past two decades, there has been a virtual explosion of new ways to treat pelvic problems.
Laparoscopic technology now allows ob-gyns to remove endometriosis and accompanying scar tissue, as well as fibroids, without cutting open the abdomen. Uterine artery embolization (UAE), which is performed through a minor incision in the groin, can shrink fibroids by cutting off their blood supply. Endometrial ablation, an outpatient procedure, can end bleeding by destroying the uterine lining via vaginal probe. Pessaries -- which are diaphragm-like devices -- and other fixes can lessen pain by lifting a fallen uterus back into place rather than removing it. Birth control pills, the progesterone IUD, and other nonsurgical therapies have also been shown to relieve disabling pain and bleeding while leaving the uterus intact. "It's true that many of the new treatments may not provide a permanent solution. After uterine artery embolization, bleeding can return," says Carla Dionne, of the National Uterine Fibroids Foundation. "But many pelvic disorders naturally subside as women get closer to menopause, after which recurrence is less likely." In other words, midlife women don't necessarily need a permanent solution; we just need a bridge treatment that can relieve symptoms of noncancerous pelvic conditions until we reach menopause.
Many of these treatments have existed since the 1980s, which is why it's appalling that the annual rate of nearly 600,000 hysterectomies in the U.S. hasn't declined significantly in 10 years, according to the Centers for Disease Control's statistics. What's more, almost 70 percent of these hysterectomies are still being performed via open abdominal surgery, which was pioneered in 1843, despite the fact that laparoscopic hysterectomy, available since the mid- to late-1990s, is a less-invasive removal method. The surgery is guided by a tiny camera inserted into the body via a small incision, in a procedure that causes less pain, less scarring, and less risk of infection. And women who have laparoscopic surgery are back at work in about one-third the time as those who undergo an open abdominal hysterectomy.
With such effective alternatives now available, why do physicians continue to treat non-life-threatening problems by removing our reproductive organs? Why, even when a hysterectomy is appropriate for noncancerous conditions, is it being done in the most scarring and disabling way possible? And why are we -- a generation of women who research and challenge personal trainers, investment advisers, and other professionals in our lives -- allowing this?
Our Mistaken Acceptance
The idea that hysterectomy is okay is deeply ingrained in our culture, Dionne says. "The 20 million American women who have had hysterectomies indoctrinate their daughters, sisters, and friends: Just do it. You'll feel so much better once the pain is over." Granted, if you are a woman who is seriously worried because she is bleeding heavily, any relief will seem like an improvement. "What many women don't realize is that they might have resolved their problem without such a drastic measure or without the physical complications that may result -- the complications that many of their friends and relatives don't connect with the removal of their uterus," Dionne says. One eye-opening statistic: Compared with women who haven't undergone the surgery, those who've had a hysterectomy have a 60 percent greater risk of being incontinent after age 60, according to a study from the University of California, San Francisco.
"Women also may not realize that the uterus supports everything above it. Removing it is like pulling out the cork from an upside-down wine bottle. Unless the woman has strong muscles, her bladder or her bowels can descend into her vagina," says Beth Battaglino Cahill, RN, of The National Women's Health Resource Center (NWHRC), in Red Bank, New Jersey. Finally, the surgery itself can shorten the vagina and damage nerves, making sex less enjoyable or downright painful.
Some research has nonetheless suggested that hysterectomy improves women's sexual lives, but that claim is controversial. "I'm wary of such studies," says biologist Winnifred Cutler, PhD, author of the upcoming Hormones and Your Health.
As an example, she cites the 1995 Maryland Women's Health study, in which women two years beyond hysterectomy reported they were more sexually active, more orgasmic, and had sex more frequently than before the surgery. "But the researchers asked the women about their sex lives in the 30 days prior to the surgery [to establish a baseline]. What woman, experiencing and fearing pain, is going to be having a lot of sex in the month before her operation?" With such a low baseline, Cutler notes, any increase may be misconstrued as improvement due to the hysterectomy. Her own findings with coauthors on sexual response postsurgery, presented in 2000 to the American College of Obstetricians and Gynecologists (ACOG), showed just the opposite: Hysterectomy can have a negative impact on sexuality. That is why she urges women considering the procedure to look closely at the facts.
By Peg Rosen
If your doctor has recommended a hysterectomy, don't make a decision until you read this startling report on the real risks of surgery and the less-invasive alternatives your ob-gyn may not be mentioning.
A Doctor's Opinion
If someone suggested that you undergo an elective procedure that could keep you out of work -- and in pain -- for six weeks, might leave you incontinent, deep-six your sex life, increase your risk of osteoporosis and heart disease, and possibly shorten your life span, would you do it? Maybe not -- but what if your trusted ob-gyn told you it was a good move?
Chances are you would agree to it. In fact, every day, as often as 11 times every 10 minutes, women in the United States struggling with noncancerous pelvic conditions -- including fibroids, endometriosis, and heavy periods -- agree to resolve the problem by getting rid of their reproductive organs. Ninety percent of hysterectomies in this country are performed for reasons other than cancer treatment, and the vast majority involve major open abdominal surgery. Women between 40 and 54 are most at risk, and not just because the onset of many pelvic disorders occurs during the years leading up to menopause. The hysterectomy rate is so high because many of us take our doctor's word that once we are finished bearing babies, it's no great loss if our problematic uterus, and maybe even our ovaries, are removed. Don't believe it. And don't believe that there are no alternatives to open abdominal surgery. The question is, why isn't your doctor telling you about them?
Why the Uterus Is Worth Keeping
Evidence is growing that our reproductive organs serve a purpose beyond birthing babies. In 2005 a landmark study showed that removing ovaries, which is still done during most hysterectomies to reduce the relatively small risk of ovarian cancer, actually increases the risk of heart disease and osteoporosis, according to study coauthor William Parker, MD, of the UCLA School of Medicine. While the ovaries produce a diminishing level of estrogen after you turn 45, for decades they will continue to produce testosterone and androstenedione, hormones that convert to estrogen when they circulate throughout the body. These provide crucial protection against heart disease and osteoporosis. Testosterone also helps preserve our sex drive, bolster energy levels, and maintain lean body tissue. Even though some women opt to keep their ovaries when they undergo a hysterectomy, Parker says that within four years of the operation about 15 percent will experience postoperative ovarian failure, which triggers premature menopause.
All of this might be acceptable if doctors had no alternatives to offer women suffering from noncancerous pelvic disorders. But that is far from the case. Over the past two decades, there has been a virtual explosion of new ways to treat pelvic problems.
Laparoscopic technology now allows ob-gyns to remove endometriosis and accompanying scar tissue, as well as fibroids, without cutting open the abdomen. Uterine artery embolization (UAE), which is performed through a minor incision in the groin, can shrink fibroids by cutting off their blood supply. Endometrial ablation, an outpatient procedure, can end bleeding by destroying the uterine lining via vaginal probe. Pessaries -- which are diaphragm-like devices -- and other fixes can lessen pain by lifting a fallen uterus back into place rather than removing it. Birth control pills, the progesterone IUD, and other nonsurgical therapies have also been shown to relieve disabling pain and bleeding while leaving the uterus intact. "It's true that many of the new treatments may not provide a permanent solution. After uterine artery embolization, bleeding can return," says Carla Dionne, of the National Uterine Fibroids Foundation. "But many pelvic disorders naturally subside as women get closer to menopause, after which recurrence is less likely." In other words, midlife women don't necessarily need a permanent solution; we just need a bridge treatment that can relieve symptoms of noncancerous pelvic conditions until we reach menopause.
Many of these treatments have existed since the 1980s, which is why it's appalling that the annual rate of nearly 600,000 hysterectomies in the U.S. hasn't declined significantly in 10 years, according to the Centers for Disease Control's statistics. What's more, almost 70 percent of these hysterectomies are still being performed via open abdominal surgery, which was pioneered in 1843, despite the fact that laparoscopic hysterectomy, available since the mid- to late-1990s, is a less-invasive removal method. The surgery is guided by a tiny camera inserted into the body via a small incision, in a procedure that causes less pain, less scarring, and less risk of infection. And women who have laparoscopic surgery are back at work in about one-third the time as those who undergo an open abdominal hysterectomy.
With such effective alternatives now available, why do physicians continue to treat non-life-threatening problems by removing our reproductive organs? Why, even when a hysterectomy is appropriate for noncancerous conditions, is it being done in the most scarring and disabling way possible? And why are we -- a generation of women who research and challenge personal trainers, investment advisers, and other professionals in our lives -- allowing this?
Our Mistaken Acceptance
The idea that hysterectomy is okay is deeply ingrained in our culture, Dionne says. "The 20 million American women who have had hysterectomies indoctrinate their daughters, sisters, and friends: Just do it. You'll feel so much better once the pain is over." Granted, if you are a woman who is seriously worried because she is bleeding heavily, any relief will seem like an improvement. "What many women don't realize is that they might have resolved their problem without such a drastic measure or without the physical complications that may result -- the complications that many of their friends and relatives don't connect with the removal of their uterus," Dionne says. One eye-opening statistic: Compared with women who haven't undergone the surgery, those who've had a hysterectomy have a 60 percent greater risk of being incontinent after age 60, according to a study from the University of California, San Francisco.
"Women also may not realize that the uterus supports everything above it. Removing it is like pulling out the cork from an upside-down wine bottle. Unless the woman has strong muscles, her bladder or her bowels can descend into her vagina," says Beth Battaglino Cahill, RN, of The National Women's Health Resource Center (NWHRC), in Red Bank, New Jersey. Finally, the surgery itself can shorten the vagina and damage nerves, making sex less enjoyable or downright painful.
Some research has nonetheless suggested that hysterectomy improves women's sexual lives, but that claim is controversial. "I'm wary of such studies," says biologist Winnifred Cutler, PhD, author of the upcoming Hormones and Your Health.
As an example, she cites the 1995 Maryland Women's Health study, in which women two years beyond hysterectomy reported they were more sexually active, more orgasmic, and had sex more frequently than before the surgery. "But the researchers asked the women about their sex lives in the 30 days prior to the surgery [to establish a baseline]. What woman, experiencing and fearing pain, is going to be having a lot of sex in the month before her operation?" With such a low baseline, Cutler notes, any increase may be misconstrued as improvement due to the hysterectomy. Her own findings with coauthors on sexual response postsurgery, presented in 2000 to the American College of Obstetricians and Gynecologists (ACOG), showed just the opposite: Hysterectomy can have a negative impact on sexuality. That is why she urges women considering the procedure to look closely at the facts.
Due to my current issues with uterine fibroids I have been doing a lot of research into how to deal with them effectively and preserve my fertility. I picked up MORE magazine for the first time in months; and found a great article on uterine health and avoiding hysterectomies.
