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 Hysterectomy: Reasons To Have It, Reasons To Avoid It
Why To Avoid A Hysterectomy
If a woman wants the option of having more children, then why she would want to avoid a hysterectomy is obvious. This desire is part of the medical decision. Most women who are presented with the choice are past that. Still, there are many reasons to keep those organs until death do us part. Simply wanting to keep her organs is an official medical reason that must be factored into the decision. In many cases, ovaries are removed at the same time. Surgical menopause, even with hormone replacement is a much rougher ride than the natural. It is, of course, major surgery. Furthermore, there are concerns and patterns of other functional disturbances that are associated with hysterectomy. Decreased libido is commonly reported in post-hysterectomy patients who retain their ovaries. It is speculated that nerves or blood vessels that are cut are somehow respnsible. While it is done to help urinary continence, in some cases, it may actually contribute. Weight gain is also commonly reported after a hysterectomy.
Reasons To Have Hysterectomy And Not To Have Hysterectomy -- General
Good categories of reasons to have a hysterectomy are: save the woman's life (usually advanced cancer, severe bleeding or infection), restore function (severe prolapse), and relieve pain (various). Even so, hysterectomy should not be done when there are comparably effective and less drastic measures available.
If a woman does not have a clear diagnosis, she should not have a hysterectomy. In the past, hysterectomies were done for symptoms, not just disease. Bleeding and pain are symptoms. While the goal may be to stop these, the doctor needs to know what is behind those symptoms before hysterectomy should proceed. If she has a lot of other medical problems that would make any surgery more risky, it should be avoided. If she has a lifestyle and responsibilities that preclude a normal recovery period, she should think twice. It also has no place in the management of menopausal or P.M.S. symptoms.
It is important for a woman to look into the details of her diagnosis when a hysterectomy is suggested. Not all cancers, fibroids, and such require a hysterectomy. Finding a woman's precise sub-category within these and matching it against the medical profession's standards is key. Always asking for a surgery that removes less or for a non-surgical alternative, and second opinons help greatly. Valid reasons are in bold below, invalid reasons and pitfalls are in italics.
Hysterectomy For Cancer
About 10% of hysterectomies are done for cancer. They can be done for cancers of any part of the uterus or tubes or ovaries, or nearby organs that have spread. But, far from all cancers require them. Cancer must be formally diagnosed, it is not for unspecified abnormalities. How advanced the cancer is, the woman's age and desire for future pregnancies, and her overall health are the factors that determine it.
Cervical CIN II ("C I N 2", Cervical Invasive Neoplasm, Dysplasia), but only if cone biopsy has failed, Early invasive cervical cancer But NOT for mild or moderate cervical dysplasia, there are other options. Not when cone biopsy is still an option. Leukorrhea, or chronic cervicitis are not cancers and are thus not appropriate
Endometrial Adenocarcinoma But not, endometrial hyperplasia (overgrowth)
Uterine Sarcoma
Leiomyosarcoma
Ovarian or tubal carcinoma Except some stage 1s can be treated without it
Gestational trophoblastic disease but only after chemotherapy has failed
Colon or Bladder Cancer that has spread to the uterus or blocks removal of the cancer
Hysterectomy for Fibroids (leiomyomata uteri)
The most common reason for non-cancer hysterectomies, about 30%. Here the important point is to determine if they are severe enough to warrant the procedure. Symptoms include pain and pressure, bleeding, childbearing problems, etc.
Size of the uterus alone (bigger than a 12 week pregnancy) was once used as criteria, because it would block the examination of the ovaries and tubes. Now ultrasound can do this.
Anemia
Uncontrolled Bleeding
Long-term back or abdominal pain or pressure Not occasional pain or pressure, nor when the uterus size has not been clearly identified as the cause
Rapid Growth but approaching menapuse will slow this growth
Compression of the urinary tubes and back-up into the kidney
Pedunculated Fibroid But NOT a prolapsed submucous fibroid, and NOT for fibroids that are small and not causing problems
Depo-Lupron is a medicine to shrink fibroids. Some fibroids can be removed individually. A new procedure is blocking the arteries that serve them and eliminating them that way.
Hysterectomy For Dysfunctional Uterine Bleeding (DUB)
Dysfunctional Uterine Bleeding is also a major cause of hysterectomies. It is defined as vaginal bleeding that has no specific genital tract causes, and is excessive. The subjectiveness of "excessive" and the decision to declare vaginal bleeding as being without specific pathology are the pitfalls here.
Profuse Bleeding After Medical Attepts to Stop It Have Failed and without medical causes It is NOT for unevaluated post-menopausal vaginal bleeding. If a woman has not been evaluated for the major causes of bleeding, she should not have a hysterectomy. OB/Gyns official criteria for "excessive" bleeding is longer than 8 days, requiring additional pads or tampons, or that lowers an indicator of bleeding called hematocrit. This crieria are met far too easily, and do not put the woman at risk in most cases if they are surpassed.
Recurrent Bleeding Causing Anemia
Hysterectomy for Endometriosis
Pain relief is the major motivation here, and it accounts for about 20%.
Endometriosis has been identified through laproscopy or lab tests
Failed Medical Treatment
Major adherence to the pelvic organs It is NOT appropriate to assume dysmenorrhea is due to this and
operate
Major involvement of pelvic organs The assessment of "major" is key here
Obstruction of the urinary or intestinal tract
Hysterectomy for Uterine Prolapse
This accounts for about 16%. Prolapse can cause urine loss or blockage, and problems with bowel movements. The uterus can fall down the
vagina so that the cervix is exposed and irritated by being outside the body.
Protrusion outside the body spontaneously or after bearing down
Major bowel or bladder symptomsIt is NOT for mild urinary loss or incontinence
Decreased quality of
life Again, look for other options such as pessaries, urinary ballons, or surgeries that reposition the uterus
Fundus chronically prolapses around cervix
Hysterectomy for Chronic Pelvic Pain
The pain must be present for more than 6 months and a laproscopy must have been done and be negative. The pain must be
severe enough to interfere with the woman's life. Of course, other alternatives must be tried first. Dysmenorrhea does not
count here
Hysterectomy for Other Reasons
The remainder of valid reasons are obstetrical complications (bleeding and infection, or uterine rupture or inversion),
and infections. Many of these are done on an emergency basis. So, the woman should address this in her birth plan for
obstetrical reasons. If she finds herself in the Emergency Department, she should get a clear explanation and alternatives
as possible, given her situation. If she faces a failed medical treatment of a pelvic infection, she could request another
round of antibiotics, if the situation allows.
Abcess of the ovary/tube that has ruptured
Infection after pregnancy loss that doesn't repond to antibiotics
Infection of the ovary/tube that doesn't repond to antibiotics
Infection of the endometium that is repeated or chronic (pyometria)
Post-birth bleeding that cannot be stopped
Post-birth uterine rupture or inversion
Pregancy that is in the abdomen, cervix, or interstitially
Severe post-birth endomyometritis, that hasn't responded to antibiotics
Adenomyosis, that cause severe menstrual pain, excessive bleeding, or significant enlargement of the uterus
NOT for sterilization or the simply because a woman does not wish to have periods
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