Should I have a hysterectomy?
There are several conditions for which hysterectomy is advisable or medically necessary.
These include ovarian, uterine, or cervical cancer;
uncontrollable bleeding; severe
endometriosis or adenomyosis; and complex hyperplasia, to name a few.
A large percentage of hysterectomies are performed to relieve
fibroids, endometriosis or other conditions related to hormonal imbalance.
Hysterectomy in these cases may be avoidable, but women are often unaware that there
are alternatives. Many women in this second group find sufficient relief from their
symptoms once their hormonal balance is restored through a program of natural support.
This approach is an especially good alternative for women with fibroids, as fibroids
often subside after menopause anyway.
It’s also important to weigh the long-term consequences of a hysterectomy.
The loss of hormonal balance can create myriad symptoms, including premature aging,
vaginal dryness, and so on. There are also other complications, including
heightened incidence of urinary incontinence.
The estrogen made by the ovaries plays a protective role in a woman’s health,
so a complete hysterectomy
in a premenopausal woman increases her risk of heart disease and other major medical
problems. The testosterone made by the ovaries (yes, women have testosterone too,
just as men have estrogen) plays an important role in sexual desire and response,
so after an oophorectomy
women often suffer a loss of libido and sexual enjoyment.
Many women who enter menopause as a result of hysterectomy face years of hormone
replacement therapy (HRT) to restore their hormonal balance. HRT is generally prescribed
as a combination of synthetic progesterone and estrogen, and the synthetic hormones
commonly used in HRT have been shown to carry health risks. While
bioidentical hormones have not been shown to have the same risks, we are
beginning to understand that perhaps there are some risks associated with bioidentical
HRT as well, depending on how an individual woman metabolizes estrogen. Micronized
progesterone (bioidentical) does not appear to fall in this category. In any event,
more study is needed of their long-term use.
Women with higher levels of estrogen before surgery may have the worst experience
after surgery. Women who are full-figured often have high estrogen levels. We encourage
you to have a hormone panel as part of your decision-making process and to serve
as a baseline for later therapy to restore hormone balance after surgery.
In addition, there are emotional aspects to hysterectomy that affect both your initial
decision and your experience following surgery. These emotional issues have a profound
impact on your health that is too often overlooked. We recommend the relevant chapters
in Dr. Christiane Northrup’s classic book,
The Wisdom of Menopause.
For all these reasons, we urge women to try a program of support as a natural alternative
to hysterectomy. If that approach doesn’t relieve your symptoms, you can always
choose to go forward with the surgery.
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