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, weight gain, 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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