To Have a Hysterectomy or Not? - A Personal Journey Part 1

Disclaimer: this article is not written to provide medical advice and does not advocate one medical procedure over another. It is a personal account and simply meant to be infomative. Always consult your physicain when making medical decisions of this caliber .

My Painful Journey Begins.

I have always suffered from painful and heavy menses since the start of my menstruation at the age of twelve.

For decades I presumed that this was a normal part of life. In 2010 however, I realized the abnormalities of my menstrual cycle when I began to have two menstrual cycles in one month.

Thanks to a invasive technique called Uterine Ablation (which go by other names such as Novasure and Endometrial Ablation - where the lining of the uterine wall is burned off - my menstrual flow was cut down drastically. While this procedure reduced the pain slightly, I still experienced noticeable discomfort.

This past year however, my discomfort gradually increased. I noticed that every month instead of just working through the pain, I had to drastically increase my intake of over-the-counter medications.

While I opted for a more natural approach in the beginning (such as applying heat to the affected areas and using a premenstrual solution blend that contained herbs such as Shepherd’s Purse, Cramp Bark, Passion Flower and other vital ingredients that provided support before and during the menstruation) these did not seem to be enough.

I often contributed the pain I was experiencing to the daily stress and grind of life and nothing more. However, in August of this year, following a laparoscopic surgery due to an ovarian cancer scare, my menstruation returned and returned with a vengeance.

Though my flow remained the same, my menstruation returned, stayed on and the pain increased a hundred-fold. I felt as if I were having labor pains.

During my post-op visits to my gynecologist, I described the pain I was experiencing (which felt like labor pains that spread from my stomach to my back and down the back of my legs - pain medication didn't seem to take the pain away or would take an extremely long time to become effective) and he immediately ordered an ultrasound.

The ultrasound detected three fibroids measuring 1 ½ inches in diameter embedded in my uterus. While these are small considering the size of fibroids found in other women, it was their exact placement that was causing me so much pain.

All three were located deep inside the cavity of my uterusand it is these types; called intracavitary fibroids; that often cause bleeding between menstrual cycles and severe cramping and discomfort.

Due to the extreme pain and constant bleeding, the quality of my life was drastically reduced. I was a stay at home mother to two small children and a wife to a devoted husband.

I had many responsibilities to care for and it had become more than challenging to keep up with the day-to-day duties. Mundane task became increasingly hard and my life consisted of laying in my bed curled in the fetal position from all the pain I was experiencing.

My condition affected my family as well. It was now time to make a decision. I had to address two vital questions: What treatment options were available to me and how was I to choose the option that would work best for me and my family?

What are my Options?

My gynecologist presented me with three options:

1. Birth control pills - which could either regulate my menstruation and help reduce my PMS symptoms, or stop my menstruation altogether.
2. Uterine ablation - which could help reduce the bleeding
3. Hysterectomy - This is the removal of the uterus. A total hysterectomy involves removing the uterus and cervix and a supracervial hysterectomy is the removal of the uterus but the cervix is left in place. A side note: removal of the ovaries is called an oophorectomy and the removal of the fallopian tubes is called a salpingectomy.

I was advised to do some research, talk things over with my husband and get back with him with my decision.

I immediately poured over the brochures my gynecologist provided for me and did additional research via the Internet.

I searched for other options that included:

• The use of ultrasound to shrink fibroids
• Uterine Artery Embolization - a procedure that entails a physician using special x-ray guidance to treat the blood vessels (constricting and stopping the blood flow) supplying the fibroid from the inside. This in turn shrinks the fibroids.
• Medications that are in the family of GnRH agonists that induce a temporary chemical menopausal state. Since the lack of estrogen and menopausal symptoms go hand in hand, then these medications will cause the fibroids to decrease in size. Unfortunately, once the medication is discontinued, the fibroids rapidly grow back to their pre-treatment size.
• Hysteroscopy - this procedure does not require an incision since it involves using a special tool called a resectoscope. It is a special type of hysteroscope that contains a built in wire loop which uses high-frequency electrical energy to cut or coagulate tissue. The resectoscope is inserted through the cervix. The fibroids are then cut out in pieces and the pieces are removed through the cervix.

• Homeopathic medications - this is a more natural approach to ridding the body of fibroids. It is advisable to consult a homeopathic physician and do not attempt to treat yourself.

• Myomectomy - a surgical removal of fibroids, leaving the uterus in place (instead of removing the entire uterus).

There are several types - 1.) Abdominal myomectomy, 2.) Laparoscopic myomectomy, and 3.) Robotic myomectomy.

1. Laparotomy/Abdominal myomectomy- an incision is made in the abdomen. Then the fibroids are removed through the incision.
2. Laparoscopy/Laparoscopic myomectomy - an incision is made in the abdomen. The fibroids are removed through the use of a laparoscope which is used to view the inside of the abdomen.
3. Robotic myomectomy - use of robotic arm to assist in surgery.

Each procedure carry different risks and have different recovery times. Therefore, it was a matter of determining what procedure was best for me.

It’s Decision Time!

Once I completed my research, my gynecologist referred me to a MD who specializes in minimally invasive vascular procedures. The specialist informed me of a minimally invasive technique called Embolization or Uterine Artery Embolization.

This procedure is much less evasive compared to a hysterectomy, yet the idea that the fibroids have a large chance of growing back made this option less appealing to me.

Therefore, after pondering over the risks, the recovery times, the chance of fibroid recurrence, the cost, as well as the emotional ramifications involved, I determined that a total hysterectomy was the best option for me.

This was not an easy decision for me what-so-ever. Frankly, it was one of the weightiest decisions I have ever had to make in my life.

In addition to researching the different types of hysterectomy available, I interviewed friends and family members who have underwent a hysterectomy and enquired of them why they chose a hysterectomy, how it affected them emotionally, mentally, and physically, and enquired rather they have experienced any long-term effects.

There were some who stated it was the worst decision they had ever made, then there were those who said it was the best decision they had ever made.

On the one hand, I was told of several downsides of a hysterectomy such as weight gain, vaginal dryness, emotional distress, depression, a hollow or empty feeling, decreased or lack of sex drive and early menopausal symptoms.

On the other hand, I was told of several upsides of a hysterectomy such as no more bleeding, no more pain from menstrual cycles, no re-growth of fibroids, and increase sex drive and better intercourse. In retrospect, the effects of a hysterectomy varied depending on whom I spoke with.

After weighing all the pros and cons, I opted for a hysterectomy.

There were several determining factors that helped me reach this decision, 1.) I have been dealing with difficult menses for over two decades, 2.) The quality of life for my family and I have been adversely affected, 3.) A prior cancer scare may leave me susceptible to other gynecological problems, 4.) I do not plan to have more children due to problematic pregnancies, and 5.) Though several options may have initial success, there is a very good chance the fibroids will return.

Now that I had made my decision, the next step involved determining what type of hysterectomy was best for me.

Types of Hysterectomies.

When it comes down to hysterectomies, one size does not fit all.

Although the end result is the same; a removal of the uterus or the removal of the uterus and the cervix; there are three different types of hysterectomies available.

1. Vaginal - the uterus is removed through the vagina. The incisions are made inside the vagina not the abdomen.
2. Abdominal - a vertical or horizontal incision is made through the skin and tissue in the lower abdomen to reach the uterus.
3. Laparoscopic- a laparoscope is used to guide the surgical removal of the uterus. There are different types of laparoscopic hysterectomies:

• Total laparoscopic hysterectomy - a small incision is made in the navel for the laparoscope. One or more small incisions are made in the abdomen for other instruments and the uterus is detached from inside the body. The uterus is then removed in small pieces through the incisions or the pieces are passed out through the vagina.
• Laparoscopically assisted vaginal hysterectomy (LAVH)- this procedure entails a vaginal hysterectomy with the assistance of a laparoscope. A small incision is made in the navel for the laparoscope, then the uterus, ovaries, fallopian tubes, and cervix are detached and removed through the vagina.
• Robot -assisted laparoscopic hysterectomy - surgeons make use of a robot attached to the laparoscopic instruments to help perform the surgery.

A side-by-side comparison is helpful in the decision making process as well.

Vaginal Hysterectomy versus Abdominal Hysterectomy

• Shorter hospital stay
• Faster return to your normal activities
• Fewer infections
• Less pain during the recovery since the incision is made in the vagina

Vaginal Hysterectomy versus Laparoscopic Hysterectomy

• Shorter operating time

Laparoscopic Hysterectomy versus Abdominal Hysterectomy

• Faster return to your normal activities
• Smaller incisions - thereby less pain
• Shorter hospital stay
• Less loss of blood
• Fewer infections
• Longer operating time - the longer you are under general anesthesia, the greater the risks for certain complications.

Once I completed my research and consulted with my gynecologist, we both came to a unanimous decision that a laparoscopically assisted vaginal hysterectomy (LAVH) was the best option for me. (stay tuned for my personal surgery account and recovery in future articles)

To Have a Hysterectomy or Not? - Guidelines to Help you decide.

Deciding rather a hysterectomy is the best option for you can be emotionally and mentally challenging. Fear of the unknown and the what-if's can create a larger challenge.

Here are some basic guidelines that could help you determine if a hysterectomy is for you or not:

1. Are you still of childbearing age and want to conceive in the future?
2. What about the recovery time? Will you be able to take an extended period of time off and does your lifestyle require less time off.
3. What about other medical conditions? Do you have certain medical conditions that may put you at a higher risk for certain types of surgery?
4. What about cost? Since some procedures only offer a relief from the symptoms and some procedures provide only a temporary fix, additional costs may incur due to repeated procedures.
5. What about the risk? Each surgery technique carries a risk. What risks are you the most comfortable with?
6. What about the emotional ramifications? All surgeries have the ability to affect the patient emotionally and mentally. Will you be able to effectively deal with these emotions?

A hysterectomy is just one solution to uterine problems many women experience on a daily, monthly, and yearly basis. Though it has become the solution for some of the 20-25% of women who suffer from uterine fibroids, it may not be the best option for others.

It is advisable then, that every woman who suffers from this condition takes proactive measures to stay healthy.

Become informed of every available option. Talk with other women who have been treated for uterine fibroids. Work closely with your gynecologist. Get a second or third opinion if you deem it necessary.

A hysterectomy, no matter how performed, is a life-changing procedure. Once completed, it cannot be reversed.

Making a decision of this caliber can be frightening and confusing. Therefore, take your time, look at your options, be proactive. Keep positive and take vital steps to stay mentally, physically, and emotionally healthy.

In the end, the choice is up to you!

Resources: ACOG Patient Education Brochure, Special Procedures Patient Education Brochure, Savannah Health Perspective News Letter, My personal gynecologist.

copyright © 2011