Hysterectomy is Not Always Avoidable,
But Sometimes it is
Why do Women Get Hysterectomies?
Some of the more common reasons women get hysterectomies are
- Fibroids
- Cancer of the uterus, ovaries, cervix, or endometrium
- Excessive Bleeding
- Uterine Prolapse (falling down of the uterus)
- Endometriosis (cells from uterine lining implanted elsewhere)
- Endometrial hyperplasia (over growth of the inner lining of the uterus)
- Adenomyosis (growth of endometrial tissue into the muscles of the uterus)
- Pelvic Inflammatory Disease
- Chronic Pelvic Pain
- Complications from Birth
- Gender Affirming Surgery
What is a Hysterectomy?
There are several different kinds of hysterectomies
- Total Hysterectomy is when the uterus and cervix are removed and the ovaries are left
- Total Hysterectomy with Opherectomy is removal of the uterus, cervix, and ovaries
- Radical Hysterectomy is when the uterus and cervix are removed as well as the top part of the vagina by the cervix, and possibly lymph nodes
- Supracervical Hysterectomy (or partial or subtotal hysterectomy) is when the uterine body is removed, but the cervix is retained
Ovaries are sometimes removed with the “just in case” mind-set. The ovaries are in good condition and functional, but you are encouraged to have them removed just in case you might get ovarian cancer or another surgery some day.
What Are the Long-Term Risks of Hysterectomy?
Until recently, the long term risks of hysterectomy were not available.
In my practice, I see the long term outcome of hysterectomy.
A systematic review of 29 studies compared risk of getting the following conditions for women who had a hysterectomy for a benign condition (not cancer) vs. women who did not have a hysterectomy. This was not a meta-analysis or a randomized controlled trial, so inferences of causality are not possible. This systematic review is a suggestion that we need to design good studies of the long term effects of hysterectomies for non-emergent benign conditions.
Cardiovascular Risk
Women who had a hysterectomy-oopherectomy were at increased risk of
- Congestive heart failure
- Coronary artery disease
- Hypertension
- Cardiac Arrhythmias
- Hyperlipidemia (high cholesterol and/or high triglycerides)
- Obesity
Women who had a hysterectomy but conserved their ovaries fared better. However, they still experienced increased risk when compared with women who did not have a hysterectomy for
- Hypertension
- Cardiac Arrhythmias
- Hyperlipidemia (high cholesterol and/or high triglycerides)
Cancer
Women who had a hysterectomy were at increased risk of
- Renal cell carcinoma
- Bladder cancer
- Urinary tract cancer
- Papillary thyroid cancer
Pelvic Anatomy & Lower Urinary Tract Symptoms
If you can believe it, only four studies evaluated the long term effect of pelvic anatomy and lower urinary tract symptoms in women who had a hysterectomy vs women who did not have a hysterectomy.
Women who had a hysterectomy were at increased risk of
- Dysuria (pain with urination)
- Urinary retention
- Urinary incontinence
- Urinary frequency
- Urinary urgency
- Pelvic organ prolapse surgery
- Pelvic organ fistula surgery
Premature Menopause, Osteoporosis, Vasomotor Symptoms (hot flashes)
Women who had a hysterectomy and retained their ovaries were compared with women who did not have a hysterectomy
Women who had a hysterectomy and retained their ovaries were at increased risk of
- Premature menopause and ovarian failure
- Osteoporosis and Frailty
- Vasomotor symptoms
Mental Health
Women who had a hysterectomy were compared with women who did not have a hysterectomy
Women with a hysterectomy were at increased risk of
- Depression
- Anxiety
- Earlier onset dementia
- Decline in verbal memory, semantic memory, processing speed
How is a Hysterectomy Performed?
There are several ways hysterectomies are performed.
If you are considering a hysterectomy, your doctor would select the approach that is best for you and your condition.
Types of Hysterectomies
- Abdominal Hysterectomy
- A 6-8 inch incision is made horizontally or vertically in your lower tummy
- If you have fibroids or need to have the ovaries and fallopian tubes also removed, this could be the chosen surgery
- If you have disseminated endometriosis, this could be the type of surgery suggested
- Vaginal Hysterectomy
- If you have prolapse, your surgeon could recommend removal of the uterus through the vagina
- Laproscopic Hysterectomy
- A laproscopic hysterectomy is a type of vaginal hysterectomy that is camera guided
- Incisions will be made in your tummy and air will be blown into your tummy, then a camera will be introduced
- The uterus will be removed in sections through the vagina
What Types of Conditions Might Natural Medicine & Manual Hands-On Therapy Help With?
Good Candidates for Natural Medicine & Manual Hands-On Trial of Therapy
- Endometriosis, Adenomyosis, and endometrial hyperplasia all have similar mechanisms of action, and are worthy of a mixed approach of natural medicine & manual hands-on therapy, and pelvic floor therapy prior to a hysterectomy
- Uterine Prolapse is a good candidate for natural medicine & manual hands-on manual therapy, pelvic floor therapy, and exercise prior to hysterectomy
- Chronic Pelvic Pain is a good candidate for natural medicine & manual hands-on therapy and pelvic floor therapy prior to a hysterectomy
- Chronic PID is a good candidate for natural medicine & manual hands-on therapy, and pelvic floor therapy prior to hysterectomy
Equivocal Candidate for Natural Medicine & Manual Hands-On Trial of Therapy
- Fibroids
- If the fibroids are not very large, do not impact your bowel and bladder function and do not create other discomfort, and you are nearing 50 you could be a good candidate for natural medicine & manual hands-on therapy to balance hormones and release adhesions
- If you are of reproductive age or if the fibroids are bothering you at any age, conservative care is probably not aggressive enough to reverse or resolve the fibroids.
- If you do get surgery for fibroids, you will be a good candidate for after-surgery care
Not Good Candidate for Natural Medicine & Manual Hands-On Therapy
If you have cancer, you will not be a good candidate for this type of conservative care.
However, after the cancer is removed, you will be a good candidate for manual hands-on therapy after-care.
Emotional Strain
Many patients experience emotional strain when considering a hysterectomy. Neuroemotional technique (NET) helps patients to understand and release the underlying fears that that cause them discomfort when considering a hysterectomy or conservative trial of therapy.
