HYSTERECTOMY...MYTHS
AND REALITIES
The
debate rages on about hysterectomy -- when
to
have it done; who should have it done; how
to have it done; and if to have it done.
According to the National Center for Health
Statistics, there are about 547,000 hysterectomies
performed each year in this country and, unlike some
other treatment options, this one is final.
Once the uterus is removed, it is too late to
change your mind about having children.
Fortunately,
today women have more choices and alternatives when it
comes to "female surgery."
One of the choices is to avoid surgery
altogether. However,
statistics show that thirty-one percent of American
women between the ages of 45 and 49 have had
hysterectomies.
Traditionally,
hysterectomy has been one of the most common -- and
one of the safest --operations women have.
The surgery is often recommended to relieve
chronic pain and excessive bleeding, in severe cases
of pelvic inflammatory disease,
or in cases where cancerous cells are present.
The procedure involves removal of the uterus
only. If
the Fallopian tubes and ovaries are also taken out,
the surgery is called salpingo-oophorectomy.
FIBROIDS
AND HYSTERECTOMY
According
to recent statistics, fibroids are responsible for
about 30 percent of all the hysterectomies performed
in this country each year.
Between 20 and 40 percent of all women
eventually develop fibroids -- composed of connective
tissue and muscle fiber that arise from the muscular
layer of the uterus.
They may be as small as a pea or as large as a
grapefruit; they may or may not produce any symptoms;
and they are almost always non-cancerous or benign.
Fibroids
are known to grow in three direction: they can stick
out from the surface of the uterus into the pelvic
cavity (subserous); they can be buried inside
the wall of the uterus (intramural); or they
can protrude from the endometrial lining into the
uterine cavity (submucosal).
Although
scientific research has not been able to determine the
cause of fibroids, they tend to
grow during the childbearing years and develop
when a woman is in her late 30's or early 40's, they
happen more frequently among black women than white
women; they often run in families; and they can cause
excessive bleeding, pain, pressure and infertility.
A
recent study at the University of Iowa College of
Medicine demonstrated that there is no greater risk of
surgical complications when
hysterectomy is done for large fibroids than
there is when the tumors are small. Many physicians
have believed that hysterectomy is justified when
fibroids enlarge the uterus to the size it would be in
a 12-week pregnancy, but after recent reports, more
and more are challenging the "12-week rule."
Now, many argue that there is no reason to do
anything about fibroids, regardless of their size,
unless they cause severe symptoms.
There
is an alternative to hysterectomy for fibroids, thanks
to some new technology and changing attitudes on the
part of both patients and their doctors. Myomectomy -- the surgical removal of formed
for almost a century, but has not been the procedure
of choice because it was technically more difficult.
A hysterectomy can be performed in about an
hour, whereas a myomectomy can take up to four or six
hours.
Today,
with the aid of laparoscopes and lasers, myo-mectomy
is safer than it used to be with the risk of bleeding
almost non-existent.
The surgery
-- which allows most women to return to normal
routines in about a week -- does not guarantee that
the fibroids won't return at some time in the future,
and they do in about 25 percent of the cases.
But it does allow women an alternative to the
finality of hysterectomy.
MAKING
INFORMED CHOICES
When
gynecological conditions arise that indicate
hysterectomy, there may be other options and
alternatives. Don't
be afraid to ask about them.
"It
is our objective to recommend the most appropriate
treatment for the diagnosis," explained Dr.
Birken. "That
calls for a thorough discussion about
the risks and realities of each procedure and
the alternatives. Sometimes, after all is said and done, it comes down to
hysterectomy. Now,
in about 80 percent of the cases, with laparoscopic
hysterectomy we can offer patients a minimally
invasive, safe surgical technique that requires a
shorter recovery time."
"The
procedure is done with the aid of the laparoscope, a
narrow tube-like instrument that has a miniature
camera at its tip that -- when inserted through a tiny
incision in the umbilicus (belly button) -- enables
the surgeon to view internal organs on a television
monitor mounted in the operating room.
One of the benefits of this method," Dr.
Birken continued, "is that you have an
unobstructed view of the uterus without surgically
opening the abdomen."
The
surgeon uses a specialized instrument to cut and
staple the uterine tissue that controls the bleeding,
and allows the procedure to be completed by removing
the uterus through the vagina.
"This
method reduces post-operative pain and, since there is
minimal trauma to the tissues, healing time is also
shorter than in an abdominal incision
hysterectomy."
"Here,
then," he said, "is a choice for women
concerned with the cosmetic impact of abdominal
surgery and for those who cannot afford to take months
off work for recovery.
It is entirely possible that this procedure
will be done in an outpatient setting in the
not-too-distant future."
SOME FREQUENTLY ASKED
QUESTIONS ABOUT HYSTERECTOMY
Q.
What
are the most common reasons a hysterectomy is
performed?
A.
Fibroids, cervical or uterine cancer, heavy
bleeding not related to a menstrual period, or
endometriosis. Hysterectomy may be also performed in
cases of uterine prolapse, when the organ sags into
the vagina because the ligaments that support it in
place have grown weak over time.
Q.
How is hysterectomy performed?
A.
Most
hysterectomies are done through abdominal incision,
although when appropriate, the vaginal procedure --
when an incision is made in the upper end of the
vagina through which the uterus is removed -- can
result in fewer complications and a shorter recovery
time. Currently,
use of the laparoscope to assist in this procedure
makes it possible to accomplish a higher percentage of
hysterectomies by this method.
Q.
What physical changes should I expect after the
surgery?
A.
It
depends upon which type of surgery was performed.
Recovery time can be as short as a week or as
long as six weeks before returning to normal activity.
If the ovaries are also removed, menopause will
begin immediately.
When this is an option, before surgery we will
discuss some of the side effects you might expect as
well as hormone replacement therapy.
Some women experience emotional discomfort when
they realize that their childbearing years are finally
over. Others
report changes in sexuality -- some say they find more
pleasure in sex, others less. All these issues and concerns should be discussed with your
physician or nurse.
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