A Doctor’s Opinion
If someone suggested that you undergo an elective procedure that could keep you out of work — and in pain — for six weeks, might leave you incontinent, deep-six your sex life, increase your risk of osteoporosis and heart disease, and possibly shorten your life span, would you do it? Maybe not — but what if your trusted ob-gyn told you it was a good move?
Chances are you would agree to it. In fact, every day, as often as 11 times every 10 minutes, women in the United States struggling with noncancerous pelvic conditions — including fibroids, endometriosis, and heavy periods — agree to resolve the problem by getting rid of their reproductive organs. Ninety percent of hysterectomies in this country are performed for reasons other than cancer treatment, and the vast majority involve major open abdominal surgery. Women between 40 and 54 are most at risk, and not just because the onset of many pelvic disorders occurs during the years leading up to menopause. The hysterectomy rate is so high because many of us take our doctor’s word that once we are finished bearing babies, it’s no great loss if our problematic uterus, and maybe even our ovaries, are removed. Don’t believe it. And don’t believe that there are no alternatives to open abdominal surgery. The question is, why isn’t your doctor telling you about them?
Why the Uterus Is Worth Keeping
Evidence is growing that our reproductive organs serve a purpose beyond birthing babies. In 2005 a landmark study showed that removing ovaries, which is still done during most hysterectomies to reduce the relatively small risk of ovarian cancer, actually increases the risk of heart disease and osteoporosis, according to study coauthor William Parker, MD, of the UCLA School of Medicine. While the ovaries produce a diminishing level of estrogen after you turn 45, for decades they will continue to produce testosterone and androstenedione, hormones that convert to estrogen when they circulate throughout the body. These provide crucial protection against heart disease and osteoporosis. Testosterone also helps preserve our sex drive, bolster energy levels, and maintain lean body tissue. Even though some women opt to keep their ovaries when they undergo a hysterectomy, Parker says that within four years of the operation about 15 percent will experience postoperative ovarian failure, which triggers premature menopause.
All of this might be acceptable if doctors had no alternatives to offer women suffering from noncancerous pelvic disorders. But that is far from the case. Over the past two decades, there has been a virtual explosion of new ways to treat pelvic problems.
Laparoscopic technology now allows ob-gyns to remove endometriosis and accompanying scar tissue, as well as fibroids, without cutting open the abdomen. Uterine artery embolization (UAE), which is performed through a minor incision in the groin, can shrink fibroids by cutting off their blood supply. Endometrial ablation, an outpatient procedure, can end bleeding by destroying the uterine lining via vaginal probe. Pessaries — which are diaphragm-like devices — and other fixes can lessen pain by lifting a fallen uterus back into place rather than removing it. Birth control pills, the progesterone IUD, and other nonsurgical therapies have also been shown to relieve disabling pain and bleeding while leaving the uterus intact. "It’s true that many of the new treatments may not provide a permanent solution. After uterine artery embolization, bleeding can return," says Carla Dionne, of the National Uterine Fibroids Foundation. "But many pelvic disorders naturally subside as women get closer to menopause, after which recurrence is less likely." In other words, midlife women don’t necessarily need a permanent solution; we just need a bridge treatment that can relieve symptoms of noncancerous pelvic conditions until we reach menopause.