If you’re a woman with a womb, you’re probably still reeling from the Supreme Court’s anachronistic affront to your reproductive rights. And like many of us at Monet, you may be wondering which sexual freedoms are next to be stripped away.
Thanks to so-called “trigger laws,” abortion is now illegal in at least 13 states, even in cases where childbirth carries a high risk of mortality to the mother. Fortunately, for now, women are still entitled to undergo a hysterectomy — the surgical removal of the uterus — when doctors deem the procedure medically necessary.
Each year, about 600,000 hysterectomies are performed in the United States, making the procedure the second most common operation (after C-section) in women of child-bearing age. And while you can’t cut out your uterus just to avoid the abortion ban (though, trust me, my friends and I have joked about it), there are some circumstances when a hysterectomy may be the most viable option to treat a life- or quality-of-life-threatening situation.
Reasons To Have a Hysterectomy
According to Johns Hopkins Medicine, a hysterectomy may be performed for the following reasons:
Fibroid tumors. Non-malignant tumors can grow large enough to put pressure on surrounding organs and cause significant pain or bleeding.
Endometriosis. The lining of the uterus (endometrium) can grow outside of the uterus and attach itself to other organs in the pelvic cavity, causing chronic pain or prolonged, heavy bleeding.
Endometrial hyperplasia. The endometrium can sometimes become overly thick and cause abnormal bleeding.
Cancer. About 10 percent of hysterectomies are performed to treat early-stage cervical, ovarian, or endometrial cancer.
Blockage of the bladder or intestines. An abnormal growth or the uterus itself can cause a blockage of the bladder or intestines
Types Of Hysterectomy
If your doctor decides that you are a candidate for hysterectomy, you may be wondering how much of your reproductive organs will be removed. The different types of hysterectomy include:
Total hysterectomy. This procedure removes the entire uterus and the cervix, but leaves the ovaries intact.
Partial hysterectomy. This procedure removes the body of the uterus but leaves the cervix intact.
Hysterectomy with bilateral oophorectomy. This procedure removes the uterus and cervix plus one or both ovaries and fallopian tubes.
Radical hysterectomy. This procedure removes the uterus, cervix, ovaries, fallopian tubes, the upper part of the vagina, and sometimes the pelvic lymph nodes.
Myths About Hysterectomy
Despite how frequently hysterectomies are performed in the United States, myths and misconceptions still abound about the procedure. No major operation comes without the risk of complications, but hysterectomies are generally very safe and well tolerated — especially with new technological advances like robotic-assisted surgery.
Desperate to end your discomfort but deterred by the rumors you’ve read? Here, OB/GYNs and other women’s health experts correct the most egregious myths they’ve encountered when it comes to hysterectomy.
Myth #1: Hysterectomy is always very painful.
Fact: Sure, you may feel some pain and discomfort after the procedure, especially if you overexert yourself too soon. “It is important to note that recovery after surgery will not be 100% pain free,” points out Alex Juusela, M.D., M.P.H., F.A.C.O.G., a board-certified OB/GYN who performs multiple types of hysterectomies. “Pain is subjective, and it is important that it is treated appropriately.”
Still, recent medical advances have made remarkable strides towards relieving the experience of pain. “Smaller incisions, along with advances in pain management protocols — such as the ERAS (enhanced recovery after surgery) pathways — have led to faster return of bowel function, decreased postoperative pain, less requirement for pain medication, and, most importantly, a lowered risk of complications,” Dr. Juusela explains. “To have the best outcomes, it is important to discuss your pain management plan with your OB/GYN prior to surgery.”
Myth #2: Hysterectomy requires a long hospital stay.
Fact: Advances in surgical technique have also resulted in shorter hospital stays, Dr. Juusela points out. Newer surgical approaches can completely avoid abdominal incisions (such as a vaginal-only route) or require only small abdominal incisions (such as laparoscopic and robotic surgery).
“The type of surgery performed depends on multiple factors, such as the reason for the hysterectomy, the size of the uterus, a patient’s history of previous abdominal or pelvic surgery, and a patient’s medical conditions,” Dr. Juusela explains. But “patients are routinely discharged home the same day, or the following day after,” he says.
Myth #3: Hysterectomy immediately leads to menopause.
Fact: A hysterectomy alone will not cause a patient to immediately enter menopause, Dr. Juusela says, particularly if the ovaries are left intact — as is the case in a total hysterectomy. Total hysterectomy is the most common type of hysterectomy performed in the United States.
“Menopausal symptoms are related to a decrease in estrogen and progesterone, two hormones produced by the ovaries,” Dr. Juusela explains. “If only the uterus is removed, the ovaries will remain in place and continue to produce estrogen and progesterone, and therefore will not cause immediate menopausal transition symptoms.”
While the onset won’t be immediate, you could still experience menopause sooner than you would without a hysterectomy, Dr. Juusela warns. “There is evidence that the blood flow to the ovaries after a hysterectomy is decreased and there is a risk of earlier menopausal transition,” he says. Women who are candidates for the procedure should discuss this possibility with their OB/GYN to determine whether this risk is acceptable.
Sometimes, a woman does require a hysterectomy with bilateral oophorectomy — that is, the removal of both ovaries in addition to the uterus — because of a suspicious mass or genetic predisposition to ovarian cancer later in life. “In those circumstances, there may in fact be a withdrawal of hormones immediately following surgery, which we call ‘surgical menopause,’” explains Taniqua Miller, M.D., F.A.C.O.G., a board-certified OB/GYN and assistant professor of medicine at Emory School of Medicine. “Depending on a person’s health history, they may be a candidate for hormone therapy to give back some of the estrogen and progesterone that are now absent,” she says.
Myth #4: Hysterectomy means you’ll never enjoy sex again.
Fact: Ladies, you can maintain a healthy sex life even after you’ve had the surgery. “Yes, there are dramatic shifts that happen almost instantaneously when you have a hysterectomy, but they are all manageable,” says Bat Sheva Marcus, L.C.S.W., M.P.H., Ph.D., a licensed social worker and sexual health specialist. “With additions of hormones (both local and systemic), and use of some of the new lasers, your vagina can go back to feeling every bit as good as pre-surgery.”
Many times, women can actually enjoy a better sex life after they’ve had a hysterectomy, Dr. Miller points out. “Some studies show that patients who have hysterectomies for pelvic pain, bleeding, or bulky uterine fibroids report a better quality of sex life and orgasm because the uterus is now removed and there are no worries for bleeding or pain,” she says.
Myth #5: Hysterectomy leaves an empty space in your pelvis.
Fact: No, you won’t have a gaping hole in your body once the uterus is gone. “The reality is, no matter the size of the uterus that is removed, there is no ‘empty space’ following removal,” says Lauren Streicher, M.D., an OB/GYN and clinical professor of obstetrics and gynecology at The Feinberg School of Medicine.
“Picture this: If you have a bowl of spaghetti with a large meatball in the middle and a few smaller meatballs on the side, and then someone removes the large meatball, the space the meatball formerly occupied is replaced by the spaghetti. No one would know that the meatball was ever there,” Dr. Streicher describes. “A woman’s pelvis is like a bowl, the uterus like a meatball, and the ovaries are like small meatballs. Bowel, of course, is the spaghetti. If the uterus is removed, the bowel falls into the space — which is only the size of a small pear — and there is no empty space. Phew.”
Myth 6: Hysterectomy always leads to urinary incontinence.
A hysterectomy itself does not cause urinary incontinence in most women, Dr. Miller says. However, if you’re already predisposed to urinary incontinence — for instance, from pregnancy and vaginal childbirth, pelvic floor weakness, or abdominal obesity — you may start to experience symptoms following the procedure.
If you do experience urinary incontinence after a hysterectomy, don’t despair — you can get the symptoms under control. “There are a host of options for treatment of urinary incontinence, including pelvic floor exercises,” Dr. Miller notes. “Working with a pelvic floor physical therapist is magical for this!” Other treatments for incontinence include medications for overactive bladder symptoms and surgeries, she says.
Myth #7: Hysterectomy is always the best or only option.
Fact: Though the procedure is generally safe and associated with a short recovery time, a hysterectomy isn’t right for everyone — and it’s always a good idea to explore alternative options, particularly if your condition isn’t life threatening.
“As a medical professional, I know for a fact that too many hysterectomies are being performed than are medically necessary,” points out Donna F. Brown, a retired registered nurse and author. “There are many health conditions that require having a hysterectomy to either save or improve a patient’s life, yet it is always prudent to discuss alternative treatment options with a trusted primary care doctor or OB/GYN specialist prior to undergoing major surgery.” Women should also not be afraid to seek second and even third opinions, Brown recommends.
“I would like to say that many people are not given conservative options like a pessary, or exercise (namely hypopressives), or diet and lifestyle guidance that could help them avoid the need for a hysterectomy,” adds Kim Vopni, a pelvic health coach. “Finally, all women having a hysterectomy should be counseled to work with a pelvic floor physical therapist.”
Have you undergone a hysterectomy? Are you seeking a hysterectomy? Share your experience in the comments below!
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