The trouble with being a Baby Boomer is that it`s hard to have a private life. Even if you resist the pressure to ”share your experiences” as if they were breath mints, an oversimplified version of them soon blares at you as some magazine, movie or TV show mirrors the real problems of real people who are just like you, really.
All that attention can lead to complacency. Used to having our pulses taken so often, Boomers assume that we`ll learn whatever we need to know about any problem enough of us share. But that assumption, I`ve learned, can be dangerous.
It began last spring when a gynecologist I consulted about heavy menstrual bleeding said it was caused by fibroid tumors in my uterus. Enormously relieved to hear that I didn`t have cancer-fibroids are cancerous in only about 1 in 1,000 cases-I nodded politely as she launched into a torrent of facts.
Whorled masses of muscle, fibroid tumors start as single cells inside the wall of the uterus and multiply. Some stay inside the wall as they grow, distorting the neatly triangular uterus with bulging lumps. Others press into the abdomen, attached to the uterus by stems. A few protrude into the womb itself. Usually women with fibroids have more than one. And often, my doctor said, the best course of action is simply to monitor them, to make sure they`re not growing too quickly.
”Fine,” I said, sneaking a look at my watch. ”So I just need regular checkups so you can keep an eye on them?”
Well, no, the doctor replied. When the fibroids get large-tumors as big as oranges are not uncommon-they can cause excessive menstrual bleeding, pelvic pain or pressure on the bladder or bowels.
In my case, one tumor was the size of a grapefruit (doctors, I`ve discovered, are fond of comparing tumors to fruits). Since the bleeding it caused already had made me anemic and would only get worse, her recommendation was surgery.
And the most commonly performed operation for fibroids is hysterectomy.
Hysterectomy! The word crashed through my detachment like a bullet through glass. I stammered that I hadn`t had any kids and very much wanted some. And soon, I hoped, since I was already 34 and had met the man I wanted to have them with. Anyway, removing my uterus simply was out of the question. Luckily, the doctor said, there was an alternative to hysterectomy: An operation called abdominal myomectomy would remove the fibroids but leave my uterus intact. A myomectomy is a lot like a Caesarean section except that, instead of a baby, the surgeon removes tumors from the uterus through an incision in the abdomen. Like a hysterectomy, a myomectomy is major surgery;
it usually requires a four- to five-day hospital stay.
The difference is that I`d still be able to have children-in fact, my chances of having a trouble-free pregnancy might even improve, since there`s evidence that fibroids can prevent healthy, full-term pregnancies. The tumors grow in response to hormones, so they often become larger during pregnancy, when a woman produces more hormones. Large ones may cause miscarriage or premature labor, or squeeze the baby into an awkward position so that delivery has to be by Caesarean section.
I decided myomectomy was the way to go. Nothing about the surgery was as bad as I had imagined-not my nerves as I waited outside the operating room, not the pain for the first few days afterward, and not the time it took to feel fine again, except for the lingering ache of my scar.
Then outrage kicked in. If myomectomy was such a good solution for me, why wasn`t it being offered to more women? After all, my situation was hardly unique. Fibroids are as common as crabgrass: One in every four or five women of reproductive age has tumors that cause pain, bleeding or other symptoms. And plenty of women have postponed having children until their mid-30s or later, the age when fibroids most often become large enough to start causing problems. So why are just as few myomectomies being performed today as 10 years ago? Why are five of every six women who have surgery for fibroids still getting hysterectomies?
One possibility is that it`s a matter of cultural bias. Until recently, myomectomies were nearly unheard-of in this country, although in parts of Europe they`re the standard treatment for fibroids.
When Lynn Payer, an American medical journalist, was diagnosed with fibroids while living in France, the French doctor who performed her myomectomy never even mentioned hysterectomy as a possible remedy. Several years later when she needed another operation for recurrent fibroids in the United States, the doctors she consulted strongly recommended hysterectomy. Payer discovered that American doctors do about three times as many hysterectomies as French doctors do, and French doctors rarely do
hysterectomies to remove fibroids.
Some American surgeons simply haven`t been trained to perform myomectomies, which require more time and skill than hysterectomies. That`s why it`s important to get a second opinion.
”It`s very common for us to see patients who are adamant about not having a hysterectomy whose gynecologists have told them that`s their only option,” says Mitchell Rein, a reproductive endocrinologist at Brigham and Women`s Hospital`s Division of Reproductive Endocrinology and Infertility in Boston. ”I`m not exactly sure why that is, but it`s probably related to a doctor`s training and comfort with performing myomectomies.”
Rein and his colleagues perform many more myomectomies than hysterectomies for fibroids, usually because a woman still wants to have children.
But there are plenty of reasons why even a woman who doesn`t want kids might want to keep her uterus. Many women report depression, serious doubts about their femininity or a decreased enjoyment of sex after a hysterectomy. When the ovaries are removed along with the uterus, as they are in about half of the cases, a woman enters premature menopause and may experience hot flashes, mood swings and other symptoms associated with decreased hormone production. And it was only last year that studies confirmed that estrogen produced by the ovaries lowers the risk of heart disease. Who knows what benefits the uterus may prove to have in the future?
”We`re seeing more women past childbearing who are requesting myomectomy,” says Rein. ”Women just don`t want to lose their uteruses.” But even Rein and his colleagues don`t recommend myomectomy first to women over 40 who no longer want children. ”My own recommendation in that setting is usually hysterectomy first, but myomectomy as an alternative,” he says.
And why is that? Well, for one thing, Rein says, many believe that myomectomy is a more dangerous operation because it`s associated with more bleeding. During a hysterectomy, the arteries bringing blood to the uterus can be tied off to prevent too much bleeding. But because there are usually no large blood vessels connected directly to the fibroids, that`s not always possible during a myomectomy. Still, says Rein, studies show that the chance of dying from either surgery is very small.
Then, too, there is a slim but serious possibility that uncontrollable bleeding during a myomectomy will force the surgeon to go ahead and perform a hysterectomy. But that happens very rarely, Rein says: ”In our experience, the risk of having to do a hysterectomy during a myomectomy appears to be less than 1 percent.”
Perhaps the main reason American doctors see hysterectomy as preferable to myomectomy is that it gets rid of fibroids once and for all. In as many as one in four cases, fibroids can recur after a myomectomy, sometimes growing big enough to require another operation.
As many times as I heard this argument, it never made sense to me. I`d much rather have two myomectomies than one hysterectomy-and so, I suspect, would a lot of other women if they knew they had the choice.
Surgeons who take the time to search the uterus thoroughly for small tumors report fewer incidents of recurring tumors.
Hysterectomy is still the first or only option recommended each year to thousands of women with fibroids, especially if they`ve already had children. Thirty-one percent of American women between 45 and 49 have had hysterectomies-more than a quarter of them for fibroids.
When it comes to removing a woman`s most vital reproductive organ, the question shouldn`t be ”Why not?” but ”Why?” And the only acceptable answer is ”Because you have no better choice.” That`s why I felt compelled to, uh, share my experience. Because the shocking truth is, even we Baby Boomers aren`t always told what we need to know.
