The topic of hysterectomy is controversial enough that at least two groups have mobilized to focus on it.
The HERS Foundation, for example, will be capping a yearlong nationwide protest about unnecessary hysterectomies March 11-19 in the nation’s capital. And the Web site www.hystersisters.com serves as a support and recovery resource for hysterectomy patients; it takes no stand on the issue.
The procedure still struggles to shake an image of a harsh tactic that adversely affects a woman’s life physically, sexually and socially. But the medical community is offering an increasing number of less-invasive procedures that can prevent serious aftereffects.
Hysterectomy, or removal of the uterus, is the second most often performed major surgical procedure among reproductive-age women, after Caesarean delivery, according to the National Center for Health Statistics.
The number of hysterectomies in the U.S. increased to 669,000 in 2002 from 592,000 in 1990, according to the center. Doctors interviewed for this article say, however, they are performing fewer such procedures, reserving them for cancer and conditions that fail to improve with other treatments.
The majority of hysterectomies are due to fibroids, non-cancerous growths in the uterus, which usually are monitored and cause no symptoms. When fibroids grow excessively, they can cause painful intercourse, pelvic pain and pressure, and heavy menstrual bleeding. Twenty to 40 percent of women older than 35 have fibroids.
Less-invasive treatments
Alternative treatments for fibroids include hormone therapy and anti-inflammatory drugs; myomectomy, a surgical procedure to remove the fibroids while preserving the uterus; and uterine fibroid embolization (UFE), a minimally invasive radiology procedure that decreases blood supply to the fibroids, causing them to shrink.
Secretary of State Condoleezza Rice recently underwent UFE. “Uterine fibroid embolization is growing in popularity due to its short recovery time, short hospital stay and preservation of the uterus,” said Dr. David Hahn, interventional radiologist at Evanston Northwestern Healthcare. The procedure also has fewer serious complications than hysterectomy or myomectomy, he said.
Lizabeth Kollmorgen, a 45-year-old North Shore psychologist, had UFE in May 2004. The mother of two had asymptomatic fibroids for years, but they began to grow.
“I felt like I had a bowling ball in my gut,” she said. She had a myomectomy in 1993, but three years later another fibroid appeared.
Eventually her doctor referred her to Hahn. “The procedure was a breeze,” Kollmorgen said. “The first week was a little difficult, but I started running 10 days later and returned to work within five days. The fibroids are there, but they are asymptomatic and I can live with that.”
Dr. Howard Topel, of Rush North Shore Medical Center in Skokie, said that there are many options, and doctors must tailor treatment to the patient. “One treatment is not good for all,” he said.
Topel, who is director of gynecologic surgery at Rush North Shore, considers several factors when deciding on fibroid treatment. These include the patient’s age, desire to bear children and the number and size of the fibroids.
With the trend toward conservative surgery and alternative treatments, Topel’s practice is performing fewer hysterectomies. Still, there are conditions that warrant hysterectomy, he said. Examples are large uterine fibroids, heavy bleeding and uterine cancer.
Most hysterectomies performed today remove the uterus while preserving the ovaries. If the ovaries are preserved in a woman who still menstruates, side effects such as hot flashes, night sweats, personality change, loss of sexual desire, irritability and insomnia are prevented.
Doctors can preserve cervix
If a woman does need a hysterectomy, the surgeon can either remove the entire uterus or do a subtotal hysterectomy to preserve the cervix, which supports the bladder and reduces the chance for urinary incontinence, Topel said.
Jody Lucchesi, a 45-year-old mother of two from Algonquin, had a subtotal hysterectomy in November. Her doctor told her she needed a total hysterectomy for submucosal fibroids, those just under the uterine lining. She went to see Topel, who said she was a good candidate for a subtotal hysterectomy.
Topel removed her entire uterus laparoscopically through three half-inch incisions under her belly button. He left her ovaries and cervix intact.
“My uterus was five times its normal size before surgery,” Lucchesi said. She left the hospital the next day and returned to work two weeks later; a total hysterectomy requires a four- to six-week recovery.
“We’re trying to educate women about their female organs and their function because they know so little about their anatomy and the loss of function if they undergo hysterectomy or removal of the ovaries,” said Nora W. Coffey, 62, who founded HERS in 1982 after her own hysterectomy and removal of her ovaries at age 36. (HERS stands for Hysterectomy Educational Resources and Services.)
Coffey spent years researching the effects of hysterectomy. “I had a loss of sexual sensation, was numb from the waist to mid-thigh, and had such severe bone and joint problems I couldn’t return to work or school or care for my three young children,” she said. “Doctors all said it had nothing to do with my surgery.”
Her symptoms became less severe with acupuncture and hormone therapies, but she continues to have significant joint pain.
Joint/musculoskeletal problems are a rare side effect of hysterectomy if the ovaries are removed, said Dr. John Gianopoulos, chairman of the department of obstetrics and gynecology at Loyola University Chicago Stritch School of Medicine.
“There is an immunological function in the ovaries, and there are interactions between hormones in the body that can affect arthritis in someone with pre-existing musculoskeletal conditions,” he said.
Once a woman understands the cause of her medical problem, she can consider all options and treatments, Coffey said.
Loyola limits its use of hysterectomy to uterine cancer, incontinence and prolapse of pelvic organs, Gianopoulos said.
Some doctors may opt for hysterectomy because they haven’t been trained in newer techniques. “Lack of training and skill are involved, but allowing doctors to use that as an excuse lets them off the hook,” Coffey said.
Economic incentive may play a role, she said.
Topel, however, said there is no economic incentive for doctors to promote hysterectomy.
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Hysterectomy and pelvic pain
Research has shown that:
9 million U.S. women are affected by chronic pelvic pain. (March 2003)
10-20% of hysterectomies performed in the U.S. are due to pelvic pain. (March 2003)
38% of women undergoing hysterectomies because of pelvic pain continue to have pelvic pain afterward. (Dec. 1995)
79% of post-hysterectomy patients with continued pain likely had a bladder dysfunction instead of a uterine problem. (Oct.-Dec. 2004)
SOURCES: Obstetrics & Gynecology journal, Journal of the Society of Laparoendoscopic Surgeons
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E-mail: ctc-woman@tribune.com.
