07 Feb 2018
Considering Hysterectomy? 5 Things You Need to Know BEFORE Surgery
Although hysterectomy is one of the most common surgeries for women living in the United States, myths about removal of the uterus abound.
As many as 600,000 American women have hysterectomies each year, estimates the U.S. Centers for Disease Control and Prevention. If you are about to be one of them, a heart- to -heart discussion with your gynecologist is essential first.
If your doctor is recommending a hysterectomy, there are things you’ll want to consider before going ahead. You’ll need to know what it could mean for your sex life, your hormones, and your future before you schedule surgery.
Here are 5 questions you’ll want the answers to.
1) Will a hysterectomy CURE my problem?
Removal of your uterus and/or ovaries is major surgery and has long-lasting implications for your health. Unfortunately, it can be the path of least resistance for some doctors.
Let’s look at a couple of examples. In situations such as endometriosis, there is a possibility that the tissue will regrow and cause problems outside of the uterus, thus not curing the problem. With depression, hysterectomy may be recommended, but unless the ovaries are removed, it is unlikely to fix the underlying depression which is most likely due to hormone imbalance.
Hysterectomy is one of many options if you have fibroids (noncancerous tumors), excessively heavy periods, or uterine prolapse (a dropped uterus). Hysterectomy could be a real medical necessity, not simply another option, if you have invasive cancer of the reproductive organs — the uterus, cervix, vagina, fallopian tubes, or ovaries.
2) When can I have sex again?
How soon you can have sex after a hysterectomy really depends on the type of hysterectomy: partial, total, or radical. Waiting two to four weeks to get back to sex is generally okay, with your doctor’s go-ahead, if your cervix was not removed along with your uterus. But if your cervix was removed, it takes about six weeks for the back of the vagina to heal.
And when you ask about sex, be clear about the question. Are you asking about vaginal intercourse, oral sex, orgasm? Be specific so you get the correct answer.
3) Do I need hormone replacement therapy?
This is a conversation that definitely needs to happen on the front end of surgery if you are having a total hysterectomy, especially if you are younger than the typical menopause age of 51. A total hysterectomy puts you into menopause overnight and that is tremendously hard on the body. Most women feel better using a combination of estrogen, progesterone and testosterone since all of these hormones are depleted after removal of the ovaries. Many doctors still subscribe to old-school thinking and may tell you that you don’t need progesterone since you no longer have a uterus to protect from estrogen effects. Do not buy this. Advocate for yourself… progesterone has positive effects on the body that go far beyond uterine protection. These include helping with anxiety and mood swings, bone health, nerve health and weight management. Request that you be prescribed bioidentical estrogen (estradiol) in a topical form along with progesterone capsules or cream. Progesterone cream is available over-the-counter.
If you have a partial hysterectomy, you will keep your ovaries, but the likelihood is that the blood supply will be disrupted during the surgery. They will continue to produce hormones on average for 3-4 years, then your hormone levels will fall gradually.
4) Can I avoid a hysterectomy?
Depending on the condition you are dealing with, you may be able to keep your uterus intact. Alternatives are available for about 90 percent of hysterectomies surgeons do. Fibroids, for example, may be treated using a nonsurgical procedure called uterine artery embolization that cuts off the fibroids’ blood supply. Another option to treat fibroids is myomectomy, which removes fibroids but spares the uterus. For heavy bleeding, an ablation procedure, which freezes or burns the uterine lining, may be a treatment option. Talk with your doctor about alternatives and if you are not comfortable with what you’re being told, get a second opinion.
5) What should I be aware of psychologically after a hysterectomy?
For some women, the emotional trauma of hysterectomy may take longer to heal than the physical effects. Feeling a little down or having a sense of loss after a surgery is normal. But be on the lookout for postoperative depression and get professional help if you need it. It can be a painful experience to realize that you’ll no longer be able to have children or have periods. Every woman’s experience is unique.
Unless you ask, certain critical and highly sensitive topics might not come up when you discuss hysterectomy pros and cons with your doctor. So speak up and get specific. Find out what a hysterectomy could mean for your sex life, your hormones, and your future.
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.
Find out more about working with her at https://www.drannagarrett.com/work-with-me/.