Elective Hysterectomy at age 57--please advise

I am new to this group and I thank you all for taking the time to read my situation and give me some advice.

My mother and her 7 sisters all had hysterectomies due to fibroids before they were 45. Of course, at that time ('50s, '60s) that was the standard fix for the fibroids (and excessive bleeding) problems.

I endured a horrid perimenopause with excessive bleeding and clotting. The doctor told me that once I entered menopause, the fibroids would shrink. So I held on courageously and made it, despite my family history.

I had my last period December, 2001. Since then, menopause has taken its toll on me. Not only do I still have hot flashes galore, I suffer from horribly itchy eyelids, formication (feeling of ants crawling over your skin), nausea, and periods of instense fatigue, not to speak of many other symptoms.

I thought that by now, after six years of menopause, things would improve. But I find my quality of life is getting worse and worse.

I have been reading alot about bio-identical HRT. Because my fibroids are the size of a 12-week old fetus, I can't take the risk of having the added estrogen make them even larger.

My doctor believes he can do a laproscopic hysterectomy, but I am still wondering if I am doing the right thing. Has anyone opted for an elective hysterectomy at my age? Should I remove my ovaries (I want to keep my cervix) but my ovaries can't be doing much since I am suffering so greatly from menopause. If they are removed, the risk of eventual cancer is too, or so goes my reasoning

Since I am suffering so much from menopause, I can't imagine anything could be worse after the hysterectomy. But maybe I am wrong?

I would be so grateful for any comments from the network as to persons who had the hysterectomy at my age and were satisfied...or dissatisfied. I really don't know what to do and need help.

I'm also so confused about this whole bio-identical hormone option. I would really prefer the most natural way to relief, but don't really know where to turn.

THANK YOU to all the Hyster-sisters out there for any advice you can give.

Can you have the fibroids removed and see how that works? Could be they are stimulating your other hormones. I would go less invasing first and also start a swimming program 2 times a week which really helped me. No joke, try your local YMCA. I just moved to a little hick town and was feeling BLOATED and started this 2 days a week indoors 45 minutes and I feel like a new woman.

I am loosing the belly bloat and I do it early enough in the day that I have an energy boost in the afternoon to get stuff done. Go GIRL. I wear a flippin bikini!

I am not in your age range but I had a total hysterectomy at age 33. It has been a roller coaster but if I had to do it all over again, I would have still had the hysterectomy.

There comes a point in your life when you are sick and tired of being sick and tired. My endomteriosis robbed me of so much time and fun that I could have had with my family. Now I am grateful to be able to have that good time and move on with life without the turmoil.

Best wishes to you!

Hi Gianna57,

I was 46 when I had a laparoscopic hyst for two large fibroids. Would I do it again??? In a second to have the quality of lfie I have now without fibroids.

Like you, the females in my famly have had fibroids. My mom had smaller ones..and never had a hyst. My younger sister had a myomectomy for the removal of a grapefruit-sized fibroid a few years ago..and she just had a laparoscopic hyst last year for reoccuring fibroids. And my other sister had a vaginal hyst a couple of years ago for her fibroids.

As you said..generally...a hyst for fibroids is elective surgery. That can make the decision to have a hyst somewhat harder. For me it boiled down to my quality of life..or lack of..with fibroids.

I would say...make your decision on what you feel is *best* for you. Your Dr. sounds well trained if he is suggesting a laparoscopic hyst. It takes more training to do the hyst type.

Also...the ovaries secrete important hormones that help with the bones, skin and hair to name a few. And...newer studies are showing that the ovaries secrete their important hormones well into menopause. And the hormones are free. In pre-op, my Dr. told me that 5% or less of women get ovarian cancer. That was good odds for me...to leave my healthy ovaries. If you decide to have a hyst..you might opt to leave your ovaries and see how they are doing in post-op...and add HRT at that point..when the estrogen feeding fibroids are gone. Just my thoughts.

If you decide to possibly remove your ovaries...check out the Hormone Issues (HRT-No HRT Forum) on Hyster Sisters. It goes over surgical menopause and what to possibly expect.

In the end...don't worry...you will make the right decision for yourself. We Hyster Sisters are here to help if we can.

Sending best wishes~

Mary

Before making your final decision, I would suggest seeking a second opinion. This can help you see if there are other options that would be a better fit for you or if the hysterectomy your current doctor is suggesting is the right path for you.

Removing the ovaries could increase your menopause symptoms as the ovaries secrete trace amounts even during menopause. So talk to your doctor(s) about what is best for you with regard to your ovaries. I wouldn't suggest removing them just because you may have cancer down the road, unless there is a strong family history, as you wouldn't remove other body organs just because they might cause future problems. But it could very well be best for you if you have a hysterectomy to have your ovaries removed since your purpose is to try some time of HRT to relieve the terrible menopause symptoms that are decreasing your quality of life.

In the end, weigh your pros and cons and do what is best for you! S

I am overwhelmed at your generous advice. I know it takes time to respond to these requests, and I thank you all for your input.

My doctor actually isn't advising me one way or the other, so I don't really need a second opinion. He is leaving it up to me, as elective surgery.

I know I have this dead weight in my pelvis, which isn't easy to live with, despite the fact the horrid periods have stopped. But I do know that I cannot increase my estrogen levels safely while I still have this uterus, so if I want to go on some sort of Bio HRT, the uterus has to go.

I guess at this point I am wondering about ovary removal. My doctor said it is my choice. Big help, I know. I know he is leaning towards taking them out because of my age....how long do they actually produce? If I were in my 40s, I certainly would reconsider, but if they are not going to help me in the future (obviously they haven't done their job at this point, otherwise I wouldn't feel so bad). I am accepting the hyster at this point....now I need to get some advise on the ovary removal.

Thanks to the sister who recommended swimming. I am extremely active. My husband and I hike, dance, swim, etc. so I am definitely not a couch potato! Unfortunately, nothing helps that protruding uterus!

THANK YOU all so much for your kind responses. You have helped me more than you know,

Best, Gianna

I had an LAVH at the age of 53 after being in menopause for 2 years. I had a horrific perimenopause with many of your same symptoms. I began HRT during perimenopause for control of those symptoms. As a result of the HRT my fibroids (too many for the surgeon and the pathologist too count) did not shrink. My uterus was causing me much discomfort (but only minmal spotting). I opted for the LAVH and kept my ovaries (no family history of gynecological cancers and my ovaries looked healthy during the surgery). As mentioned previously they continue to produce small quantities of beneficial hormones even in menopause. I also continue to take estrogen with no worries of uterine cancer. I am thrilled that I had the surgery, no regrets whatsoever. I have become much more active since having my bulky uterus out, to the extent that I've been able to lose the 16 lbs that I had accumulated. I had an uneventful recovery with no complications, however please be aware that such has not been the case with all the women on this board. You should definitely discuss the risks involved with your doctor (nicked bladder or colon etc.) before you make your decision. I asked my doctor how often he experienced complications during surgery, how quickly would he recognize a problem and how he would "repair" a problem. He was very forthcoming with his complication rate and how repairs would be made. I felt very comfortable with his skill level, plus he had performed hysterectomies on several friends as well as my sister and was highly recommended. Hope this helps and if you have an specific questions for me don't hesitate to ask. Rose

Thank you so much for relating your experience. My doctor is actually the head of the department at our HMO, and has an excellent reputation for performing LAVHs. But of course, that doesn't mean accidents don't happen, and I will definitely take note to discuss these eventualities with him.

What my HMO doesn't seem to offer, yet others here in San Diego, where I live do, is the DaVinci robotic hyterectomy. I can't quite understand the difference between the two, and whether or not one is preferable to the other. I have the option of changing my health plan this November, and I am wondering if I should switch and find a plan that offers the seemingly advanced DaVinci method.

I understand what you are saying about the ovaries. I am between a rock and hard place with that one. There is some history of cancer in my family, but not ovarian cancer. However, my rationale is, how much good could my ovaries be doing at the present if my symptoms are currently so severe? My doctor doesn't answer the question either...he is leaving it up to me. However, I know he favors removal, as he probably thinks that is one less spot cancer can develope when one gets older.

I find that one really does have to research the pros and cons of every medical procedure on one's own, since doctors, as any person, can be somewhat biased.

How long was your convalescence? I am such an active person I fear the forced bed rest almost more than the operation (but I admit, I am afraid of that, too).

Thank you again for your guidance. This site has been a true Godsend. Gianna

Hi Gianna,

My recovery was so uneventful that even though it was only a year ago (Oct.2007) I have trouble recalling. I stayed overnight in the hospital and did not return home until late the next afternoon (my doctor was held up in surgery and could not get to my room any sooner to release me). I took my pain meds, went to bed and slept pretty comfortably. I was up and walking inside my home by the third day following surgery and my husband drove me 15 miles into town for lunch. I was driving myself after the 5th or 7th day. No problem with preparing my own food and drink, although I didn't have much of an apetite for a while especially in the mornings. My surgery was on a Monday and by at least Thursday or Friday I was walking up and down my driveway ( about 1/4 of a mile) 2 or 3 times a day. I found that the more I walked the more discomfort I had at night, but nothing unbearable. I also was able to discontinue the regular use of Darvocet after a couple of days and took only 800mg Motrin as needed. On the odd day that I overdid the walking or lifting I would take a Darvocet at bedtime. One month following the surgery, I rode for 1 1/2 hours (each way) and stood for several hours to see a rare bird. By that stage the biggest problem I had was "bladder spasms". I found that if I didn't head for the restroom as soon as I felt the need, my bladder would spasm very painfully. Urinating would immediately halt that pain. Any time my tummy hurt I would lie down and alternate a heating pad with an ice pack. My doctor's instructions were to lift no more than 5 lbs until my first check-up. At this check-up (2 wks) he released me to lift up to 25 lbs. I took care not to lift anything approaching that amount as I just didn't want to take any risks with my recovery. As best I can remember I felt pretty much recovered at the 6 week point, my husband's recollection is that it was two months with an occasional odd pain here or there. I don't work, so that wasn't an issue for me. I'm an outdoor person who loves walking, birdwatching, gardening etc. I was slower to return to the gardening, since it put the most stress on my tummy. I think I slowly returned to that beginning in January. That first week was spent mostly on the sofa watching my bird feeders and reading accumulated magazines and journals, with the daily walks outside. I'm not a television watcher and I found that my brain fog (residual anesthesia?) did not make reading books very enjoyable, but short articles were fine.

I found myself scared silly the two days & nights before the surgery, pretty normal feelings I'm sure. Even though I scoffed when my doctor prescribed a couple of Valium tablets for pre-surgery nerves, I filled that prescripition and made use of them.

My doctor also favored the removal of my ovaries, but left the decision up to me. He did stipulate that he would only do the surgery with the provision that if my ovaries looked the least be unhealthy, he would remove them. I think the deciding factor in my keeping the ovaries was the production of testosterone for sex drive. I've read that it's very difficult to get the correct dosage of replacement testosterone without some nasty side effects. I thought since my sex drive was not totally gone that my ovaries must still be producing at least a tiny bit even though they clearly were not willing to offer up any estrogen. I figured I only wanted to worry with tweaking my estrogen replacement and possibly balancing that with a bit of progesterone cream or Prometrium (even though medically speaking those are not necessary once the uterus is removed).

I'm sorry I can't address the DaVinci hysterecomy at all. I live in a small town in central Georgia where it wasn't available and I didn't feel the benefits of it would justify driving to Atlanta.

Good luck with whatever you decide and continue to ask any questions that may pop into your head.

Rose

Rose, You are truly an angel of mercy, and I hope that our discussions will help all those other ladies out there who are dealing with such decisions.

I am so happy to hear that your recovery was so swift. I, too, am not a television watcher, so the thought of spending untold numbers of hours in front of the tube truly depressed me. But now I realize that I can get up and walk, albeiit with restrictions, and that lifts my spirits greatly.

My husband and I are also avid gardeners, and here in Southern California we can pretty much grow our own produce year round. I'll let him till the soil, though, and watch as he plants our winter veggies.

I will have to give some serious thought to the issue of testosterone. My libido is not dead, so perhaps that is the only thing that my ovaries are producing at the moment....definitely not estrogen though.

I guess I need to do some research on this. What scared me, actually, was a visit to the lab to do a sonogram on my fibroids. The technician was 39 and very friendly. We started to talk about health matters, and she relayed to me the fact that she is now seeing an unprecedented rise in ovarian cancer.

Not only do many elderly women have the disease (understandable as cancer probably hits the weakest point when you are elderly), but she relayed that there were more and more young women in their 20s and 30s being diagnosed with ovarian cancer! She says it is almost an epidemic, and no one can figure out why.

Well, that leads me to think all sorts of things....our air, water pollution, etc. I grew up in the 50s in, of all places, Pittsburgh when the steel mills had their heyday and the smell of sulphur permeated the air continuously.

My husband and I embraced a vegetarian (and occasional fish) lifestyle years ago, using our own vegetables, so I want to think this helped offset all the poisons I was exposed to in my youth. But who knows?

But then again, this decision may be totally premature and based on ungrounded fear. As one sister wrote, you can't prevent cancer by removing your vital organs!

Guess I need to do more research.

It is so wonderful chatting with a fellow Hystersister and I thank you from the bottom of my heart for helping me in all these decisions!

Gianna