Hysterectomy to Avoid Future Problems?

I am a long-term cancer survivor and have had three subsequent cancers (originally Hodgkins Disease, then skin cancer, then a stroke, then more skin cancer, then bladder cancer). I have been in menopause for three years. When I started spotting about three weeks ago, I made an appointment with a new gyn. She did an endometrial biopsy and told me I would have results in two weeks.

She called yesterday and said everything was benign but I did have a spot of focal atypia. She suggested it be treated with a three-month course of progesterone (Megace), then she would do another biopsy. If that failed, we would try a six-month course of a higher dosage.

With all I've been through, I am not willing to take more pills every day just to see if a problem will go away. The gyn didn't say the problem would disappear and never come back. It might and it might not.

The gyn didn't offer a hysterectomy as an option. Since she didn't, would my insurance cover a hysterectomy if I elected to have one? I feel that a hysterectomy would help avoid future problems, particularly at my age. The longer I wait, the harder it will be to recover.

Does anybody have any advice for me?

Vanaken,

From reading forums, it sounds like a number of Drs. offer a hyst as a last alternative.

It sounds like your Dr. may be working through all alternatives and that is why a hyst has not been brought up.

However, I could suggest you bring it up with her, if you want. Her office accountant may also be able to answer your question about a hyst being covered by your insurance.

You may try calling your insurance company directly and asking them.

Just some thoughts. I actually had to pay for my hyst out of pocket. My DH had just got a new job and new medical insurance and I was diagnosed in the interium period. Luckliy, I have a great mom and she helped me with my hyst bill.

Good Luck.

	Quote:
I feel that a hysterectomy would help avoid future problems, particularly at my age.

Unfortunately, for some women, a hysterectomy causes more problems than it solves, which is why many DRs prefer to exhaust all non-surgical alternatives first.

Many women have hysterectomies and are very happy they did; however, sometimes either things go wrong during surgery, or the removal of the uterus and/or ovaries leads to long term complications that most of us would never even imagine could be associated with the hysterectomy (things like fibromyalgia, sjogren's and other immune system disorders, for example, in addition to problems related to adhesions).

The unlucky minority to whom these things happen stand a much better chance of being able to live with their fates if they know they HAD to have the hysterectomy, rather than that it was something they chose to do without fully exploring other ways to treat the problem and without being sure that the benefits of having a hysterectomy were worth the risks they were taking in going through with it.

I am one who has had serious health issues arise only since my hysterectomy... pre-hyst I was the picture of health. If it weren't for the fact that I know I didn't have any reasonable alternative to surgery, I would be a very angry person now. Perhaps your DR is trying to help you avoid having to feel that way... the only way to find out is to ask.

I am not aware of an insurance company that would cover a hysterectomy that was done without a DR's recommendation. In fact, I would hope no DR would perform a hysterectomy in this day and age which they did not consider medically necessary... the risks they would be taking in doing so are just too great.

I think your DR's plan sounds very sensible. I would also agree that a second opinion is never a bad thing to have, especially if you have doubts about whether your DR's proposed treatment is the best alternative for you. Who knows, down the road somewhere you might end up having a hysterectomy, but hopefully by then you'd know it was the right thing to do.

Good luck!
s,
-Linda

Dear Vanaken,

I am sorry to learn of your difficulties..

I can certainly understand your reluctance to start a course of Megace. I don't have a great understanding of the mechanisms of breast cancer, but from what I understand, progestins are beneficial to some while detrimental to others w/breast cancer depending on their hormone receptive status.. and the effects/benefits of progestins tend to be argued about anyways.
Unless you are one of the people that show clear benefit from progestins, it isn't what I would prefer for you to do.

I can understand your feelings about having a hysterectomy. Many people do tend to think of hysterectomy as a final and maybe even simple solution to uterine problems. I would tend to think that your insurance company may side with you on the decision;.. However.. I think it needs to be kept in mind that somehow a problem was created, and that imbalance problems don't necessarily confine themselves to one organ. Typically, uterine problems such as hyperplasia atypia are caused by estrogen excess/unopposed estrogen which won't necessarily go away by removing organs. In a case like yours, the drugs you have taken may have caused the imbalance.. tamoxifin is a known culprit.
My mother passed from breast cancer and I developed uterine cancer young. I have Mom's records, but haven't read them yet to determine if it was an estrogen or progesterone receptive situation, but whacky as it may seem, I believe that terrible coffee habits were the undoing of both of us as it raises estradiol levels.. of course, this may be far too simplistic. I have now cut back drastically on my coffee and alcohol consumption.

One option which I can offer you for consideration is the Mirena hormonal IUD. Knowing your age, I would like to mention that this isnt the oldtime risky IUD that still comes to mind w/many women. The reason that I think that this may be preferable for you over pills is dosage... it has less progestins than even birth control pills but it's actions are direct because of location.
I have heard of women w/breast cancer using the Mirena for prevention/correction of uterine problems, however, I don't know if your doctor would actually be allowed to prescribe this for you considering that you are postmenopausal. I believe it would be considered an experimental use.

The Mirena IUD is fairly new in the USA(2001) and contains progestins only. The progestin is in lower amounts than that of bcps and therefore dont tend to cause as much side effects as people tend to hear about with progestins (though I didnt have them) and it's effects are more direct considering it's location. It usually decreases the monthly flow and a good number of women dont even get a period with it. It is good for five years. I have one.

Though it's primary use is as a form of birth control, it is used in cases of endometrial hyperplasia (sometimes even in low stage cancer), fibroids (if there isnt too much distortion), cases of excessive bleeding where the cause has been elusive, endometriosis, and adenomyosis.
Mine is doing fine now (I have it to prevent recurrence of hyperplasia) but I will admit that the placement is not fun, and it seems that good placement is somewhat a matter of luck (having had 2 placed in the past) or ongoing cramping may occur. Mine has been so comfortable that I've had moments of doubt that it was there. To give a sense of dosage.. the Mirena typically releases 20 mcg levonorgestrel/day and bcps release .1-.35 mg/day

http://imaginis.com/breasthealth/news/news11.20.00.asp
http://www.womens-health.co.uk/mirena.htm
http://www.annieappleseedproject.org/iudmayprotta.html

Pat