Why To Avoid A Hysterectomy
If a woman wants the option of having more children, then why she would want to avoid a hysterectomy is obvious. This desire is part of the medical decision. Most women who are presented with the choice are past that. Still, there are many reasons to keep those organs until death do us part. Simply wanting to keep her organs is an official medical reason that must be factored into the decision. In many cases, ovaries are removed at the same time. Surgical menopause, even with hormone replacement is a much rougher ride than the natural. It is, of course, major surgery. Furthermore, there are concerns and patterns of other functional disturbances that are associated with hysterectomy. Decreased libido is commonly reported in post-hysterectomy patients who retain their ovaries. It is speculated that nerves or blood vessels that are cut are somehow respnsible. While it is done to help urinary continence, in some cases, it may actually contribute. Weight gain is also commonly reported after a hysterectomy.
Reasons To Have Hysterectomy And Not To Have Hysterectomy --
Good categories of reasons to have a hysterectomy are: save the woman's life (usually advanced cancer, severe bleeding or infection), restore function (severe prolapse), and relieve pain (various). Even so, hysterectomy should not be done when there are comparably effective and less drastic measures available.
If a woman does not have a clear diagnosis, she should not have a hysterectomy. In the past, hysterectomies were done for symptoms, not just disease. Bleeding and pain are symptoms. While the goal may be to stop these, the doctor needs to know what is behind those symptoms before hysterectomy should proceed. If she has a lot of other medical problems that would make any surgery more risky, it should be avoided. If she has a lifestyle and responsibilities that preclude a normal recovery period, she should think twice. It also has no place in the management of menopausal or P.M.S. symptoms.
It is important for a woman to look into the details of her diagnosis when a hysterectomy is suggested. Not all cancers, fibroids, and such require a hysterectomy. Finding a woman's precise sub-category within these and matching it against the medical profession's standards is key. Always asking for a surgery that removes less or for a non-surgical alternative, and second opinons help greatly. Valid reasons are in bold below, invalid reasons and pitfalls are in italics.
Hysterectomy For Cancer:
About 10% of hysterectomies are done for cancer. They can be done for cancers of any part of the uterus or tubes or ovaries, or nearby organs that have spread. But, far from all cancers require them. Cancer must be formally diagnosed, it is not for unspecified abnormalities. How advanced the cancer is, the woman's age and desire for future pregnancies, and her overall health are the factors that determine it.
Cervical CIN II ("C I N 2", Cervical Invasive Neoplasm, Dysplasia), but only if cone biopsy has failed, Early invasive cervical cancer But NOT for mild or moderate cervical dysplasia, there are other options. Not when cone biopsy is still an option. Leukorrhea, or chronic cervicitis are not cancers and are thus not appropriate
Endometrial Adenocarcinoma But not, endometrial hyperplasia (overgrowth)
Ovarian or tubal carcinoma Except some stage 1s can be treated without it
Gestational trophoblastic disease but only after chemotherapy has failed
Colon or Bladder Cancer that has spread to the uterus or blocks removal of the cancer
Hysterectomy for Fibroids (leiomyomata uteri):
The most common reason for non-cancer hysterectomies, about 30%. Here the important point is to determine if they are severe enough to warrant the procedure. Symptoms include pain and pressure, bleeding, childbearing problems, etc.
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