LAVH: Hysterectomy next week (8/16). Cervix? HRT?

Hi.

I'm scheduled for a LAVH/BSO on the 16th. I haven't had a whole lot of time to think about it because just found out I have a 10-cm mass on my ovary and it needs to come out fast.

I had an exam with my doc last Wednesday, when the decision was made. I started doing some research then.

I've read that it's a good idea to leave the cervix to avoid future prolapse.

I've also read about the abruptness of surgical menopause and the benefits of HRT.

I left a message for my doc, asking if she was planning to leave the cervix and if I would be on HRT immediately.

The nurse called back and said the doc said that she will be taking the cervix unless there's a complication because there's no benefit to keeping it.

She also said that due to my age (49), she wouldn't start HRT right away; she'd wait and see how I did without it.

I'm especially nervous about NOT starting HRT right away because I have a strong history of depression and anxiety and I'm afraid the surgical menopause will throw me into a deep depression.

Fortunately, my doc had a cancellation tomorrow, so I will be able to talk through these 2 concerns, but I was just wondering if anyone here had an opinion.

Thank you!

Hi Purple Bloom -

I had a TAH BSO at age 46, so a little younger than you.

Regarding your cervix: The medical community is not in agreement on the benefits of keeping your cervix. Some doctors believe keeping your cervix is beneficial, while other doctors do not think that it helps at all to keep your cervix. Here are 10 Questions to Help You Decide about the Cervix. Do talk to your doctor about your concerns.

I lost my cervix (no choice) and have not had any issues with prolapse. My surgery was over 5 years ago.

Regarding HRT. I also waited to see how my body would react to being rudely dumped into surgical menopause. I was absolutely MISERABLE. I waited 3 months and then went to my GP and said HELP! She put me on bio-identical oral estrogen and it gave me my life back. For me, she said it was also better for my health.

However, there are some women that do just fine without HRT, and some women who cannot take it due to other health concerns. So it really just depends. Here are articles that may help:
5 Interesting Facts about Surgical Menopause
6 Tips to Help You Prepare for Surgical Menopause
Do This - Not That: Managing Surgical Menopause

Hopefully your meeting will go well with your doctor, and your concerns will be addressed.

Hi Purple Bloom,

I had a subtotal hyst (kept my cervix) for several fibroids on and in uterus, and removal of my tubes almost a year ago. After reading a lot of info on here, I opted to fight to keep my cervix. The doc was originally thinking of full hyst for me. The decision came down to this between the doc and me:
The doctor approved on his end bsc:
* I had no prior problems with a pap smear
* I have no family history with cervical problems
I fought for it bsc:
*I'm against removing things that are healthy
*I read orgasms are stronger with the cervix (though this may be debatable. I have had really strong O's since full recovery.)
*Not the best reason perhaps, but my hubby is, um, well-endowed, and I wanted to loose as little as possible to accommodate (blushing on this end)
Bottom line, I wanted the least amount of tampering with my body and it was my choice.

This is a personal choice though.

You may have mini periods like I do about each month if you keep your cervix. My doc cauterized the cervical cells (same type as in uterus), but it's hard to get all of them. My periods weren't a problem, the fibroids were, so I am ok with the mini periods. I'm closing in on 51 and in premenopause now with the periods coming irregularly and other things that come with this time.
I hope you come to the right decision for YOU. Hugs.

Wow, marestail and windchime, thank you for the replies!

I so appreciate all the resources to check out and the personal experiences you've shared. You can read lots of clinical information but personal stories really help me feel safer about my options. Thank you so much for taking the time.

I just had it all taken on July 15 and while I can't say anything about prolapse, my doctor and my decision was that since she was going in once, she felt it was better to take it all. That way she didn't have to go in with another surgery to remove it at a later date.

I am on estrogen (i am 41) as I had horrible hot flashes for years and years before. Now i have 1 or 2 a day. My biggest problem is insomnia, I seem to have my days and nights mixed up.

I also have severe depression, anxiety and panic. As long as I take my medications like I am supposed to, I am pretty even, however with having my days and nights reversed, my meds have been missed and then it gets a little rough. I am going to discuss this with that dr this morning.

Jenn

	Quote:
Originally Posted by jswitz I just had it all taken on July 15 and while I can't say anything about prolapse, my doctor and my decision was that since she was going in once, she felt it was better to take it all. That way she didn't have to go in with another surgery to remove it at a later date. I am on estrogen (i am 41) as I had horrible hot flashes for years and years before. Now i have 1 or 2 a day. My biggest problem is insomnia, I seem to have my days and nights mixed up. I also have severe depression, anxiety and panic. As long as I take my medications like I am supposed to, I am pretty even, however with having my days and nights reversed, my meds have been missed and then it gets a little rough. I am going to discuss this with that dr this morning. Jenn

Hi Jenn. Thanks for sharing with me! Ugh, sorry about your continued insomnia and hot flashes. I have insomnia already, don't need that to be worse.

I met with my doctor yesterday and she was super receptive to my questions. She explained some things about keeping the cervix that I hadn't heard - some other cells can get left and you can still have a bit of bleeding monthly. Also if she takes the cervix she can't remove things vaginally, which would put me at a higher risk of complications. So that put my mind at ease about that.

Once I shared with her my depression history she agreed it would be best to start me on a small dose of estrogen and see how things progress. I'm so relieved about that.

I'm unclear if I've been having hot flashes or not. For the last 5 years or so I get very hot and start sweating, which gives me anxiety and makes me sweat even more and the cycle continues. These would seem like hot flashes but they don't go away very fast...

I hope your symptoms will settle down quickly.

	Quote:
Originally Posted by Purple Bloom Hi Jenn. Thanks for sharing with me! Ugh, sorry about your continued insomnia and hot flashes. I have insomnia already, don't need that to be worse. I met with my doctor yesterday and she was super receptive to my questions. She explained some things about keeping the cervix that I hadn't heard - some other cells can get left and you can still have a bit of bleeding monthly. Also if she takes the cervix she can't remove things vaginally, which would put me at a higher risk of complications. So that put my mind at ease about that. Once I shared with her my depression history she agreed it would be best to start me on a small dose of estrogen and see how things progress. I'm so relieved about that. I'm unclear if I've been having hot flashes or not. For the last 5 years or so I get very hot and start sweating, which gives me anxiety and makes me sweat even more and the cycle continues. These would seem like hot flashes but they don't go away very fast... I hope your symptoms will settle down quickly.

I am glad that your doctor answered your questions. That is almost always the best resource for information as she (or he) knows you.

As far as the hot flashes, I remember getting them when I was in high school. I would really hot, sweat, and then it was gone. My hormones have never been in balance. I went through infertility treatment and because my body and hormones are so screwy I didn't even respond to different meds. Thankful, I did end up with a beautiful daughter.

I can be sitting reading a book and for no reason flash. It sucks. Since my surgery I have only had the problem off and on. it is a win for me.

My doctor said that because my hysterectomy was vaginal (the uterus was delivered through the vagina) he would be taking the cervix. I asked about benefits for the pelvic floor, and he said that the uterus really doesn't do anything for the pelvic floor. The uterine ligaments hold up the uterus, nothing else. It's like taking the chandelier out of a room---the walls don't fall down because the chandelier wasn't holding it up.

So in a sense I didn't have a choice, this is the routine way my doctor does hysterectomies unless there is a reason to do it abdominally, but I was okay with it either way.