whether or not to have a hysterectomy

I am confused on whether or not to have a hysterectomy. I am to have another lap within the next two months. The pain is moderate. I do not know ,if I can stand another 25 years of this until menopause. I do not have any children and single. I will appreciate any advice on how to make this desicion. Thank you for help and time. Rebecca

Unfortunately all we can do is offer you our experiences and hope that you can reach a decision and find peace. If I was in my 20s or early 30s, single with no children I'd probably not even consider hysterectomy but then again if my quality of life was anything like what I was experiencing before I had my hyst then I wouldn't have had a choice but to have the op.

Although I am married and already have 3 children, I'm only 31 and often find myself very upset that I can no longer have children which is something I never thought I'd feel since before the operation we'd decided that 3 was enough. I'd hate the think what I would have felt like if I hadn't had any children at all and was still young enough to have them.

Then again, if your pain is constantly unbearable and getting worse you have to consider whether or not you can live like this for another decade or so while you wait to see whether or not you decide to have children if you know what I mean.

Perhaps starting a journal would be a good idea - you could describe exactly what you're going through on a daily basis and then come back and reflect on it before you decide. I did this myself during the year I tried to avoid a hysterectomy because I couldn't decide whether or not to have it done - in the end the decision was made for me as I was literally bleeding to death every month and couldn't recover my hb levels.

Hi Rebecca,

Xaviera is right ... only you can evaluate all your options and make the decision that is best for YOU. I think the suggestion of keeping a journal ... pain and symptom diary ... is a great idea. I did that myself and was pretty surprised to see that I really didn't have more than a couple of days a month when I was pain and symptom free. It was an eye-opener.

You don't say this, but I'm assuming you must have endometriosis since you mention lap surgery. Tell us a little more about what your diagnosis is and how you have been treating this so far. We'll do our best to offer support and share our own experiences. The treatment decision is never easy for any of us, unfortunately. Sending gentle hugs your way.

Beth

Hi , Thank you Xaviera and Beth for your advice. Yes,I do have endo. I was diagnosed last May after a lap. I was having constant pelvic pain,heavy and painful cycles,big blood clots. The things the first gyn did is do the wait and see method. I had already had the pain 6-8 months and he wanted to wait another 6 months. So,I waited and after 6 months the pain was still there. The gyn then did an in office ultrasound. He said ,since we found the cyst of the left ovary and your still having pain lets do a lap. So he did one and a partial D&C. I had adhesions everywhere. Endo scarring and endo.. They had to take half of my left ovary because the cyst would not go without it. He had to work with my left tube,because it was all kinked up and hard. It isn't very healthy. After a couple months post lap, I had severe pain. It doubled me over. I was in so much pain,my mother asked me if I was in labor. So, I called the gyn,he said I don't need to see you just go take some Motrin or Tylenol. I thought to myself your right I don't need to see you. So I changed to a new gyn. This gyn put me on a lupron regimen with ortho micronor, to help with the side effects of the lupron. The shots took some pain away. I had my last shot in February. I had to go for a follow up appt. May9. He said , that I had three options: have another 3 month lupron shot,do another lap, or a hysterectomy. I told him I thought a lap would be the best,but now I am having second,third, fourth,etc. thoughts. The lupron caused me some hair loss also. Right now, I have constant pelvic pain, back pain, vulva and vagina pain,problems with bowel movements,and painful urination. Yesterday, I was having ultrasound therapy on my lower back,it caused me to have moderate pain in the pelvic area. I am so confused. I have to go for a pre op interview with my gyn on June 11. Once again thanks for your advice and listening ramble on. Take care, Rebecca :confuse:

Hi Rebecca,

You say you are single, have no children and will probably have to wait 25 years for menopause ... this leads me to assume that you are not yet 30.

Given your situation, a hyst is a very difficult choice to make. But living with all the pain and symptoms you describe is not good either. Only you can make the decision ... if you have any desire for children, I would postpone the hyst decision as long as possible. If you got good relief from the Lupron, it might buy you a little more time. I never took Lupron, but I have read that it can be a good "test" to determine if a hyst will bring relief. If you get good relief with Lupron, you are likely to get good relief with a hyst. The trouble with endo is that even a hyst is no guarantee of a cure. Some ladies do great after a hyst and never have a recurrance of endo. Others are not so lucky, even after staying off estrogen for awhile post op. You just never know what your particular outcome will be ...

Please be sure to get a second opinion before you opt for a hyst, if that is what you are leaning toward doing. And I highly recommend that you see a gyn oncologist ... they are highly skilled surgeons and more capable of handling difficult endo cases. My hyst was performed by my regular gyn, but he was assisted by the gyn oncologist who trained him. The gyn oncologist did peritoneal stripping to remove all the endo and adhesions in my pelvis. I think this has had a lot to do with my good results thus far (1 1/2 years post op).

Hang in there. Sending positive energy your way as you evaluate options and come to a decision about treatment.

Beth

((Rebecca)),
I'm sorry your dealing w/ so much. The others have given you some wonderful advice The best advice I have for anyone facing surgery is to educate yourself on your DX, symptoms, treatment options along w/ any possible risks of each, list the Pro's & Con's of viable treatment/options...you can then make a well-informed desicion on what you feel is best for you.
IMO, I would exhaust all other viable, less-invasive procedures before consenting to a Hysterectomy. It is a major surgery, that can carry major risks, as can any surgery. Some have wonderful outcomes w/no problems while other's trade one set of problems for another. The reason for all the Research
Here is some excellent info on Endo, treatments along w/ info on Hysterectomy...I hope it helps:

What is the Medical Treatment for Endometriosis?

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The progression of endometriosis is estrogen dependent. Treatment with continuous progesterone can shrink endometriotic implants. Overall, the treatment that causes significant decrease in estrogen levels (pseudomenopausal state) is more effective than measures involving prolonged progesterone effect. Agents with prolonged progesterone effect such as provera may be given by mouth or by injections. Prolonged progesterone effect can also be achieved with birth control pills which contain estrogen and progesterone, taken continuously for six to eight months. Such treatment may relieve pain; some endometriotic implants may resolve and/or decrease in size. Agents that suppress ovarian estrogen production include Danazol, a weak androgenic (male) hormone, and GnRH agonists such as Lupron. These agents are more effective than progestins in suppressing symptoms and reducing implants. However, their use is limited by side effects which resemble those of menopause. The low estrogen state leads to hot-flashes, bone demineralization, increase in "bad" cholesterol (LDL) and decrease in "good" cholesterol (HDL). The latter changes increase the risk of cardiovascular disease. Therefore, these agents are rarely prescribed for more than six months. Usually, the beneficial effects do not last very long after the cessation of treatment. At times a course of a GnRH agonist is prescribed in preparation for surgery or as adjuvant treatment after surgery. What is the Surgical Treatment for Endometriosis? Surgical treatment of endometriosis is indicated when medical treatment fails, when large endometriomas (ovarian chocolate cysts) are present, or in the treatment of infertility. The role of surgery, via laparoscopy or laparotomy, is to resect or destroy endometriotic implants, remove an endometrioma, remove pelvic adhesions and repair obstructed fallopian tubes (tuboplasty.) Removal of the uterus, alone or with the ovaries and fallopian tubes, should be considered only when it has been established that the ovaries or uterus are the source of the symptoms and that all other treatment modalities have failed. The last requirement is critical. "Failed treatment" is a relative term and depends to a large extent on the dedication, expertise, surgical skills and motivation of the treating physician to spare the involved organs. Meticulous surgery including microsurgical technique in resecting endometriotic implants, lysis of adhesions and pelvic reconstruction may achieve better and more lasting results than less sophisticated surgical techniques. Combining medical and surgical treatment may also be helpful. A special procedure to relieve pain caused by endometriosis is LUNA (laparoscopic uterosacral nerve ablation.) It involves the destruction of many nerve fibers that provide sensation to the cervix and lower uterine segment. The effectiveness of this procedure in relieving menstrual pain is variable (50-75%). Another procedure known as presacral neurectomy involves severing the nerve fibers which convey pain sensation from the uterus and pelvic floor and is more effective in relieving pain. If presacral neurectomy is performed meticulously it may give long term relief from pelvic pain even if the endometriosis progresses. In my experience hysterectomy with or without ovarian resection is necessary in only a very small percent of patients with endometriosis. It should be emphasized that hysterectomy is not a foolproof treatment for the symptoms of endometriosis. The rate of recurrent symptoms is high (up to 63%) after hysterectomy; after hysterectomy and bilateral oophorectomy recurrent symptoms appear in a significant percent of women (10%). http://www.althysterectomy.org/endometriosis.htm

Endo support:
http://www.endo-online.org/family.html
http://www.geocities.com/fightendo/treat.html

recurring Endo-Q&A:
http://www.endometriosis1.com/indexj.html
http://www.angelfire.com/fl/endohystnhrt/resource.html
https://www.hystersisters.com/vb2/sho...threadid=81855
http://forums.obgyn.net/forums/women...0202/1958.html

Endometriosis Conquering The Silent Invader:
http://www.ivf.com/ch17mb.html

Recurring Endo at the Center For Endometriosis Care:
ttp://www.centerforendo.com/news/recurrance/recurrance.htm

Endometriosis-Dr. Stanley West:
http://www.repmed.com/endo.html

Hysterectomy & Endometriosis Questionnaire:
http://www.angelfire.com/fl/endohystnhrt/quest.html

Post-Op Ovarian Suppression:
http://www.centerforendo.com/news/ov...n/ovarysup.htm

Incisional Endometriosis:
http://www.facs.org/dept/jacs/lead_a...apr00lead.html

Endometriosis Research Center:
http://www.endocenter.org/

Radical Endometriosis Surgery:
http://www.reproductivecenter.com/radical.html

Surgical Procedures for Endo:
http://www.universityobgyn.com/laparosc.htm
http://www.umm.edu/surgery-info/methods.htm
http://www.kenes.com/cogibook1999/Me...rine_Bleeding-
_Does_Hysterectomy_Still_Have_a_Place_in_Modern_Management.html
http://www.gyndr.com
http://www.reproductivecenter.com/radical.html
http://www.drdeljuncojr.com/surgicalprocedure.html
http://www.kumc.edu/instruction/medi...endometr4.html

Endo Specialists & Resources:

http://www.hcgresources.com/resources.htm
http://www.geocities.com/friday_sfws/ind.htm
http://www.endoangels.com/links.html
http://www.lupron.com/

Painful Signs of Endometriosis Should Be Taken Seriously:
http://www.nytimes.com/2002/07/09/he...th/09BROD.html

Hysterectomy~risks, complications:

http://www.obgyn.net/women/articles/...anter_0512.htm
http://www.wdxcyber.com/nbleed13.htm
http://www.gynalternatives.com/hysterec.htm
http://www.findings.net/positive-exp.html
http://www.gyndr.com/hysterectomy.htm
http://www.oxford.net/~tishy/hystasm.html
http://www.nlm.nih.gov/medlineplus/n...ory_10679.html

Outcomes Similar After Total, Partial Hysterectomy: http://www.nlm.nih.gov/medlineplus/n...ory_10040.html
http://hcd2.bupa.co.uk/fact_sheets/m...terectomy.html
http://www.vagisil.com/frame_general_surgical.html
http://www.estronaut.com/a/hysterect...ternatives.htm

Reducing Complications At Laparoscopic Hysterectomy:
http://www.reproductivecenter.com/reducing.html
http://www.lucanus.co.nz/Ops.htm#Laparoscopic Hysterectomy

Supracervical hysterectomy versus total abdominal:
http://www.biomedcentral.com/1472-6874/2/1/abstract

Nerve-sparing Hysterectomy:
http://www.newshe.com/articles/hysterectomy_3.shtml

If you are facing surgery:
http://www.gynsecondopinion.com/surgery.htm

Surgical Menopause:
http://www.surgimenopause.com/
http://www.menopausehysterectomy.com/Menopause.htm
http://webmd.lycos.com/content/article/1680.50792
http://my.webmd.com/content/dmk/dmk_article_5963052
http://members.tripod.com/fiona_51/faq.html
https://www.hystersisters.com/surg.php

HRT: The Whole Story:
http://health.discovery.com/centers/...hrt_whole.html

The role of ovarian hormones upon brain:
http://www.bbsonline.org/Preprints/O...bbs.fitch.html

Old Ovaries-still of value?
https://www.hystersisters.com/vb2/sho...threadid=10987

Myths vs. Facts about Hysterectomy:
http://www.mayohealth.org/mayo/9406/htm/myth_sb.htm

http://www.womenshealth.org/ask/hyst.htm

Benefits vs. Side Effects of Hysterectomies:
http://www.usatoday.com/life/health/...r/lhwhy002.htm

hormone replacement after complete hysterectomy: http://www.medicinenet.com/script/ma...MNI&qakey=2339

Making The Choice:
http://www.denver-rmn.com/health/ar-pc-hy.htm

Hysterectomy: when is it necessary?
http://www.healthgate.com/healthy/woman/1998/hys/

Hysterectomy: Know Your Options:
http://www.healthywomen.org/qa/hysterectomy.html

Hysterectomy Guidelines:
http://www.usatoday.com/life/health/...r/lhwhy003.htm

Hysterectomy: Get the Facts Before You Act:
http://www.plainsense.com/Health/Womens/hystrctm.htm

A Quality of Life Issue:
http://medseek.com/glennbradley/newsdetail.cfm?ref=251

Chronic Pelvic Pain Diagnosis and Management: http://www.obgyn.net/displayarticle....ter/cpp_carter

The Endometriosis Association Houston Support Group:
http://www.endohouston.org/

Endometriosis Symptoms and Treatments: http://womenshealth.about.com/librar.../aa102400a.htm

Understanding & Managing Endometriosis:
http://www.endometriosis.org.ausavvy...ndoBro_web.pdf

When is hysterectomy a woman's only option for treating endometriosis?

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Hysterectomy used to be a much more common treatment for endometriosis than it is today. However, it may still be necessary when other avenues of treatment have failed. Many times, physicians will also recommend removal of both ovaries (bilateral oopherectomy) at the time of hysterectomy because some studies suggest this results in greater long- term pain relief.used to be a much more common treatment for endometriosis than it is today. However, it may still be necessary when other avenues of treatment have failed. Many times, physicians will also recommend removal of both ovaries (bilateral oopherectomy) at the time of hysterectomy because some studies suggest this results in greater long- term pain relief. If you spend any time with women who have this disease, you realize what a difficult decision this is. I've heard positive hysterectomy stories as well as negative ones. At our most recent meeting, one member told me she felt that having a hysterectomy was the only way she could get her life back. Another member had a different opinion and felt she had traded one set of problems for another. Unfortunately, there are no right or wrong answers with endometriosis treatment, only difficult decisions. Having a hysterectomy is often very emotional because women may view it as a loss -- not only of reproductive organs, but also as loss of control over our bodies and this disease. Even after definitive surgery, many women still have health- related issues to contend with, the most significant of which is hormone replacement decisions. There is a theory among some endometriosis specialists that hormone replacement should be delayed for a time following hysterectomy and removal of ovaries to allow the endometriosis lesions to "die out." (Estrogen is usually thought of as the hormone that influences the growth and development of endometriosis.) But other specialists don't agree, and begin hormone replacement immediately in order to take advantage of estrogen's heart- protective and bone- protective benefits. Women in the support groups have discussed the merits of natural hormone replacement for endometriosis, but little data exists on this topic. There is also the question of whether hysterectomy is the answer for everyone. In our support group, we have a few members who continue to suffer with continued symptoms and documented existence of the disease even after hysterectomy and bilateral oopherectomy. http://womenshealth.about.com/librar...y/aa030898.htm

Endometriosis Despite Hysterectomy:
http://www.stanford.edu/group/whpu/qa/07,09,99.html

Lupron a cure for Endometriosis?_

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Let's first address the fact that not only are GnRHs like Lupron not a cure, but there is currently no definitive cure for Endometriosis._ Given the current research underway, there certainly may be one on the horizon, but the best we can hope to attain at this time is long-term remission...which, thankfully, is completely possible when working in partnership with an Endometriosis specialist.__ We owe a debt of gratitude to the men and women, lay persons and professionals alike, who do treat the disease seriously and who have dedicated their lives to understanding it better._ It is these people who will lead the way to early detection and definitive treatment for the Endometriosis daughters of the future.__ Unfortunately, however, the longer certain members of the medical establishment continue to prescribe stop-gap measures without addressing the significant need for a cure, the longer we will be without one. What can we do to help speed the process along?_ Get educated._ Get involved._ With awareness comes recognition of needs: the need for more funding for disease research, the need for better support of patients with Endometriosis, the need for more doctors to better understand the disease, the need for more effective treatments, and ultimately, the need for a cure._ Women with Endometriosis do not deserve to have to travel thousands of miles, often at their own expense, for effective treatment with an Endometriosis specialist because they are few and far between._ Women should not have to resort to ER visits on a monthly basis because they are crippled with unresolved pain._ Women should not be misled as to the efficacy of their treatment options and blamed for the subsequent - yet inevitable - return of symptoms at the treatment end._ Most of all, women with Endometriosis do not deserve to feel alone with their disease. Let's begin the education process by debunking some 100+ yr. old myths about Endometriosis which, unbelievably, are still circulating today._ The more we know, the more we can take charge of our own healthcare._ The more we take charge, the more empowered over Endometriosis we become. Fallacy Number One:_ Endometriosis is a career woman's disease: Most likely, these "career women" were the ones that sought medical care most often, and therefore obtained the most diagnoses._ We know now, of course, that Endometriosis knows no barriers whatsoever and is found in every socio-economic and ethnic class world-wide._ Myth Number Two: Endometriosis only affects women in their reproductive years. While certainly most_ prevalent in reproductive-aged women, especially those in their 20s and 30s, Endometriosis has been found in the autopsies of infants, in 7 year old girls, in women well into their 80s, in post-hysterectomy and menopausal women; and even in a few men who were treated with estrogen for certain cancers. Sadly Mistaken Idea Number Three: Pregnancy and/or hysterectomy will cure Endometriosis. It is frightening to know that students just out of med school, when asked for treatment alternatives, responded by saying that pregnancy would cure the disease, as would a hysterectomy. Women all over the world are still being offered the same treatments that were initially given when the disease was first mentioned in 1870: "prescribed" pregnancies and hysterectomies._ Neither is a definitive cure. Misleading Myth Number Four:_ Medications can cure Endometriosis. There are many non-surgical alternatives to treating the disease, the most common of which are medical therapies like GnRH agonists, oral contraceptives and medroxyprogesterone acetate._ Some women are led to believe that such therapies will cure them - they won't._ They certainly have their purpose in Endometriosis treatment and can be very useful, even provide long term relief for some._ But there has never been any medical evidence to support the notion that they will cure the disease._ Women need to be fully informed about the drug they will be taking: what the possible side effects are, what the expected outcome might be, what the realistic expectations of the treatment are...all the pros and cons._ They should not be misled to believe that popping a pill or getting an injection will solve all their problems - Endometriosis tends to be a sleeping giant which awakes angrily at the end of the treatment. On a side note: GnRHs are still, as of this writing, only FDA-approved for 6 months in a lifetime._ While there are trials going on and other research being done into long-term usage, re-treatment beyond a 6 month period is not recommended._ Request that your physician perform a bone density scan prior to undergoing GnRH therapy to establish a baseline, and another at the end of treatment to determine if there has been significant loss of trabecular bone density._ And always, always establish that you are not pregnant prior to beginning treatment and use caution throughout the treatment period._ Although difficult, it is not impossible - and is ill-advised - to become pregnant while undergoing GnRH therapy. Lupron, like all GnRHs, is a hormonal agent [GnRHs=gonadotrophin releasing hormones]._ It was initially used in the treatment of prostate cancer and has since extended into other areas, such as reproductive disorders and precocious puberty._ There seems to be a widespread misconception that "Lupron has chemotherapy in it."_ Chemotherapy is not a substance, it's a concept - it simply means "treatment of disease through chemical therapy." Should GnRHs be taken prior to surgery?_ That is a decision best left to the woman and her Endometriosis specialist._ Sometimes, GnRH therapy is needed to debulk the disease._ However, it can also shrink lesions enough to be missed by a lesser-trained surgeon. Misinformed Notion Number Five: Only higher stages of Endometriosis cause pain and infertility. Stage of disease does not indicate pain or fertility status; it is simply a method by which the disease is scored._ While it is true that higher stages (3 and 4) are more likely to be involved in infertility, this is not always the strict case._ A woman with stage 1 disease may be debilitated and infertile, while a woman with stage 4 has no symptoms - and vice versa._ Staging has been defined by the American Society for Reproductive Medicine (formerly the American Fertility Society), with criteria based on the location of the disease, amount, depth and size. These factors are all graded on a point system and classification is thus determined. The first classification scheme was developed in 1973, but since then it has been revised and refined 3 times for a more precise method of documentation. As of 1985, the stages are classified as 1 though 4; 1-minimal, 2-mild, 3-moderate and 4-severe. There are many other myths circulating today which continue to hinder the diagnosis and treatment of some women with Endometriosis; these are just a few of the more common ones._ In summary, the facts as supported by medical literature:_ any woman of any age can have Endometriosis, no matter how many children she may have had [or not had, as the case may be]._ Currently, the best bet for long term remission is the meticulous excision of disease and care by an Endometriosis specialist. Luckily, most patients know that these are just myths and will not stand for a physician who subscribes to them._ But what of the doctors who don't keep up on current research and the newly diagnosed patients who are not being properly informed?_ Let's help make a difference - working together, the Endometriosis community will get the answers we seek, doctor and patient alike._Get educated. Get involved._ Do your part to help shatter the myths surrounding this disease. http://www.hcgresources.com/myths.htm http://www.endocenter.org/

HRT and special situations: Endometriosis and post-hyst HRT:

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It is now becoming accepted that a hysterectomy/oophorectomy does not “cure” endo, although it may remove some of it. The most realistic expectation of the surgery is that subsequent use of HRT may provide a more stable hormonal environment with less endo stimulation. Because estrogen stimulates endo growth (just as it stimulates proliferation of the uterine endometrium) and progesterone inhibits it, current post-hyst endo management theory calls for the addition of progesterone to estrogen HRT. This is to avoid the stimulation of endo proliferation and the risk of converting that endo to a cancerous state. Many endo specialists also call for a post-op period (varying from 6 weeks to 6 months to “as long as you can stand it”) without HRT, in order to encourage any remaining bits of endo not removed during surgery to shrink away. Some take that a step further and prescribe the use of progesterone alone to directly squelch that endo growth. This has the additional benefit of helping ease some of the transitional menopause symptoms experienced during the wait for estrogen. Not all doctors espouse this theory, of course. Some surgeons are highly indignant at any suggestion that they might not have cleared all traces of endo; others freely admit that microscopic bits of endo are virtually guaranteed to remain and require other treatment. We're not going to argue with your doctor's take on the situation, other than to suggest that if your doctor insists that all endo is gone and you continue to experience post-op endo-like pains, you might want to research this part of the question further. Endo is a long, grim battle, and it's sadly not one that seems to be over after a hyst. http://www.geocities.com/NoLinks/endo.htm

What Questions Should You Ask Your Doctor if it is Recommended that you have a Hysterectomy?

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It is important for you to understand the reasons that your doctor has suggested a hysterectomy as treatment for your gynecologic problem. The best way to help you make a decision as to whether the procedure is right for you is to ask your doctor the right questions._ The most common reasons for surgery are pain, bleeding, or symptoms from fibroids. You know the reason you went to see the doctor in the first place. And, the first question that you should ask is what specifically is the cause of your problem. For example, ask, "What exactly is causing my pain?" Sometimes the reason will not be entirely clear to the doctor. In particular, the cause of pelvic pain may originate in the intestines or the bladder and not from the uterus. You should ask if there are other tests that can be done to make the diagnosis more apparent. The decision whether to have these tests or not should be yours and should be balanced with the side effects and cost of the tests. For example, laparoscopy can help to make a diagnosis of the cause of pelvic pain, but you may or may not wish to go through an operation to have an exact diagnosis made._ Once a diagnosis, or probable diagnosis, has been established, you should also ask what the consequences to your health will be if you do not have surgery, either at all, or at this time. For non life-threatening problems, one option is always to do nothing. However, doing nothing often means more frequent visits to your doctor to monitor your problem._ The next question to ask the doctor is what are the non-surgical alternative therapies available to treat your condition. For every condition, there are usually alternatives of varying degrees of effectiveness. As described throughout this book, medications, pain management, even homeopathics or other alternative therapies, may sometimes be tried to alleviate symptoms. But again, I would advise you to continue to see your doctor regularly in order to detect any changes in your condition._ You should also ask about your doctor's experience doing the operation that has been proposed. You should feel comfortable with the number of procedures he or she has performed for problems like yours. If their experience is limited, you may ask who the assistant is going to be, and how much experience the assistant has had. For some of the newer procedures, such as endometrial ablation, laparoscopic surgery, or laparoscopic hysterectomy, additional training and experience must be acquired before the procedures can be safely performed. The same questions should be asked of an interventional radiologist regarding uterine artery embolization. Some hospitals have strict requirements for training before a doctor is allowed to perform these operations or procedures, while other hospitals have no such requirements. Therefore, it is important for you to ask about surgical training and experience. Should You Get a Second Opinion? You should also ask your doctor whether a second opinion would be a good idea. Most doctors will welcome the idea of a second opinion. If they have done a complete job on the diagnosis and on the explanation of the problem to you, then they should feel confident about the range of options they have suggested to you. In addition, no doctor knows everything, and your doctor may welcome any other new ideas about your problem. This is your body and your life and you deserve to know everything you can about all the options available. If you need a hysterectomy, should you also have your ovaries removed? I have changed my view about this controversial subject since the first edition of this book was published._ At that time, I suggested that women who were having a hysterectomy performed for appropriate reasons also consider having their ovaries removed after the age of about forty-five._ My thinking at the time was that the ovaries would continue producing hormones for only a few years thereafter, and this advantage would be overshadowed by the benefit of removing the ovaries and eliminating the 1 percent chance of developing ovarian cancer in your lifetime._ However, a number of issues have come to my attention since then, and I now believe that the ovaries should almost never be removed at the time of hysterectomy._ First, the risk of ovarian cancer goes down if the ovaries remain after hysterectomy._ The reason for this is not clear, but it may be that the path for potential carcinogens from the vagina to the ovaries is interrupted when the uterus is removed._ Thus, the risk of a woman developing ovarian cancer after hysterectomy is probably closer to 1 in 300 rather than 1 in 80 for women who have not had a hysterectomy._ The benefit of removing ovaries for ovarian cancer prevention has been overstated in the medical literature and is, therefore, misunderstood by most physicians. Significantly, the ovaries produce hormones long after menopause._ Estrogen continues to be produced in small amounts, about 25 percent of normal pre-menopausal levels._ Blood levels of estrogen in some post-menopausal women are equivalent to the levels attained by low-dose estrogen patches used for estrogen replacement in menopause._ The circulating level of estrogen produced by the patch has been shown to be sufficient to prevent bone loss in clinical studies._ Studies also show less bone loss in women who have ovaries than in women who have had their ovaries removed._ Studies show that women who have had their ovaries removed (and have not taken replacement estrogen) have higher rates of heart disease than women the same age who still have their ovaries. it is always best to make these decisions based on accurate and current medical information._ This decision is yours to make and should be discussed in detail with your doctor._ As always, if there are unanswered questions or concern, get a second opinion. What Is Right For You?_ The decision to have a hysterectomy should not be taken lightly. There are medical conditions that require treatment - cancer, prolonged heavy bleeding to the point of severe anemia, or incapacitating pain. However, as outlined throughout this book, all medical conditions have more than one option for treatment. Medicine is an evolving art as well as a science. Recently, with more open attitudes towards women's opinions and feelings, and with the advent of new technology, doctors have been looking for new medical treatments for gynecologic symptoms in order to avoid hysterectomy. As outlined above, there are possible side effects of hysterectomy, none of which are entirely predictable for each individual. But, for some women, hysterectomy will be the right treatment._ As with most decisions, you should carefully consider the pros and cons of hysterectomy as they relate to your particular medical situation and emotional well-being. On one hand, you should weigh the degree of discomfort that your gynecologic problem presents to you, the ways in which it interferes with your health, both emotionally and physically. On the other hand, weigh the potential risks of the operation, including the possible physical as well as the emotional side-effects of having a hysterectomy. There are women who happily choose to live with fibroids the size of a 5 month pregnancy despite the fact that they have some daily discomfort and look pregnant. Other women choose surgery for small fibroids because they are distressed by symptoms, or by worry, and don't wish to live with the problems any longer. Ultimately, the final decision about the appropriateness of a hysterectomy, or any type of surgery or medical care, should be made by each woman herself. Questions for your Dr: If You Need a Hysterectomy, Should You Also Have Your Ovaries Removed?_ Can Having a Hysterectomy Affect Your Sexuality?_ Can Hysterectomy Lead to Psychological Problems?_ Can Having a Hysterectomy Lead to Psychological Problems for Your Partner?_ Can Having a Hysterectomy Affect Your Bladder Function?_ Can Removal of the Uterus Increase the Risk of Heart Disease?_ Does Removal of the Ovaries Increase the Risk of Heart Disease?_ What is a Radical Hysterectomy?_ What Happens to a Woman's Monthly Cycle After Hysterectomy?_ Can Removal of Your Ovaries Affect Your Sexuality?_ What Are the Possible Complications of Hysterectomy?_ Can Hysterectomy Relieve Gynecological Symptoms?_ Can Hysterectomy Improve the Way You Feel?_ Can Hysterectomy Improve Quality of Life?_ Can Medication Relieve Pain or Bleeding?_ Should You Get a Second Opinion?_ http://www.gynsecondopinion.com/hysterectomy.htm

Good Luck w/ everything My thots & prayers will be with you that you can find some relief to your pain soon...((((hugs))))