to Hystersisters!
I am so happy to see that you are investigating all of your options before making a decision. A hysterectomy is major surgery and should be given careful consideration. While most women seem to do well with their hysterectomies, there are some who have lifelong difficulties after their hysterectomy, so there's always that risk:benefit ratio to consider.
I cannot answer all of your questions, but I will focus on the dysplasia issue since I'm fairly familiar with that.
Cervical dysplasia is a fairly common occurrence among women. You didn't indicate how involved yours is, but it can range in severity from CIN 1 (mild) to CIN 3/CIS (severe), or from LGSIL to HGSIL (docs use different terminology, so I'm providing both sets of terms to cover the possibilities of what you might have heard). Typically with CIN 1 (LGSIL) the preferred treatment appears to be "watch and see what happens" because it will frequently regress on its own. More intervention is typically required for CIN 2/3/CIS (HGSIL) because it is much less likely to go away on its own. Those cases are typically treated with a LEEP or cone biopsy, and approximately 90% of women are cured after such a treatment. Follow-up is typically done every 3 months for the first 2 years, and then if everything comes back normal most women go back to their annual routine. Keep in mind, that the same follow-up is recommended for a TVH (Total Vaginal Hysterectomy--remove uterus, cervix, leave the ovaries in place) or TAH (Total Abdominal Hysterectomy (same procedure, completed through the abdomen rather than vaginally). While it is rare for the dypslasia to recur on the vaginal wall, it does happen once in a while, so recommended follow-up is exactly the same as for a LEEP (every 3 months for 2 years, then annually).
Most women experiencing their first occurrence of dysplasia have a LEEP completed. This serves a couple of purposes: 1) it removes the abnormal cells and in most cases cures the condition; 2) it provides more thorough information of the extent of involvement. Many docs will not perform a hysterectomy until a LEEP is completed--they want the most information possible before surgical intervention (the LEEP will occasionally show that there's more or less involvement that the biopsy previously indicated). So even when the intent is to complete a hysterectomy anyway, many docs will complete the LEEP/cone first.
Hysterectomy for dysplasia is not generally recommended unless there has been a history of recurrence. For example, I had several treatments for dysplasia before a hysterectomy was recommended. Keep in mind, I am a rarity. Most women do not have ongoing problems--their immune systems are able to fight this off after the initial episode. Unfortunately, my body does not have the natural immunity to this that most women are lucky enough to have.
Now, all that being said, when you have other issues going on (as you do) the decision process may become a little more "murky". I cannot comment on the extended bleeding, since I did not have that issue. As far as bringing on menopause early, well, there are some cases of women whose ovaries did not perform as well (or may have completely shut down) after having a TAH/TVH. Those women may require hormones to help them out. I had a TAH 8 years ago and my ovaries are still working fine, but that's not necessarily the case for all women. Some women have their ovaries removed with the surgery (that would be a TAH/BSO - total abdominal hysterectomy with bilateral salpingo-oophorectomy), and those women may use hormones post-surgically.
I have read mixed information on pelvic support issues--perhaps someone else will address that. I have not experienced any problems with pelvic support. Everything is right where it should be.
You can do a search on this site for additional information. Or you might go to this page that will provide you access to some of our articles on various hysterectomy topics:
https://www.hystersisters.com/vb2/view_anr.htm
Good luck with your decisions! Please feel free to continue to ask questions. I'm sure others will be along to answer some of those questions that I did touch on.
Am I crazy? Hyst for dysplasia?
