Hysterectomy
At
the age of 26, I underwent a total hysterectomy with removal of
both my ovaries for treatment of ovarian cancer. This experience
imparted first hand knowledge of what it's like to undergo a
hysterectomy as well as the sudden menopause that followed.
Additionally, I am a registered nurse who provides
menopause counseling at a hospital-affiliated women's center.
Many of my clients have had a hysterectomy and been thrust into
menopause. Often, these women aren't educated about the
consequences of a hysterectomy even though they had one.
Countless other women are faced with the decision about whether
to have a hysterectomy, yet aren't in possession of the facts
they need to make this irrevocable decision.
The following excerpt from my book, Sudden
Menopause,
will provide you with some information regarding hysterectomy as
well as the sudden menopause that may accompany it.
Hysterectomy is the second most commonly performed
surgery in the United States. Approximately 600,000
hysterectomies are performed annually, with the ovaries removed
in about half of these cases.
A
total or complete hysterectomy is a surgical procedure in which
the uterus and cervix are removed. The term oophorectomy (or
ovariectomy) refers to the removal of the ovaries, either one
(unilateral) or both (bilateral). The fallopian tubes also may
be removed in a procedure called salpingectomy. Therefore, when
the ovaries and the fallopian tubes are removed along with the
uterus, the procedure is called hysterectomy with bilateral
salpingo-oophorectomy (BSO).
According to the National Center for Health Statistics,
45.5 percent of all women who undergo a hysterectomy have their
ovaries removed at the same time.
In some cases, surgery is performed to remove only
one ovary; even though the other ovary remains, sudden menopause
can occur if the blood flow to the remaining ovary is
compromised during surgery.
Commonly cited reasons why hysterectomies are performed
include the following:
q
Pelvic
inflammatory disease (PID)--The
phrase pelvic inflammatory disease is a generalized term for an infection in the uterus and/or fallopian tubes and ovaries. It
is primarily a result of sexually transmitted disease that has
spread into the pelvic region. Signs and symptoms of PID may
include abdominal pain, mid- to lower back pain, fever, nausea,
vomiting, foul-smelling vaginal discharge, pain or bleeding
during or after intercourse, and burning upon urination.
q
Endometriosis--This
condition occurs when tissue from the endometrium (the lining of
the uterus) attaches itself to other organs, usually in the
pelvic area. Organs often affected include the fallopian tubes,
ovaries, bladder, and bowel. Since the tissue originated inside
of the uterus, it responds to the monthly hormonal cycle in the
same way the uterus does. It builds and grows, then breaks down
and bleeds. The inflammation and internal bleeding can result in
the formation of scar tissue and symptoms such as pelvic pain,
painful intercourse, heavy menstrual flow, fatigue, painful
bowel movements, constipation, and diarrhea. Endometriosis also
is a cause of infertility.
q
Uterine
fibroid tumors--Fibroid
tumors, or myomas, are very common and almost always benign (noncancerous).
They originate from the muscle tissue of the uterine wall and
can grow outward or inward. Small fibroids usually do not create
problems, but large ones or clusters of fibroids can cause
symptoms, including heavy, prolonged, or irregular menstrual
bleeding; abdominal swelling; pelvic or back pain; constipation;
and frequent urination.
q
Uterine
prolapse--When
the uterus "drops" from its normal position and
protrudes through the vagina, it is said to have prolapsed. The
normal uterus is anchored in place by ligaments, muscles, and
fascia, but over the years, the uterus may change position. It
can drop straight down, or tip forward or backward. Childbirth
or obesity may entice the uterus to descend. Symptoms of
prolapse may include pressure and heaviness in the vaginal
region, a feeling of heaviness in the lower abdomen, lower
backaches, and urinary frequency and incontinence.
q
Menorrhagia/metrorrhagia--The
term menorrhagia refers to excessive or prolonged menstrual
bleeding. Metrorrhagia refers to uterine bleeding between
periods. A variety of conditions can result in one or both of
these problems. Possible causes include fibroids, polyps,
ovarian cysts, hyperplasia, birth control pills, hormonal
imbalances, stress, or cancer. Menorrhagia and metrorrhagia need
to be carefully evaluated.
q
Breast
cancer--Some
forms of breast cancer are estrogen-dependent. This means the
hormone estrogen fuels their growth. If this is the case, the
ovaries may be removed as part of the cancer treatment. Another
breast cancer treatment option is the use of a special
medication, such as Tamoxifen, that blocks the estrogen
receptors on the cancer cells so they are not responsive to
estrogen. Since these medications have become available,
oophorectomy is less commonly performed for treatment of breast
cancer.
q
Uterine,
ovarian, and advanced cervical cancer--The extent of treatment for these cancers depends upon the type of
tumor and how it is staged. Uterine cancer and ovarian cancer
normally necessitate a hysterectomy. However, unless cervical
cancer is advanced, it usually can be treated more
conservatively.
It is important to note that, with the exception of
cancer, hysterectomy is not the treatment of choice for the
above conditions.
Hysterectomy, with removal of one or both ovaries, is the
most common cause of sudden menopause. Because it is surgically
induced, hormone levels plummet quickly and menopausal changes
follow closely behind. By implementing the appropriate
strategies, which are highly individual and span from natural
remedies to medication, a high quality of life can be restored.
For detailed information on how to manage menopausal
symptoms and reduce risk of osteoporosis, heart disease and
cancer, click on Premature Menopause.
Questions Abound Following
Hysterectomy
“How
long will it take to get back to normal?” “Will I have hot
flashes immediately?” These
are a sampling of the questions women ask when faced with a
hysterectomy.
Each
year 600,000 women in this country undergo a hysterectomy. It is
the second most commonly performed surgery in the United States.
Hysterectomy
is surgery to remove the uterus and often the cervix. Almost
fifty percent of the time, the ovaries and fallopian tubes are
taken too. Reasons cited for having a hysterectomy include
uterine bleeding, fibroids, uterine prolapse, endometriosis,
chronic pelvic pain and reproductive cancer. With the exception
of cancer, hysterectomy is not the treatment of choice for any
of these conditions.
Recovering
from a hysterectomy takes at least six to eight weeks. During
this time, a woman’s body undergoes a variety of physical and
emotional changes. Although every woman’s recovery and healing
process is unique, some of her concerns are universal. As a
menopause educator and author of Sudden Menopause, I frequently field
questions from women across the country regarding hysterectomy.
Here are four of the top ones.
Is
it normal to be tired? It is normal to feel fatigued
following major surgery. Your level of fatigue is influenced by
many factors, such as your preoperative state of health and
level of fitness. The single most common reason for profound
fatigue is anemia. If your blood count was low before surgery or
dropped after surgery, you will be more tired than what would be
expected. During recovery, you should feel progressively more
peppy; but don’t be surprised if it takes up to a year for
your energy level to fully return.
When
can I exercise my stomach muscles? One of the first
observations of women who undergo an abdominal hysterectomy is
that their stomach muscles are lax. Since these muscles have
been cut and sutured during surgery, they need time to heal.
Once you have received medical clearance, typically in six to
eight weeks, you can begin toning and strengthening them. Before
heading directly to “crunches”, prepare your abdominal
muscles by doing isometric exercises. Simply contract your
stomach muscles for five to ten seconds and release. Begin by
performing 10-20 repetitions, two to three times daily.
Strengthening these core muscles will also help alleviate the
lower backache that often accompanies a hysterectomy.
Will
I become depressed? The debate continues over whether a
correlation exists between hysterectomy and emotional health.
Many women report no noticeable changes in psychological
well-being, in fact, some even state that they feel better. This
is particularly true of women who tolerated intense pain or
profuse menstrual bleeding. On the other hand, self-reports by
countless women, as well as some studies, indicate that the
likelihood of experiencing depression is higher after a
hysterectomy versus other types of surgery, especially if the
ovaries were removed or cease to function post-operatively.
Often, changes in mood are attributed to circumstances
surrounding the surgery such as coping with infertility,
perceived loss of femininity, aging and presence of disease.
However, these issues don’t exist for all women having
difficulty with their mood. Clearly this experience varies with
each individual and is worthy of further research.
Will
I go into sudden menopause? If a woman is premenopausal at
the time of a hysterectomy with removal of both ovaries, then
she will be thrust into sudden menopause. If one ovary remains,
it may be able to sustain normal hormonal functioning. Keep in
mind though, of the women who have one remaining ovary, fifty
percent enter into menopause within five years.
Sudden
menopause is more abrupt and generally more severe than natural
menopause because the body is thrown into a hormonal tailspin
without time to adjust. Menopausal signs such as hot flashes,
night sweats, mood swings, memory disturbances and sexuality
changes can be managed by implementing dietary strategies, soy,
flax, supplements, lifestyle modification and medicine when
necessary.
As
you can imagine, there isn’t one “right way” of healing
from a hysterectomy and no one can predict how you will feel.
Each woman’s experience is as unique as the woman herself.
Allow yourself the time and support you need, so that your
health and well-being will be restored.
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