Hysterectomy: Ready or Not?

Contributed by Barbie Taylor, MD

Remember when you were a kid playing Hide and Seek? The kid who was “it” hid his or her eyes and waited for everyone else to go and hide. After counting to ten, he or she hollered, “Ready or not, here I come!” And whether or not you were ready, the search was on to find you.

The decision whether or not to have a hysterectomy isn’t like that! You don’t just proceed with surgery, ready or not. As a gynecologic surgeon, I have always said, when it comes to surgery, readiness is everything. I believe there are two types of patients who have had hysterectomies: those who were ready and those who were not.

Women who were ready for a hysterectomy had a problem for which they sought medical care. They learned about their condition, evaluated all of their options, and decided a hysterectomy was the best for them. They were ready for the surgery because the quality of life was compromised to a degree that they were convinced a hysterectomy was the best thing for them to pursue. They were ready for the surgery because they knew it was the best option for them. They proceeded with the surgery and typically recovered easily. In the end, they felt as though having a hysterectomy was one of the best things they had ever done.

Then there are the women who were not ready for a hysterectomy. They, too, had a problem for which they sought medical care. They, too, learned about their condition. And while a hysterectomy was the option designated as the best one for them by their medical professional(s), they just weren’t convinced, or they were not at a point of full acceptance of the diagnosis (such as uterine cancer). Perhaps they felt a hysterectomy was premature, too aggressive, or unnecessary. Despite reluctance, though, they proceeded with the surgery. And many times recovery for them was not as smooth.

What I’m getting at is this: You owe it to yourself to determine whether or not a hysterectomy is for you. You know yourself better than anyone else does, and you need to combine your own body knowing with solid advice from medical professionals. So, before having a hysterectomy, it’s a good idea to do some research.

The vast majority of hysterectomies are planned rather than emergency events. As such, you will likely have time to evaluate your options. Most problems for which a hysterectomy is an option also have other options for treatment. Sometimes an alternative treatment will solve the problem; although, it may only be a temporary solution. For example, some women experiencing continual bleeding have the option of destroying the inner lining of the uterus (called uterine ablation), and some women who have fibroids have the option of removing just the fibroids or plugging the blood vessels to the uterus (called uterine artery embolization). If you are willing to revisit the problem again later, and possibly even have another surgical procedure later, then a less aggressive or less definitive treatment is right for you. However, if you feel as though you want to take care of a problem once and for all and never bother with it again, a hysterectomy may be the best option for you.

Another factor of critical importance in making decisions about which surgical procedure to pursue is to realize we are NOT all created equal. What I mean is, you may or may not be a candidate for various procedures. You may have a physical or medical condition that limits or eliminates some of the available options. When it comes to choosing treatment (surgical or medical) for a patient, doctors match the option to the patient. Doctors want to make sure the treatment you have is the very best one for YOU. I’m sure you want that, too.

Here’s a simple example: Body weight has a significant effect on the procedures. Some surgical procedures are too risky for women who are extremely overweight or obese. Obesity affects the doctor’s ability to administer anesthesia, position the patient on the operating table, perform the actual surgery, and avoid infection. It affects the patient’s ability to recover from the procedure and avoid complications. In this scenario there are risks which must be considered in relationship to the benefits.

Almost everything you do in life depends on benefits versus risks. And options surrounding a hysterectomy are no different. You want to choose the option which maximizes your benefits and minimizes your risks.

So how do you go about learning of the options available to you and matching yourself to the one with the greatest benefits and fewest risks? You get a second, and maybe even a third, fourth, or fifth, opinion. Listen to the reasons your medical caregivers offer in proposing one procedure over another. If you find you have multiple options, you can choose the one you prefer.

When working with your doctor, clearly describe your problem; share how it interferes with your quality of life, and request information on all the options that are available in YOUR circumstance. Let your medical professional match your complaints to the available treatment options. If there are multiple options that are appropriate for you, choose the one you prefer. Remember, not all surgical procedures are suitable for all people.

If you follow these guidelines, you will be in that group of women who are ready if you have to consider a hysterectomy. It’s whether or not you need a hysterectomy, rather than hysterectomy, ready or not.

Dr. Taylor began her private ob-gyn practice in 1989 and developed a niche practice specializing in interested patients who want to understand and participate in their healthcare choices and decisions. She is an author and educates women about midlife health. www.tayloredhealth.com