The decision to have a hysterectomy is never an easy one. Healthy reproductive organs are central to a female's womanhood beginning with her first period at puberty, through pregnancy and childbirth, and ending with menopause. Yet, it is the second most common surgery performed on reproductive-aged women after delivery by cesarean section. More than a half a million of these surgeries are performed in the US every year, which begs the question - how could they all be necessary?
The (In)Dispensable Uterus
There was a time when doctors didn't think much about removing a woman's uterus, fallopian tubes, ovaries, cervix and parts of the vagina, particularly if a woman had already produced children or was beyond childbearing age. Hysterectomies were standard treatments for everything from anxiety (known back then as hysteria) to abnormal bleeding.
We now know that making the decision to have a hysterectomy should never be taken lightly. It not only closes the door to childbirth, it has other potential repercussions, beyond the risks posed by any surgery - bleeding, infection, reactions to anesthesia and injury to nearby organs, nerves and tissue. A hysterectomy can also cause the vaginal dryness, mood swings and hot flashes of menopause if the ovaries are also removed; impact sexual pleasure, particularly uterine orgasm; produce bladder and intestinal changes; and provoke emotional distress and depression.
A hysterectomy may be the only choice if a woman has cancer of the uterus, ovary, cervix, or endometrium. But most hysterectomies are performed for non-cancerous conditions - such as fibroids, endometriosis, and uterine prolapse. Up to 80% of women have fibroids by the time they reach age 40. Fibroids can prevent a pregnancy from taking hold, and cause enough bleeding to cause severe blood loss and anemia. While most are less then a few centimeters in diameter, they can also grow to a size of a grapefruit that can elbow organs in the abdomen to cause urinary frequency and changes in bowel habits.
While hysterectomy can alleviate the pain, pressure and bleeding caused by conditions of the uterus, and many women are pleased with the result afterwards, the pros and cons of surgery must always be carefully weighed. And there are many cases when surgery might be completely unnecessary.
So how should women and their doctors decide? It is a complex judgment call. Much will depend on why a hysterectomy is being considered, the type of hysterectomy offered, a woman's goal for treatment and her willingness to tolerate side effects or symptoms. It may also depend on where you live, as doctors practicing in certain geographical regions are more hysterectomy-centric.