Your doctor recommended a hysterectomy, but do you really need it?
Removal of the uterus is the second most common surgery women have -- second to cesarean sections -- but, in most cases, you have other options. This matters because new research shows that the procedure could raise your odds of having other health problems later in life.
What Are the Risks?
Doctors have known for some time that removal of the ovaries, also called oophorectomy, comes with a higher chance of heart disease, dementia, and osteoporosis later in life. "As soon as you remove the ovaries, women go into menopause, which raises these risks," says Shannon Laughlin-Tommaso, a gynecologist and expert in uterine fibroids at Mayo Clinic in Rochester, MN. "When we found that out, we vastly reduced the number of ovarian removals we did."
But new research finds that hysterectomy without removal of the ovaries ups some of those same risks. In a study of 4,188 women, those who had a hysterectomy without ovarian removal were more likely to have high cholesterol, high blood pressure, irregular heartbeat, and heart disease and to become obese later in life than those who had their reproductive organs. Risks were even greater for women who had the surgery before age 35.
What About Other Options?
A hysterectomy is sometimes the only way to treat uterine, ovarian, or cervical cancer. "Unfortunately," says Laughlin-Tommaso, "cancer is one of the least common reasons that hysterectomies are done." The most common, she says, are fibroids, uncontrolled bleeding, and uterine prolapse. Doctors might also recommend the procedure for endometriosis.
Women who have fibroids or endometriosis have multiple options that don't require removal of their uterus. Medicine, radiologic procedures, or minor, minimally invasive surgery can treat the pain and bleeding that these conditions cause.
For women who have a prolapsed uterus -- when the uterus slips down into the vagina because weak pelvic muscles can't support it -- Kegel exercises can strengthen pelvic muscles and relieve minor symptoms. A device put into the vagina can support the uterus and relieve symptoms as well. Surgery to repair the pelvic floor may also be an option.
"These alternative treatments have much lower risks," says Laughlin-Tommaso. "So we want to reduce the number of women who have hysterectomies and try these alternative treatments first."
Ask Your Doctor
If your doctor recommends a hysterectomy for your condition, ask some questions.
What are the alternatives, and which symptoms would they treat? Not every woman is a candidate for all the options. Some alternatives to hysterectomy are best suited to treat abnormal bleeding, while others work better to relieve pain and discomfort.
Can I get pregnant after treatment? Some treatments for fibroids, for example, can make pregnancy complications more likely or make it hard to get pregnant later on.
What are the risks of each option? Except for hormone replacement therapy, alternatives to hysterectomy are not known to raise the odds of having heart problems, but every medical treatment comes with some risks.
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