Hysterectomy Hysteria: or .... How to hang onto your uterus
by Carole Tashel, Clinical Herbalist
Imagine you were unlucky enough to be a menopausal woman in the mid- to late-1800's, perhaps with irregular painful periods, hot flashes and a dash of depression.
You most certainly would have been diagnosed with"hysteria," a catch-all diagnosis with a misconception at its foundation: that the uterus (Latin hystera) was the origin of women's physical maladies and psychological "neuroses."
The cure, then, for this distress was hysterectomy (surgical removal of the uterus, cervix and ovaries). Perfected in the 1870s, hysterectomy was eagerly adopted by doctors as a quick fix for a variety of women's problems.
If you think that modern doctors in the late 20th century would surely have jettisoned these old-fashioned misogynist ideas, you're wrong. At a 1971 meeting of the American College of Obstetrics and Gynecology, the prevailing attitude toward the uterus was summed up by Ralph W. White, MD: "It's a useless, bleeding, symptom-producing, potential cancer-bearing organ."
But things are better now in the 21st century, right? Think again. Hysterectomy is still the second most commonly performed surgery in the US (after Cesarean section). The most frequent recipients are women just approaching menopause, age 40 to 44.
In 1988, the American Medical Association got curious, did a study and found that about 50% of the 700,000 annual US hysterectomies were unnecessary. Perhaps more accurate than the AMA's conclusion, the experience of the Hysterectomy Education and Resource Services organization reveals a much more chilling reality: Of the 110,000 women HERS has counseled and referred to board-certified gynecologists for second opinions, 98% of them discovered they didn't need a hysterectomy after all! The lesson? Get a second opinion, and educate yourself about tests (like laparoscopy and ultrasound) that can determine whether you really need a hysterectomy.
Is Your Doctor Your Advocate?
Hysterectomy is not the simple, benign procedure many docs make it out to be. For too many women, hysterectomy is merely the beginning of a new set of problems. During surgery, ligaments and nerves are frequently damaged or severed, leading to problems such as constipation, urinary incontinence and disturbed sexual response.
If you have fibroids (a common reason for hysterectomy) you may be able to have only the tumors removed. If you must have your entire uterus removed, find a doctor willing to preserve your cervix and ovaries. Cervix removal leaves some women with a shortened vagina resulting in painful intercourse for the rest of their lives. Few doctors know the important role the cervix plays in urinary, bowel and sexual function; older MDs have been trained to always remove it, which they do 98% of the time.
And though women have less than a 1% chance of ovarian cancer, 60% of hysterectomies also remove the ovaries. Ovaries have an important function throughout a woman's entire life, producing androgens, affecting her sense of well-being, muscle strength and libido.
Beware of doctors who press their ill-advised opinions on you and seem not to be your advocate.
When one of my friends planned a necessary hysterectomy, her doctor recommended removal of her ovaries as well, because they were "just a cancer waiting to happen." (Are men encouraged to preemptively remove their prostates? I don't think so.) This is not my idea of prevention. And according to a 2003 survey of 700 gynecologists in the Washington, DC area, women are rarely or never counseled on the disadvantages of hysterectomy or their choice as to the extent of the surgery. This is not my idea of informed consent.
Ending the Medical Nightmare
There are some very good reasons to surrender your uterus to the knife: Invasive cancer, trauma or damage to the uterus, life-threatening bleeding or other long-standing conditions that interfere with quality of life. Otherwise, you have ample time to make a truly informed decision while exploring viable alternatives to relieve symptoms and/or correct your condition.
Two major reasons doctors suggest hysterectomy are heavy or prolonged bleeding and fibroid tumors (which are often the cause of heavy bleeding). Abnormal bleeding is rarely caused by cancer, but it does happen, so it's imperative to get a medical diagnosis before trying natural alternatives. Uterine prolapse (descent of the uterus due to weakened support) is less common, but it is treatable by an ancient Maya uterine massage technique. See resources on arvigo massage.
Bleeding is disruptive and can be pretty scary. Once you determine your bleeding is not life-threatening, work with a practitioner to identify appropriate remedies. Since many women have only a couple of episodes of abnormal bleeding while heading toward menopause, it's worth treating it naturally to avoid hysterectomy. Susun Weed puts it succinctly in her book Menopausal Years: The Wise Woman Way, "Menopausal flooding doesn't last forever; hysterectomy does."
Natural treatments might focus on addressing the anemia, enhancing vitamin K production in the colon (helps clotting), increasing bioflavonoids to strengthen capillaries and balancing prostaglandins. Herbs can strengthen uterine walls, regulate hormones and check abnormal bleeding.
Fibroids are firm, non-malignant uterine growths that occur in the majority of women over 40; most remain small and cause no problems. They develop in the context of high estrogen levels, then shrink after menopause as estrogen levels drop. Symptoms depend on the size and location of the fibroid. Natural therapies such as acupuncture, dietary changes, herbs, homeopathy and compresses can frequently stop fibroid growth and alleviate symptoms.
Avoiding Unnecessary Hysterectomy
It's important to deal with reproductive abnormalities early, before they turn into full-blown problems. If you have a small fibroid that's not causing any problems, it's possible you can shrink it. If your cycles are difficult or you have PMS, balance your hormones before things get worse. Watchful waiting is not the best choice.
Reducing excess estrogen levels ("estrogen dominance") is a critical part of any attempt to avoid unnecessary hysterectomies, as well as other serious problems like cancer. Approaches are varied and surprisingly effective for many women.
* If you are overweight, do something about it. Because fat cells convert other substances into estrogen, extra weight increases estrogen levels. Fibroids in obese women may not shrink after menopause. (What causes weight gain is a complicated topic, and beyond the scope of this article.)
* Avoid foreign estrogens (xenoestrogens). Many chemicals, pesticides and pollutants double as strong estrogens in the body, skewing the balance. Hormones added to commercial meat, poultry and dairy are definitely unwanted.
* Eating a variety of fresh, whole foods increases your intake of compounds with weak estrogen-like activity (phytoestrogens). These mitigate high estrogen levels. There are many herbal phytoestrogens as well.
* Sometimes the problem isn't excess estrogen, but rather, a compromised ability to clear estrogen. Fiber can help (especially flax, rye, buckwheat, millet, oats and barley). Your liver changes estrogen into a harmless metabolite so it can be excreted. If you've had hepatitis or taken drugs, your liver needs extra support (options include Milk Thistle and increasing your intake of cabbage family vegetables).
* Women with hormonal problems are often advised to reduce their intake of saturated fat from animal products. I have no proof, but I suspect the real reason some improve on this regimen is that they are not ingesting the xenoestrogens concentrated in the fats of commercially-raised animals.
In order for doctors to realize that women's body parts are not dispensable, women will need to educate themselves, then share what they learn with their doctors. It wouldn't surprise me if proactive, menopausal Baby Boomers begin to reduce the number of unnecessary hysterectomies.
Hysterectomy Education and Resource Services, www.hersfoundation.org, 888-750-4377. An independent, nonprofit, international women's health education organization.
National Uterine Fibroids Foundation, www.nuff.org.