The Good News About Hysterectomy

The Good News About Hysterectomy

by Elayne Clift

“You’ll have to have a hysterectomy, of course,” my doctor said nearly three years ago.

Maybe, I thought. And maybe not. I had no intention of casually parting with my uterus. Maybe this episode of cramps and heavy bleeding was simply the result of a hormonal quirk, a perimenopausal blip. I knew enough about the hysterectomy hype not be sucked into unnecessary surgery, especially since I was so close to menopause, when the fibroids (benign uterine tumors) causing my problem shrink naturally. I made it clear to my doctor that, in any event, my ovaries were non-negotiable items. Tense and oppositional, we danced around the issue every six months.

But then, things changed. I tested anemic, twice, felt deeply tired. Abdominal pain sometimes radiated down my right leg. My bloated belly made me feel heavy. And I had to put up with a menstrual flow so heavy that I routinely spilled onto my clothes despite two tampons and a pad changed every two hours.

So, when my doctor breezed in, white lab coat flapping at her sides, and asked, “How’s it going?” I clutched the paper cover, lay back, put my feet in the stirrups, and called up the warrior within. Between the V of my thighs, our eyes met. “I think it’s time,” I said.

Despite feminist arguments against hysterectomy, I was about to give up the rag. It was not a decision I made lightly. I considered all the options and alternatives, read the literature, consulted the advocacy groups. The feminist case against hysterectomy is powerful. It emanates from a movement that has warned us that millions of women have been unnecessarily sterilized, castrated, C-sectioned and subjected to the dangers of DES, Copper-T IUDs, silicone and more. It has sounded some needed cautionary notes about birth control pills, estrogen replacement therapy (ERT), and hysterectomy.

Still, each woman is different, and some of these therapies are necessary – even lifesaving – for some women, some of the time. This fact often seems ignored in the heat of feminist arguments. The anti-hysterectomy literature can be one-side, polemical and frightening to women who might need the operation.

“Hysterectomy’s damage is life long” an advocacy group says in its fact sheet (emphasis theirs). It lists a dozen “common consequences” of hysterectomy, ranging from loss of sexual desire and painful intercourse to “altered body odor” and “blunting of emotions, personality changes, reclusiveness and suicidal thinking.”

Even resources written to fully inform and support women can be alarming. “Depression is quite common,” says one source. Hysterectomized women may become “dizzy, irritable, forgetful” and are “subject to increased chronic illness.” Another book raises the spectre of memory loss with the comment – “this is the real scary stuff.”

While I have every respect for anecdotal information and women’s experience, I have to wonder at the frequency of these events. Not one woman I know who has had the surgery reports any of these sequelae. Fortunately, a major research project at the National Institutes of Health should help us to further understand the hysterectomy and menopause experience, its physiological consequences, and any possible correlation with depression.

This research has been needed for a long rime. Hysterectomy is the second most common major surgery (Caesarean section is the most common) performed in the United States today. An American woman is five times more likely than a European to have a hysterectomy before the age of 44. In fact, 35 is the average age for the surgery in the U.S.

Clearly, there is cause to be well-educated and particularly cautious whenever this surgery is recommended for any reason, especially if it is preceded by the too frequent preamble: “At your age….” (Age is irrelevant to your decision). Do carefully assess whether or not it is necessary to remove both ovaries. You should also realize you probably have a choice about whether your cervix is removed. For those women for whom surgery is medically indicated, or who choose to undergo it for lifestyle reasons, there is some good news about hysterectomy.

Due largely to the influence of the women’s health movement, the trend toward unnecessary hysterectomy is beginning to be reversed. In 1992, an estimated 590,000 hysterectomies were performed in the U.S. as compared to approximately 750,000 surgeries done each year in the first half of the 1980s. New diagnostic techniques such as CAT scans, magnetic resonance imaging (MRIs) and ultrasound mean improved assessment, and several pharmaceutical and surgical alternatives to hysterectomy have emerged as possible options.

Furthermore, the surgery is not as traumatic as it once was. Standard practices have changed a good deal since the days when our mothers spent two weeks in the hospital zonked out and wincing in pain. Due to more modern techniques generated by attempts to contain costs, a short hospital stay is now SOP (standard operating procedure).

I arrived at the hospital on the morning of surgery. Preop blood tests, urinalysis and chest X-ray had been handled easily and cost-effectively a few days earlier on an out-patient basis. Before coming to the hospital I followed instructions, adjusted my diet and took some fairly innocuous steps so that my bowel was clear. No more enemas! If possible, donate two unit of your blood, in the unlikely event it should be need- ed.

At the hospital, after the physician’s assistant took a quick history, I was offered an optional, mild oral sedative. Before I knew it, I was in the operating room, chatting with my surgeon and her team, who are much more sensitive these days about matters of dignity and modesty. (Incidentally, only the pubic hairline is shaved).

Happily, anesthesia is also not what it used to be. Many women are electing to have abdominal surgery done under epidural, which is administered more comfortably than in the old days. An epidural will block the pain but will leave you awake, unless you elect further medication to put you to sleep. One friend of mine, at her request, actually saw her uterus before it was sent down to the lab, an experience I missed for being too sleepy! Women who want to see it should ask that pictures be taken.

AJI epidural eliminates the side effects of general anesthesia. But for women who elect general anesthesia, new and better drugs can now eliminate or control side effects.

The recovery from surgery is not so painful or prolonged as in the past, when bed rest was the treatment of choice. We all have a different pain threshold, and no two surgical experiences are the same. For many, recovery’s pace is quick.

The day after surgery, the catheter was out and I was sitting up. I was walking – slowly and stooped to be sure, but walking. By then, the pain medication that I could self administer was no longer necessary. The most I needed was a codeine-laced aspirin. On the next day I began to eat and, hosanna, to take a shower. On the fourth morning, home!

Heavy lifting and sex are prohibited for six weeks, but aside from that, it’s up to you to take cues from your body about what you can handle. I wouldn’t recommend “jumping in” too quickly and dashing back to work or jogging. It is, after all, major surgery. But with enough rest, you will be amazed at how quickly you are up to speed. One very fit woman I know was back on the tennis court at three weeks. I am a modest exerciser, but I was walking a quarter mile by two weeks and my routine mile within four. I went out to lunch one week post-op, and to a dinner party a few nights later. I did a little work at home, got a lot of rest, and one month later attended a week-long conference away from home.

Because of the scary literature I read about the down side of life without a uterus, I was terrified that I would go crazy, forget my children’s names, become suicidal, obese and/or dysfunctional. The fact is that I have never felt better, physically or mentally. Given what I put up with for all those years (including packing suitcases full of sanitary supplies and worrying if my skirt had betrayed me while making presentations), I wish I had done it a couple of years ago. I have not been sexually compromised and rather than chronic fatigue, I rejoice in new levels of energy. People say I look “wonderful,” and “ten years younger,” and the nice thing is, I feel like this is true.

This sense of well-being, it turns out, is shared by many women who have had hysterectomies. When we share stories, I am continually amazed by the numbers who corroborate my own positive experience, regardless of age, life-stage, lifestyle, whether or not they elected to keep their ovaries and whether or not they are on estrogen or hormone replacement therapy.

It is important, therefore, to put the “alerts” into perspective and context (try to get incidence numbers, for example), and to realize that for every horror story there is also a perfectly happy, healthy, normally functioning hysterectomized woman.

Clearly, the reasons we decide on a hysterectomy, and our physical and emotional reactions to it, are as personal and individual as we are. Any surgery is a decision not to be taken lightly, and any surgery can have unexpected consequences. Hysterectomies are still performed when they aren’t really necessary, and a host of other women’s health issues must be taken into account whenever one is contemplating such an enormous step. But if, for sound and well-considered reasons, you elect to undergo the procedure, it should be helpful to know that when all is said and done, it really isn’t as bad as you might fear – and there is life after hysterectomy.

Contributing editor Elayne Clift’s latest book is entitled The Road to Radicalism: Further Reflections of a Frustrated Feminist.