Today’s hysterectomies aren’t your mother’s, grandmother’s procedures


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Story by Jamie Lampros
(Standard-Examiner correspondent)
Wed, Feb 13, 2013
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Approximately 600,000 hysterectomies are performed each year, making it the second most common surgical procedure (behind the Caesarean section) in American women still of reproductive age.

With one in three women under the age of 60 undergoing a hysterectomy, there are many questions out there about the procedure. There are also plenty of answers, including at www.acog.org and HysterSisters.com, a free mobile app that allows women to receive personalized information that will help them better understand the surgery.

In addition, your own physician will be able to help you sift through the myths and facts, as well as the options available.

A hysterectomy is an operation to remove a woman’s uterus. During the hysterectomy, your doctor also may remove your fallopian tubes and ovaries.

The three most common reasons women have a hysterectomy are uterine fibroids, endometriosis and pelvic prolapse, said Dr. Jeff Arrington, an OB/GYN at the Ogden Clinic Women’s Health Center in McKay-Dee Hospital in Ogden.

Uterine fibroids are benign growths on the uterus and account for approximately 40.7 percent of hysterectomies, said Dr. Kandice Nielson, an OB/GYN at Lakeview Hospital in Bountiful.

Another 17.7 percent suffer from endometriosis, a disorder in which tissue that normally lines the inside of your uterus grows outside your uterus. The condition can cause heavy bleeding and pelvic pain.

Pelvic organ prolapse, a condition in which the pelvic organs slip down into and out of the vagina, account for 14.5 percent.

The remaining reasons include such things as ovarian cysts, ectopic pregnancy or cancer.

Newer procedures

Dr. Ryan Miller, an OB/GYN at Tanner Clinic in Syracuse, said that five to 10 years ago, two-thirds of all hysterectomies were performed with a large abdominal incision. Today, there are plenty of options out there for women.

“An alternative option is a vaginal hysterectomy where an abdominal incision is not necessary,” Miller said. “Vaginal hysterectomy, however, is not always possible.”

The size of the uterus and the amount of scar tissue may prevent a woman from getting a vaginal hysterectomy, but Miller said that minimally invasive approaches have gained momentum.

“These include laparoscopic hysterectomy and robotic hysterectomy, which require only a few small incisions less than a centimeter in length,” he said.

Dr. Amber Bradshaw, a gynecologist at Ogden Regional Medical Center, said robotic surgery has taken the procedure to a whole new level, with very little recovery time needed. Robotic surgery allows the doctor to perform complex surgery with small incisions while watching the procedure on a screen with high-definition 3-D images, she said.

“One of the benefits of a hysterectomy is that it is definitive therapy for many conditions,” she said. “If a woman has heavy bleeding or uterine fibroids, taking out the uterus will resolve the problem completely.”

One drawback, Bradshaw said, is that there are more potential risks with surgery than with medical treatment. Another is that the woman will no longer be able to have children.

Hormone treatment

Arrington said the average age of a woman undergoing a hysterectomy is somewhere in her 40s.

He also said most women do not need their ovaries removed, which means they will not have to take hormone replacement therapy following the surgery. If the ovaries are removed, he said, HRT will depend on various factors, such as the age of the woman and the severity of her symptoms.

Miller said HRT after a hysterectomy is associated with a slight increase in stroke and pulmonary embolism. However, studies showed no increase in breast cancer or heart disease, he said.

“Furthermore, hormone replacement was found to reduce hip fractures,” Miller said. “The recommendation is to take the lowest dose that effectively treats symptoms.”

Though there are plenty of options available when it comes to hysterectomies, Arrington said, it’s always best to try less invasive procedures first, if possible.

Birth control pills, pain medication and endometrial ablation, a procedure that destroys the lining of the uterus, reducing or halting menstrual flow, are a few examples.

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