The MenopauseRx Hysterectomy Guide

"My doctor told me I need a hysterectomy. What are my options and what questions should I ask?"

Hysterectomy is one of the most common surgical procedures done in the U.S. Approximately 1/3 of women in the U.S. will have had a hysterectomy by the age of 60. In fact, there are over 600,000 hysterectomies performed in the U.S. per year. Hysterectomy is the second most common major surgery among women of child bearing age in the United States.

What Are My Options?

Although hysterectomy is a leading choice for many women with gynecologic problems, many disorders can respond to conservative medical treatments. A thorough discussion regarding medical and hormonal treatments should occur for bleeding, fibroids and pain. For example, bleeding due to endometrial thickening or thinning can be successfully treated with medications such as low dose birth control pills or progesterone supplementation. A treatment used to diminish estrogen production, called a GnRH agonist (such as Depo-Lupron) can treat conditions such as endometriosis, adenomyosis, and fibroids. Also, a special type of device placed in the uterine cavity, called an intrauterine device (IUD or IUS) can be very helpful to control heavy bleeding due to endometrial thickening. While many of these treatments are highly successful, they all have their own pro’s and con’s, including potential side effects, contraindications and specific patient issues. Therefore, it is prudent to discuss all of your treatment options with your health care provider.

The Survival Kit contains free educational materials and coupons for products to relieve menopause symptoms, including hysterectomy information.

There are also a number of conservative surgical procedures that can be useful to control gynecologic problems without the need for hysterectomy. Heavy bleeding due to uterine reasons such as hormonal endometrial thickening can be treated by destroying the endometrial lining using a technique known as endometrial ablation. Polyps and/or fibroids impinging upon the uterine cavity can be selectively removed using a scope placed inside the uterine cavity and removing the growth(s). This is called hysteroscopic endometrial resection. A very specialized procedure done by radiologists can precisely limit blood flow to the uterus and diminish heavy bleeding. This is called a uterine artery embolization. 

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Pelvic pain due to endometriosis or scar tissue/adhesions can be treated with small incisions in the abdomen to allow a small scope and instruments into the pelvic region. Called laparoscopy, this is the same type of procedure used in commonly done operations to remove the appendix and gallbladder. Removing the endometriosis or scar tissue can effectively treat pain without the need for hysterectomy in select individuals.

Pelvic prolapse procedures may or may not include hysterectomy. The key element is re-supporting the tissues that have dropped or fallen. There are a number of techniques available, with numerous improvements in materials and equipment. Often, using materials such as surgical mesh is used in pelvic prolapse surgery. The specific type of mesh is dependent upon the surgeon preference and type of prolapse present. 

Types of Hysterectomy

The hysterectomy procedure has changed over time. With the advent of newer surgical tools and techniques, the procedure can often be done in a manner that allows much quicker recovery time with less discomfort.  Click here to learn about the various different types of hysterectomies, including minimally invasive hysterectomy.

Questions to Ask Your Doctor:

The type of problem facing you is very unique. Therefore, you should feel comfortable asking your doctor very specific questions about your problem. A candid discussion about hysterectomy and non-hysterectomy options can be very helpful.

A specific evaluation or 'work-up' is necessary to determine which treatment is best. Also, specific testing needs to be done prior to any treatment. 'Crossing the T’s and dotting the I’s' is very important to make sure the best outcome is achieved. A thorough pelvic exam and up-to-date pap smear is necessary. Often, a pelvic ultrasound and/or endometrial tissue sampling (biopsy) is needed. Laboratory testing is frequently used to determine blood counts and hormonal levels. Lastly, a detailed review of your medical history is prudent before making a treatment decision.

If irregular or heavy menstrual bleeding is the problem, many doctors will have a patient utilize a 'menstrual calendar' to track their bleeding patterns. This often is helpful to shed light on any patterns that may be developing and can help track treatment success. Click here for a downloadable 'MenopauseRx Menstrual Calendar'.

The Survival Kit contains free educational materials and coupons for products to relieve menopause symptoms, including hysterectomy information.

If a hysterectomy is decided upon, be very clear about the type of hysterectomy (total or partial), as well as what decision needs to be made about the ovaries. Also, the route of hysterectomy needs to be very clear. Options such as abdominal, vaginal or laparoscopic routes of hysterectomy will determine pain and recover time after surgery. Click here to learn more about the specific types of hysterectomy.

All of these very specific surgical options must be done by skilled practitioners. Specific training is needed to achieve success with most of these procedures. Not all practicing gynecologists have the training or expertise to perform complex hysterectomies, hysteroscopic, laparoscopic, or prolapse procedures. Therefore, asking your doctor their experience, number of cases performed, complications and success/failure is important when deciding if a surgical procedure is right for you. Click here to learn more about hysterectomy complications.