Is Hysterectomy Obsolete for Uterine Fibroids?

Ladies, keep your uterus. It’s important for more than just having babies.

By Alicia Armeli

The uterus gets a lot of obvious attention because it’s where babies grow and develop. But its purpose extends far beyond reproduction. In fact, the uterus is important for a woman’s physical, emotional, and sexual well-being.

And yet, 600,000 hysterectomies are done each year in the US alone, with the majority performed to treat noncancerous conditions like uterine fibroids.1,2 Many of these women are being encouraged to have surgery if they don’t want children or are close to or past childbearing age.

But pregnancy shouldn’t be a reason for keeping or removing a uterus. And what’s shocking is that effective, less invasive treatments that allow a woman to keep her uterus aren’t always being offered. Despite what some doctors may tell you, if you have fibroids, you may want to consider keeping your uterus and investigating other treatment options that allow you to do so.

The Popularity of Hysterectomy: How We Got Here

From a historical standpoint, the uterus has been extremely misunderstood.

The Greeks were the first to use the word hystra, a term that blamed the uterus for just about every known psychological illness. Religion hopped on this bandwagon in the 17th century, saying the uterus was the root of everything sinful, sexual, and emotional. In the 19th century, physicians provided a medical spin, claiming its surgical removal would make women “tractable, orderly, industrious, and cleanly.”3

Hysterectomy—or the surgical removal of the uterus—has been around for centuries. And although it may have started out as a faulty panacea for every problem under the sun (even overeating), hysterectomy is still a widely used procedure.3 Even in the early 21st century, hysterectomy for non-cancerous conditions has been advertised as an “attractive option” and the uterus as a “disposable organ that serves no useful purpose once a woman has all the children she wants.”3,4  Given the years of misinformation about female anatomy, it’s not surprising these opinions still exist. And as this harmful cycle continues, many women are left uninformed and without options.

Meet Kim

Kim Fenoglia

For as long as Kim can remember, she’s had fibroids—a type of non-cancerous growth that develops in the uterine wall. Exceedingly common, fibroids are estimated to affect up to 80% of women by age 50, with African American women disproportionately affected.5 Although many women with fibroids won’t experience symptoms, 30-50% will seek treatment for relief from heavy periods, pelvic pain and pressure, and urinary frequency.6

“About six years ago my fibroids started growing and it got to the point where I was heavily bleeding for three weeks on and one week off,” recalls Kim Fenoglia, Vice President of a computer software company in Atlanta, GA. “My gynecologist prescribed progesterone, which worked temporarily. The only other options she gave me were burning the lining of my uterus [endometrial ablation] and hysterectomy. I went to four other gynecologists and was given the same options. I didn’t want either. All five doctors tried to talk me into hysterectomy because at the time I was in my early 40’s and they discouraged pregnancy at my age. But that shouldn’t matter. There are a lot of other things your uterus does.”

Kim couldn’t be more right. The uterus functions in many ways outside of pregnancy.

From Stress Relief to Good Sex: What Your Uterus Does For You

For decades, studies examining non-pregnant women have shown that proteins and molecules in cells of the uterine lining interact with the pituitary gland in the brain.7 What’s more, the uterus has been found to produce beta-endorphins—a type of “feel good” hormone that helps your body relieve things like pain and stress.7  Anatomically, the uterus is perfectly placed to provide support to surrounding organs like the bladder and bowel, keeping them separate and in place. Removing the uterus has been seen to negatively affect pelvic floor functions and lead to problems like urinary incontinence and constipation.8   

The uterus also has an intricate network of blood vessels and nerves that interact with other parts of the pelvis and play a role in sexual response and orgasm. A significant concern for women undergoing hysterectomy is how losing the uterus will affect their sex lives.9

Every Woman is Unique

Fibroids Challenge RelationshipsNo two women or two orgasms are the same. Some women have reported relief post-hysterectomy without any sexual side effects. But as many as one in five women tell a completely different story.9 Because of this, every woman should be made aware of the role the uterus plays in sexual pleasure and the risks of sexual dysfunction following hysterectomy.

Consider the cervix, which is the fleshy opening full of nerve endings that serves as the passage between the vagina and the uterus. If a woman needs cervical-stimulation during intercourse or sexual play in order to orgasm, this sensation is lost when the cervix is removed during hysterectomy.9,10 For other women, an orgasm isn’t complete without deep uterine contractions. With regards to these women, removing the uterus can weaken the intensity of an orgasm.9

Pain and Loss of Sensation

Loss of sensation can also occur as a consequence of nerve damage during surgery. Researchers at the University of Texas at Austin investigated the possibility of impaired sexual response among women who underwent hysterectomy for fibroid treatment.11 Self-reported sexual and measured vaginal responses showed that women who underwent hysterectomy experienced slightly lower vaginal responses than those who didn’t have surgery, suggesting the possibility of sexual injury post-hysterectomy.

Pain during sex can be another side effect of losing one’s uterus. And although painful sex can happen for many reasons post-hysterectomy, physical reasons like internal scarring after tissue removal is a possibility.9

In reference to painful sex post-hysterectomy, one woman commented on a support forum: “…I’m just so angry that I really didn’t need the hysterectomy but the Doctor made it sound like it would be best if I had it. I am going to try a few more thing[s] to relieve the pain. I won’t have a doctor do an unnecessary surgery and not tell about the consequences! I’d like to find a way to warn all women before they have this surgery as in my opinion this should not be done unless you have cancer or something very serious. Still trying to have some hope!”12

Ovary-Sparing Hysterectomy and Early Menopause Risk

Planning to avoid hysterectomy with UFE for fibroid treatment

Along with the many nerves found within the female anatomy so are blood vessels that circulate between the uterus and the ovaries. Although perhaps a lateral shift, in recent years ovary-sparing hysterectomy for treatment of non-cancerous conditions is becoming more common to avoid the negative effects of surgical menopause. But it has been found that premenopausal women who undergo ovary-sparing hysterectomy for noncancerous conditions are still nearly two times more at risk of ovarian failure.13

It’s clear the uterus is important for more than just childbearing and doesn’t suddenly morph into a functionless organ when not used for this purpose. But even though its significance is known, reports have shown treatment alternatives still aren’t being offered.14

Women Aren’t Given Options for Fibroids

A study published in the American Journal of Obstetrics and Gynecology showed that not only did nearly one in five women who had a hysterectomy to treat a noncancerous condition not have pathologic evidence to support needing surgery but also almost 40% had no documentation in their medical records showing they received alternative treatments prior to hysterectomy.14 Other clinicians in the medical community postulate these findings are underestimated and may actually be even higher.

“When I wanted other options, all the gynecologists I visited said the same thing. ‘You’re in your 40’s, you’re not going to have kids. You should take it [your uterus] out,’” Kim says. “I still didn’t want major surgery. I started to do my own research.”

Finding UFE

Many women like Kim have resorted to doing their own research. “I found uterine fibroid embolization (UFE) through Dr. Lipman’s website and I read everything about it I could. I decided it sure couldn’t hurt to call.”

Unlike hysterectomy that targets the entire uterus, UFE is a minimally invasive, outpatient procedure that targets each fibroid. A doctor called an interventional radiologist makes a small nick in the upper thigh to access a main artery. A small tube called a catheter is then guided to the uterine arteries where tiny particles are injected, blocking blood flow to the fibroids. Once the circulation to fibroids is lost, they shrink over time, causing symptoms to subside.

“The procedure was easy. It left me with a centimeter little line of a scar that no one ever sees,” Kim explains. “I went home on a Friday, the same day of the procedure, and only needed to take pain medication for minor cramping on Saturday. By Monday I was able to start work at my home office. I worked all day, every day of that week.”

“UFE changed my life…”

Getting Your Life Back after UFEAs expected, Kim’s life was incredibly different after UFE. Before the procedure, she remembers having heavy, painful, irregular periods that required going through multiple sanitary products in a matter of minutes. “After UFE, my periods have been monthly and last a week. I have normal periods like when I was 25. In my follow-up visit with Dr. Lipman, I saw my MRI scans and my fibroids have shrunk to half their size and are now dead. I have no heavy bleeding, zero symptoms, and zero pain.”

If you have fibroids, removing your uterus isn’t the only solution and shouldn’t be just because children aren’t a part of your current life path. You deserve to enjoy the health benefits of all your organs—including your uterus—no matter your age or stage in life. “If you don’t need a hysterectomy, don’t do it,” Kim encourages. “My period is normal and I don’t have any pain. UFE changed my life and it can change yours.”

Alicia Armeli is a medical writer, copywriter, and editor who specializes in medical articles based on research.  To learn more about Ms. Armeli, please visit http://AliciaArmeli.com.

This article was reviewed for accuracy and approved by John C. Lipman, MD, FSIR.

REFERENCES

1. Centers for Disease Control and Prevention. (2017). Data and Statistics: Hysterectomy. Retrieved from https://www.cdc.gov/reproductivehealth/data_stats/

2. The American College of Obstetricians and Gynecologists. (2015). Frequently Asked Questions: Special Procedures (Hysterectomy). Retrieved from http://www.acog.org/Patients/FAQs/Hysterectomy

3. West, S., & Dranov, P. (2002). The hysterectomy hoax: the truth about why many hysterectomies are unnecessary and how to avoid them (3rd ed.). Chester, NJ: Next Decade, Inc.

4. Stewart, E. A. (2001). Uterine Fibroids. Lancet, Jan; 357(9252): 293-8.

5. National Women’s Health Network. (2015). Uterine Fibroids. Retrieved from https://www.nwhn.org/uterine-fibroids/

6. Soliman, A. M., Yang, H., Du, E. X.,et al. (2015). The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J of Obstet and Gynecol, 213(2): 141-160.

7. Clifton, V. L., Telfer, J. F., Thompson, A. J., et al. (1998). Corticotropin-releasing hormone and proopiomelanocortin-derived peptides are present in human myometrium. J Clin Endocrinol Metab, Oct; 83(10): 3716-3721.

8. Kocaay, A. F., Oztuna, D., Su, F. A., et al. (2017). Effects of hysterectomy on pelvic floor disorders: a longitudinal study. Dis Colon Rectum, Mar; 60(3): 303-310.

9. Lonnée-Hoffman, R., & Pinas, I. (2014). Effects of hysterectomy on sexual function. Curr Sex Health Rep, Sep; 6(4):244-251.

10. Our Bodies Ourselves. (2011). Hysterectomy, Oophorectomy, and Sexuality. Retrieved from http://www.ourbodiesourselves.org/health-info/hysterectomy-oophorectomy-and-sexuality/

11. Meston, C. (2004). The effects of hysterectomy on sexual arousal in women with a history of benign uterine fibroids. Arch Sex Behav, Feb; 33(1): 31-42.

12. cdesousa5. (2017, January 16) Re: Sex is impossible [Public forum comment]. Retrieved from http://www.hystersisters.com/vb2/showthread.php?t=668209

13. Moorman, P. G., Myers, E. R., & Schildkraut, J. M., et al. (2011). Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol, Dec; 118(6): 1271-1279.

14. Corona, L., Swenson, C., Sheetz, K., et al. (2015). Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol, Mar; 212(3): 304.e1-7.

 


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