The hysterectomy threat, is it age dependent?

[Guest guest]

Hello ladies,

The topic of hysterectomies has always been " hot " in this forum. We have

read so many women's posts with the opinion that gynecologists push us into

believing that the " cure-all " answer is a hysterectomy. So many women are

still told that there is a high probability they will need a hyst even

though they are scheduled for a myomectomy. We have come to many

conclusions of why this is the case: unskilled surgeons, old-school

attitudes, " the uterus is disposable " , " you're done with TTC; you don't need

it anymore " , it's always been standard procedure, etc.

Well, since we are now in the 21st century and more and more gyns are

learning new surgical techniques to remove uterine tumors and growths while

preserving the uterus' function, we are to assume our expected outcome of

surgery will change. But it has not. Doctors are still telling us we

should expect the worst. " We may have to perform a hysterectomy if your

fibroids are too large. "

So is this because they are unskilled? Is it because they are " covering

their buts " so they don't get sued? Or is it dependent on the age of the

patient how much effort a doctor will put into the preservation of the

patient's uterus?

My experience with uterine problems started when I was 16 years old. I had

an abdominal surgery to remove what was thought to be an ovarian cyst. It

was later found to be a malignant tumor. So from then on, I was a " regular "

at my gyn's office for annual ultrasounds and follow up tests. At age 26 I

had an ab myo which left me with the diagnosis of adenomyosis. I lived

with this idea for five more years. And recently I had three resection

surgeries for more fibroids. Adenomyosis was ruled out, fibroids were the

problem after all.

But all throughout my uterine history with gyns and RE's, I was always told

I would need a hysterectomy in my future. Before every surgery they warned

me of the threat. I stuck to my instincts and told them, " No, I want to

preserve my fertility. " But the threat still lingered. I lived through

pain, terrible bleeding, blood transfusions, severe anemia, being a newlywed

with no sex life, Lupron, bc pills, you name it. And through all of this

the doctors seemed to think I would feel so much better if I just had the

blame hyst. Well, if I was willing to put up with all those years of Hell,

what do you think the reason was for? I wanted children. They never said

it was impossible, just improbable. So I held on to that hope.

Now, after finding a doctor who is " pro-preservation " and who performed my

resection surgeries, I have found that hope. Beginning at age 16, seeing 6

different gyns since then, and now finally a RE fertility specialist, I have

realized that my age made a huge difference in the attitude of my doctors.

Yes, they pushed the hyst, but knew I was young and was not easily convinced

it was necessary. I was a science-minded patient who took the best care of

myself I could. So all in all, I think my doctors knew they could not push

me into any permanent decisions.

Ladies who have had their children and are in their later thirties, forties,

or fifties seem to have the most difficulty convincing their doctors that a

hysterectomy is not favorable. They are faced with the opinion that once

you have had your kids, why live with a dysfunction uterus? All your pains

and bleeding issues could be resolved! Why suffer? Well, many women choose

this and live without their uterus just fine. But others feel it is an

important part of their physique and no matter how badly the symptoms alter

their lives, they want to hang on to the organ. Luckily, most doctors do

leave the decision up to the woman, but this comes after the long

description of why a hyst is best.

Since gynecology is rather a new medical science compared to others it is

only now that we can say we have choices with our uterine problems. And if

we don't we go see another doctor who can give us choices. But in years

past, younger women did not seek medical treatment for every day bleeding

issues. There were no ultrasounds, no MRIs, no hysteroscopy exams. If you

had a pain, you were either pregnant or just suffering from cramps. Live

with it! And don't tel.

So it was older women who would see the doctor for uterine troubles. And

their answers were hysterectomy. You had your kids, you're done, no worries.

Not until the later 20th century did doctors start discovering that women in

their teens, twenties, and early thirties were also having unusual uterine

ills. More tests began to be used, better surgical tools were invented, and

women were taken more seriously when they described their pains. There was

a need to keep the uterus finally. These women had not even begun to have

kids. They were suffering from issues that were unrelated to pregnancy. So

new strides in women's health were sought out. Women became better and

better at taking a stand for their health. More women entered the medical

field, and more women were waiting to have kids until they were in their

later twenties and thirties.

But aside from all of the medical field's strides in women's health, the old

attitude is still with us for sure. If you're over forty you'll be in

menopause soon, so why keep it?

However, here is my experience of what my " old-school " doctor did for me...

I still was told the hyst would be best, but I did find that being in my

twenties made a big difference in how my doctors treated me. After my ab

myo, under the influence of Lupron for the surgery, I had a terrible

hemorrhage the following week. My doctor put me on bc pills after I

returned home from the surgery. The pills did raise my estrogen level so I

had a period. But the bleeding did not stop. I was rushed to the ER and

waited six hours before they transfused me, meanwhile bleeding the whole

time. I had a hemoglobin level of 4.5 and a hematocrit of 12%! I was barely

conscious. My doctor said he didn't know what to do. He would have to

perform an emergency hysterectomy, he could not stop the bleeding. I had

only been married for three months, this was news I did not want to hear.

But he put his head together with the Chief gyn surgeon and a few others in

town and they decided to try one tactic first. They inserted a rubber

balloon into the uterus to put pressure on the tissues (like putting

pressure on a wound.) This worked. My bleeding slowed and the hormones

they were giving me intravenously helped stop the period. He saved my

uterus, did all he could not to perform the inevitable surgery! I was sooo

grateful. After that he concluded that the bleeding was due to adenomyosis.

I stuck with that doctor until he retired three years later. He was a good

man, respected my opinion to keep my uterus. The next gyn I saw told me I

had to hurry up and TTC because the adeno was becoming so profuse. We were

still not ready for children, but knew the time would come that we may not

be able to have our own. Finally after I had my third transfusion from

severe bleeding and anemia, it was time to do something. We went to a

fertility specialist. The new doctor told me I had submucosal fibroids,

they were operable, and if removed I should not have the bleeding problem

anymore. I did not have adeno. This was incredible news. At that time I

joined this forum.

So now that my fibroids are gone, the bleeding issue has been alleviated,

and I am currently TTC with my hubby. I look back on my experiences with my

prior doctor and am so grateful he did what he could to preserve my uterus.

He may have misdiagnosed my fibroids as adeno, but he really cared about my

opinion. He may have been practicing for years, but he did not have the

skills to see the submucosal fibroids and remove them at the time of my

first ab myo.

So I think my age had a lot to do with my gyn's efforts. He believed in my

strong feelings to keep my uterus, but didn't know all the newest techniques

of finding the actual problem.

This is why it is so important for all of us to seek other opinions. We

don't want to be lost in the cracks of medicine. We were told to be nice

and respectful as young women. Well, that is still possible, but

assertiveness and education of your own health ailment is the key to having

the best relationship with your doctor. They are more likely to take your

needs and wants seriously if they understand you are informed about the

latest techniques. You are not going to let them get away with the old

adage... a hysterectomy is your best bet.

No matter what our age, our doctors need to listen. We need to be strong

and assertive. If you are determined, they will push you harder. So

becoming educated about your choices is the best defense.

Okay, this is becoming a novel.

I hope I have given those of you who have patiently read through all of

this... words to ponder.

You are out there in the world of gynecologic care, make sure you are the

pro-active patient who doesn't have the wool pulled over her eyes.

Blessings to all of you,

:)Sonja