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Did you know that in the United States 550,000 hysterectomies are performed each year? In the vast majority of these cases the indications for surgery are benign, non life-threatening conditions. Only 10% of hysterectomies are performed for cancer. Only you can decide which direction to go after you are informed about the pros and cons on going through with a procedure such as hysterectomy.

We are taught that the role of the uterus is that of an "incubator," to carry babies into this world. Once the incubator role is over, be it because of a woman's age or her lack of desire for more children, the uterus is a nuisance. The uterus may bleed, cause pain, and/or develop cancer. At this point, hysterectomy would seem an advantage to a woman's well being and longevity. We also know that the ovaries’ function (hormone production) after age 40, are approaching their end, and we are also told that the ovaries can develop cancer it would seem only logical to remove the ovaries as well during hysterectomy. But is this attitude supported by scientific evidence and recent research? Do not forget the uterus has many roles, not just that of an incubator. Consequently, hysterectomy may potentially be followed by negative consequences, which could significantly impact the quality of a woman's life. One of those is a 50% increase of dying of cardiovascular (heart and blood vessels) disease is 50%. During menopause there is a sharp increase in the risk of coronary heart disease. It is possible that hysterectomy is not likely to prolong average life span, rather they may actually shorten it, due to an increase in heart and vascular disease. This is a risk you may want to consider before moving forward with your decision.

A report published by the Women's Health Initiative stated that there is a slight increase in the risk of heart disease, thromboembolic disease, and breast cancer in women using a combination of estrogen-progesterone (Prempro) replacement therapy. This has led medical authorities to recommend restriction of hormone replacement therapy to be used only for short-term relief certain symptoms like vaginal dryness. Overall, only 10% of menopausal women in the U.S. are taking hormone replacement therapy and this percentage is dropping rapidly. Given these facts, there seems to be a compelling argument for avoiding unnecessary hysterectomy whenever possible. I tend to believe that optimal health is maintained by uterine and ovarian preservation, except when cancer is already present or there is a family history.
There are recent studies showing that the symptoms of surgical menopause (sudden onset of menopause after removal of the ovaries) are more severe and prolonged compared to symptoms during natural menopause (when ovarian function gradually diminishes). Women who had their ovaries removed after menopause had 54% more osteoporotic fractures than women with intact ovaries. Androgen deficiency affects bone loss, libido, muscular and fat distribution, the sense of well being, energy, and appetite. Preservation of the ovarian production of estrogen and androgen, albeit reduced compared to the reproductive years, may contribute significantly to a woman's health. In a more recent long term observational study, hysterectomy was shown to double the risk of fracture in perimenopausal women. Hysterectomy also increased the risk of osteoporotic fractures by 20% regardless of whether the ovaries were removed or preserved. Another study reports that women who underwent oophorectomy had an increased risk of developing dementia and cognitive impairment, especially if surgery occurred before age 38. The risk of dementia and cognitive impairment increased 70% in women who underwent bilateral oophorectomy before age 46 and 260% in women who had unilateral oophorectomy before age 38. Other long-term adverse effects of hysterectomy have been reported such as urinary frequency, urgency, and incontinence due to bladder denervation (surgically cutting off the nerve supply to the bladder), weaker rhythmic uterine contractions (orgasm) and other emotional problems. These studies and many others are available at: http://www.nhlbi.nih.gov/whi/ I suggest you evaluate all the pros and cons of having or not having the procedure done. Best of luck!

June 13, 2008 - 11:11pm


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