Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Hysterectomy: The Choices and What You Need to Know
Posted in Hysterectomy by Dr. Sharon Orrange on Mar 30, 2012
Whether it’s for heavy vaginal bleeding, uncomfortable uterine fibroids, among other things; some of my 40-60 year old women are facing the possibility of hysterectomy and come to ask me: What can I expect?

While I am not a surgeon, primary care doctors can help you deal with what to expect. Here are the common questions I am asked:
1. Can I have a hysterectomy laparoscopically? Sure, well maybe. Laparoscopic surgery is an alternative to open surgery. A laparoscopic hysterectomy has a shorter recovery time, and less discomfort so it allows you to return to normal activities and recover faster.

2. Is Laparoscopic better than an Abdominal (Open) hysterectomy? Laparoscopic hysterectomy takes longer to perform than abdominal hysterectomy, but is associated with less postoperative pain, a shorter length of hospitalization (three versus four days,) quicker recovery, and better quality of life six weeks post-operative. So yes it is.

3. Can I have a vaginal hysterectomy? This is when the uterus is removed through the vagina. A vaginal hysterectomy CAN’T be performed; if there is a suspicious mass that is high risk for cancer, a known cancer, known pelvic adhesions, a very enlarged uterus, or if there is difficultly positioning the patient for vaginal access (i.e. severe arthritis.)

4. Is laparoscopic better than a vaginal hysterectomy? Total laparoscopic hysterectomy and vaginal hysterectomy appear to have similar outcomes, with some slight advantages for the laparoscopic approach

5. What about the Robot-assisted laparoscopic hysterectomy? Robot-assisted laparoscopic hysterectomy has become of great interest as another mode of minimally invasive surgery. Robotic surgery has higher costs and similar outcomes than laparoscopic surgery. There are limited advantages of robotic over conventional laparoscopic surgery.

6. Should I have the surgeon leave my cervix? This is called a supracervical hysterectomy. There are no proven medical or surgical benefits of performing supracervical hysterectomy if the cervix can be easily removed.

7. Will I feel better after hysterectomy? Most women report relief of symptoms, improved quality of life, no adverse effect on sexual function, and satisfaction with their surgery.

8. What to expect after laparoscopic hysterectomy The incisions are small (usually less than one-half inch,) so there is minimal discomfort following the procedure. You may spend the night or go home that day. Try to have someone with you the first 3 to 5 days after you go home, and then have someone home with you for a week or two, to help with the household activities.
What did I miss?

- Dr. O.

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CATEGORIES: Overview
CONDITIONS AND COMMUNITIES: Cervical Cancer  •  Endometriosis  •  Female Sexual Issues  •  Hysterectomy  •  Menopause  •  Ovarian Cancer  •  Polycystic Ovarian Syndrome (PCOS)  •  Vaginal Cancer  •  Vulvar Cancer
TAGS: Symptoms  •  Therapies

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18
All great points, PoisonedApple! Yes, a "partial" hyst increases risk of heart disease 3x and increases risk of hip fracture. It also increases thyroid and kidney cancer risk. Ovary removal (castration) increases risk of heart disease 7x along with stroke, hip fracture, lung cancer, Parkinsonism, dementia, cognitive impairment, depression, and anxiety.

And yes, loss of quality of life (even before the above health problems manifest) can be devastating.

Excellent point about the financial impacts. I know many women who've lost their jobs or had to change jobs because they just couldn't handle the demands any more. I was highly respected in my field and loved my job. But the post hysterectomy memory loss, insomnia, depression, and anxiety (and other symptoms) made it hard to function. Rapid aging caused me to not even want to leave my house much less face my coworkers. Unfortunately, HRT is "sold" as a substitute for the ovaries but no meds can replace glands of the endocrine system.
By fighting4change  Dec 02, 2012
17
"What did I miss?" Heart disease risk for one. I think if you were going to write an article on hysterectomies and "what you need to know" you should have written on both the cons and the pros. The cons were glossed over here, and the negative consequences of a hysterectomy can be devastating physically, emotionally, and financially.
By PoisonedApple  Nov 30, 2012
16
bernie - Did you know that there are medications (for example, OTC and Rx NSAID's, Rx progestins, Rx tranexamic acid) to reduce bleeding? Also, if fibroids cause additional problems that become debilitating, a surgeon with myomectomy skills should be able to remove just the fibroids leaving your uterus intact. Click on the link on my profile to watch the video about the lifelong functions of the uterus and ovaries.
By fighting4change  Oct 16, 2012
15
hi after my crainetomy for rupture arm; my hormones went out of whack more heavier periods, fibroids etc; so decided that the hysterectomy may give me a better quality of life
By bernie33  Oct 16, 2012
14
People need to stop blindly accepting what doctors tell them. I had a good personal experience, but did my research and asked my questions. Anytime anyone is going to cut into your body, you better be confident in that person and what they are doing. We are consumers of health care, so demand excellence. I know there are no guarantees, but too often, women have surgery when they aren't totally comfortable with it. Listen to your gut. I am happy with my choice and have no regrets. For me, it was the right thing.
By hotmom1  Apr 13, 2012
13
The trade-offs may be worth it for women who’ve had chronic pain for years. But some women say that they would have rather lived with the pain. One can’t know until the deed is done.
Personal experiences aside, ALL women deserve "informed consent." Very few women are told the known risks and adverse effects of hysterectomy, with or without ovary removal. Many women aren’t offered less invasive options and are told that hysterectomy is necessary when it isn’t. Doctors (especially internal medicine doctors) only need compare their intact patients to their hysterectomized patients to see the effects of hysterectomy on health. A nurse friend of mine who reviews patient charts as part of a hospital quality care team said that 90% of women’s charts have hysterectomy in their medical history. That’s TELLING!

The sex organs work together as a system so removing or altering part of this system can wreak havoc on health. Here’s an article about hysterectomy - http://www.rense.com/health3/hyster...
By fighting4change  Apr 04, 2012
12
Just want to say there are some GOOD stories from a hyst..I've had quite a few friends and inlaw's who have had a hysterectomy and have told me they'd never go back it was the best decision of their life! I know some women have bad experiences, I just think all experiences should be shared equally =) That way everyone can be educated via experiences fairly.
By taters90  Apr 04, 2012
11
Wow hope4acure - another sickening hyst story! My gyn (along with 2 gyn residents) also screwed something up with my bowels when they unnecessarily removed my organs. I've had bowel problems since my hyst 6 years ago.

I'm surprised the colon surgeon even made that statement. Most doctors won't say anything negative about another doctor. I guess he wasn't willing to make that statement to others since you had no recourse? I hope you at least filed a complaint with your state's medical board.

You may want to post your story on the Hysterectomy Support Group. I hope you can "rise above" having been harmed by this doctor. I know I have PTSD-like issues due to my hyst experience.
By fighting4change  Apr 03, 2012
10
Well, the hysterectomy I had to have was a nightmare from beginning to end. No sex life for me ever again after they did this to me. :(

I had a huge fibroid tumor I was told and a cyst on one ovary, a poly in the uterus as well. The surgeon couldn't see she told me. I think she cut a chunk off of my colon as I ended up almost dead in 2009 from diverticulitis. The surgeon that had to operate on me at 3:00 in the morning being I had peritonitis said to me, "Whoever did that hysterectomy on you is a very poor surgeon". No kidding is about all I could say to him. :(

So, lucky me is still alive. Isn't that great! ;-p


No recourse for any of this btw, none. :(
By hope4acure  Apr 03, 2012
9
Ladies, if you don't have a needless hysterectomy, you won't have to spend ANY time on a hysterectomy support site.

Knowledge is power. Inform yourselves. Organs are in the body for a reason. Once gone, there are repercussions and there's no going back. That is a sickening feeling. Most of these surgeries are unnecessary. Only a very few concern long term outcomes or lifesaving events that could not have been better handled with methods not involving a total hysterectomy. I cannot fathom, in this day and age, a physician making such blithe statements about a procedure which has been under scrutiny in the United States for decades, due to the number of unnecessary surgeries performed here. This major, life-altering surgery, and is being presented here as if it were an afternoon outing option. Hysterectomy is a "bread and butter" surgery for GYNs. It's main source of income for many.

figthting4change, madbookworm and mideyebrow have made very important points in their responses.
By LaurieG  Apr 01, 2012
8
Women need to know that 76% of hysterectomies don’t meet ACOG’s criteria for the surgery. But more importantly, the uterus and ovaries have LIFELONG functions as detailed in this video - http://www.youtube.com/watch?v=Ff5I...

For many women, there's a honeymoon period post-hysterectomy. They're glad to have their gyn problems resolved yet this period is oftentimes followed by hormonal, skeletal, and anatomical changes coined “post hysterectomy syndrome.” These have far-reaching physical, emotional, mental, and sexual consequences.

Since 76% hysterectomies are unwarranted, you’re likely to find that most gyns will recommend hysterectomy. I recall a woman saying it took going to 8 gynecologists to finally get one to say she didn't need any organs removed. It would be a shame to have your uterus (and maybe ovaries) removed and then regret it for the rest of your life. I know that's been the case for me. And all my gyn should have removed was an ovarian cystadenoma or one ovary.
By fighting4change  Apr 01, 2012
7
Hey LaurieG
This is an amazing hysterectomy support group. The DS hysterectomy support group is made up of women who have had good and bed experiences and yes they have amazing and very helpful posts. Thats why we love DS.
By DrOrrange  Mar 31, 2012
6
I had a vaginal hysterectomy several years ago. I was given a chirpy little booklet that said if I had a desk job, I would be able to return to it within 6 weeks.
Somebody botched something. When I awoke after surgery, I had searing pain in a place where there shouldn't have been any. The surgeon dismissed these complaints, saying that nothing was done to cause such pain.

Despite being given very strong narcotics, I continued to suffer from this pain for months afterward. The six weeks came and went and I was still in terrible pain.

This experience has made me very wary and avoidant of subsequent surgeries unless not having them would be detrimental. Even then, I am cautious. No more cutting - ever - if there is any way to avoid it.
By madbookworm  Mar 31, 2012
5
Finally, Dr. Orrange is neither a gynecologist, a surgeon nor a reconstructive surgeon. Why not speak to those who have real experience with the outcomes of these, often needless, surgeries?
By LaurieG  Mar 30, 2012
4
Many find that retaining their cervix makes their sex life much more satisfying. The cervix & uterus provide hormones, post-menopause. Ask about surgically caused adhesions and the symptoms & pain that they cause. Only you will live with the results. Read & inform yourself about ALL the risks of surgery, alternatives & various opinions throughout the medical community. Visit online forums for women who’ve had hysterectomies. Seek advice and counsel there. First-hand knowledge is best! Take a long view. You'll live a long time after you've lost your uterus and cervix. Surgery may help immediate symptoms, but may come at the expense of years of regret & discomfort, lack of sexual satisfaction, and pain. Vaginal tissues thin more rapidly after a hysterectomy. HRT isn’t a substitution. Estrogen, naturally supplied by your body, helps to keep the walls of the vagina thicker, healthier, & helps prevent dryness. Hormones from patches and pills simply do not reach the same areas with the same amount of success.
By LaurieG  Mar 30, 2012
3
Many find that retaining their cervix makes their sex life much more satisfying. The cervix & uterus provide hormones, post-menopause. Ask about surgically caused adhesions and the symptoms & pain that they cause. Only you will live with the results. Read & inform yourself about ALL the risks of surgery, alternatives & various opinions throughout the medical community. Visit online forums for women who’ve had hysterectomies. Seek advice and counsel there. First-hand knowledge is best! Take a long view. You'll live a long time after you've lost your uterus and cervix. Surgery may help immediate symptoms, but may come at the expense of years of regret & discomfort, lack of sexual satisfaction, and pain. Vaginal tissues thin more rapidly after a hysterectomy. HRT isn’t a substitution. Estrogen, naturally supplied by your body, helps to keep the walls of the vagina thicker, healthier, & helps prevent dryness. Hormones from patches and pills simply do not reach the same areas with the same amount of success.
By LaurieG  Mar 30, 2012
2
How about including the concept of a second opinion on the need for a hysterectomy, alternative treatments, and listing the possible and even probable complications and/or outcomes of this kind of surgery? Once gone, gone! Ladies, ASK questions before agreeing to this surgery. It's your body. See several doctors, not one. Is it needed? Why is it needed? What happens if I don't have the surgery? What are the alternatives? What other treatments are available for uterine fibroids (there are some very effective alternatives)? How about waiting it out if you're heading for menopause, as fibroids are fed by estrogen, and supplies of estrogen will fall with both perimenopause and menopause? Your body will thank you for it if you are able to ride it out. Even after menopause, your uterus and cervix will continue to supply bone-strengthening hormones, and help prevent osteoporosis. There's less chance of pelvic floor collapse if you hold onto your uterus and cervix. If you can retain your cervix, do!
By LaurieG  Mar 30, 2012
1
I had a total hysterectomy February 10. After the surgery, I went home next morning. Ten days later, I came down with shingles (I'm 50+, approaching menapause), sutures were very slow healing, and am dealing with a cough since the shingles eased off.
By mideyebrow  Mar 30, 2012
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