Far Too Many
Hysterectomies Still
Being Performed
By Robert Bazell - NBC News Correspondent
NEW YORK (Reuters Health) - As many as 70% of hysterectomies performed in the US may be recommended inappropriately, results of a recent study suggest.
The hysterectomy -- a removal of the uterus -- is the second most common major operation that women get and ``there are significant concerns among researchers and the public that it might be overused,'' according to study co-author Dr. Michael S. Broder of the University of California in Los Angeles, and colleagues.
The researchers looked at nearly 500 women who had hysterectomies that were not the result of emergency or cancer. Operations were performed in 1 of 9 medical groups in Southern California, over a 2-year period.
About 70% of cases ``were judged to be recommended inappropriately,'' the investigators report.
For example, many of the women did not have an adequate evaluation of the cause of their medical problems. This might have included a laparoscopy to help determine the cause of pelvic pain, or sampling of the uterine lining to determine the cause of abnormal bleeding.
Many women also failed to try alternative treatments, such as medication, before their surgery.
Sixty percent of hysterectomies were recommended due to fibroids (benign tumors that commonly occur in middle-aged women), 11% due to pelvic relaxation, 9% due to pain, and 8% due to bleeding.
``We found that the care leading to recommendations of hysterectomies in our cohort was suboptimal,'' Broder and colleagues conclude in the February issue of Obstetrics & Gynecology.
The authors note that their study results may not be applicable to all women who undergo hysterectomy. They only looked at women from one geographic region and they did not compare the study subjects with women who had similar gynecologic conditions but did not undergo hysterectomy.
The findings do suggest that women and their doctors should work together to determine the cause of symptoms such as pain or bleeding, and explore alternative treatments before resorting to hysterectomy, Broder's team adds. SOURCE: Obstetrics & Gynecology 2000;95:199-205.
Hysterectomy Hysteria
By Sherrill Sellman < Author of "Hormone Heresy"
When members of the American College of Obstetrics and Gynaecology met in 1971 their meeting hotly debated the issue of hysterectomies. The overwhelming conclusion regarding whether every woman who is finished with childbearing should have a hysterectomy was summed by gynaecologist Ralph W. White, M.D. He expressed the members' prevailing attitude of respect for the female womb by proclaiming: "It's a useless, bleeding, symptom-producing, potential cancer-bearing organ".1
It's unfortunate that such outdated views persist to the present day. When it comes to women and their reproductive organs, hysterectomies are usually the most popular solution for a range of female problems. How popular? In the U.S., hysterectomy is the most common major non- obstetrical procedure performed on women (caesareans are the most popular) with over 600,000 performed each year even though most of the 'female problems" are medically trivial. One out of three women will have had a surgical menopause before sixty years of age - a hysterectomy that includes removal of the ovaries. To date about 20 million American women have had their uteruses removed. In Europe, the proportion is only one seventh, perhaps because medicine is socialised in several European countries and there is less of a profit motive. 2
However, with the expected arrival of a huge number of baby boomers about to enter menopause, Dr. Stanley West, noted infertility specialist, chief of reproductive endocrinology at St. Vincent's Hospital, New York and author of Hysterectomy Hoax, has predicted that the statistics will soon show that up to 60 % of women in the US will have a hysterectomy by the age of sixty.
England's hysterectomy rates continue to climb. Presently, about 100,00 women annually have this procedure. Some 43 percent of hysterectomies will also involve the removal of one or both ovaries; 60 percent of those operations are performed on pre-menopausal women under the age of 49. 3
In Australia, it is estimated that at least four out of every ten women will have an hysterectomy by the time they turned sixty-five. The Australian Institute of Health and Welfare has reported that the total number of hysterectomies performed in 1994-1995 was 36, 817. There are some locations in Australia that pose a greater risk for keeping female reproductive organs intact. John Archer, author of Bad Medicine, has noted that women in the Hunter region near Newcastle had a 36% higher chance of losing their uterus than others fortunate enough to live elsewhere.4 It seems that the hysterectomy options coincide more with the particular inclinations and surgical abilities of local gynaecologists rather than medical imperatives.
The percentage of hysterectomies which are truly necessary is subject to some debate. According to Dr. West, " more than 90 percent of hysterectomies are unnecessary. Worse still, the surgery can have long-lasting physical, emotional and sexual consequences that may seriously undermine a woman's health and well-being".5 All authorities agree agree, however, that 90 percent of the procedures are "elective", that there are alternatives in at lest 90 percent of cases and that less than 10 percent of the operations are in fact medically necessary.
Of the 110,000 women that the Hysterectomy Education and Resources Foundation, based in Pennsylvania have counselled and referred to board-certified gynaecologists for second opinions regarding a recommended hysterectomy, 98 percent of them discovered that they did not need hysterectomies after all.
What is a Hysterectomy?
A hysterectomy is, by definition, the removal of a vital female organ, the uterus. More than 40 % of the time, the ovaries are also removed in the course of surgery. Sometimes the ovaries, fallopian tubes and cervix are removed along with the uterus. Technically, a hysterectomy refers only to the removal of the uterus while a bilateral salpingo-oopherectomy is the removal of the ovaries and fallopian tubes, However, it is now common for both doctors and women to use the term total hysterectomy which describes the removal of the uterus, ovaries, fallopian tubes and part of the cervix.
The majority of hysterectomies are performed on women between the ages of twenty and forty-nine. When undergoing a hysterectomy, the older the women is the more the likelihood that she will have her ovaries removed. The removal of a woman's ovaries is described as surgical menopause. It creates a radical physiological and psychological change in a woman.
According to Dr. West, "the consequences of losing your ovaries cannot be overstated. Premenopausal women will undergo an 'instant' menopause, complete with symptoms that are far more severe than those that accompany normal menopause which follows a gradual decline in hormone production. The rationale for removing the ovaries during hysterectomy is to prevent ovarian cancer, a terrible disease that is often deadly because it cannot be diagnosed early. (However, there is still some risk of ovarian cancer even if the ovaries are removed because there is ovarian tissue around the ovary making it impossible to totally eliminate the danger.) But statistically, a woman who has had a hysterectomy is at no higher risk for ovarian cancer than a woman who has not had surgery. ...without her ovaries a woman will forever be at higher than normal risk for both osteoporosis and heart disease, both of which represent a far greater statistical threat than ovarian cancer".6
A hysterectomy is major surgery, usually done in a hospital under general anaesthesia and typically women must be hospitalised for several days. Women are generally told that it will take anywhere from six weeks to three month to recover. However, most women say it takes almost a year to recover and some spend many more years tinkering with their hormones in an attempt to feel normal again.
The Risks of a Hysterectomy
There are three surgical approaches to hysterectomy. Abdominal hysterectomy, the most common method, requires an eight-inch incision across the lower abdomen, just above the pubic hair line, to remove the womb (and/or ovaries) through the abdominal wall. About 20 percent of hysterectomies are vaginal procedures. Instead of opening the abdomen, the surgeon approaches the uterus through the vagina, detaches it and pulls it out. The severed tissues are drawn out through the vagina and the wound is sutured internally using a minute stitching gun.
The newest approach to hysterectomy involves the use of a viewing device called a laparoscope. The laparoscope is inserted via a tiny abdominal incision near the belly button. Other surgical instruments are inserted through similarly small incisions. The main advantage of laparoscopic surgery of any type is that a small incision means a shorter hospital stay, less pain and more rapid recovery. Because laparoscopic surgery involves so much less physical strain than conventional surgery, it has become very popular. Unfortunately, however, not all surgeons are as proficient as they should be before attempting the procedure which increases the incidence of botched operations.
If surgeons do their jobs carefully and meticulously, few woman should suffer complications. However, considering the high percentage of complications, there is considerable risk of surgical mutilation occurring. Surgical complications include:
Adhesions: Adhesions are internal scars that develop when tissue surfaces stick together after surgery. As a general rule, because blood contains a sticky component that causes tissues to adhere, any type of bleeding can lead to adhesions. During surgery, adhesions present a risk of injury to a structure that is stuck to the organ being removed. With hysterectomy, the organ most likely to be adhered to my uterus are the bladder and bowel. There is always the danger that new adhesions will develop as a result of surgery. This is most likely to happen when the surgeon does not find and suture off all bleeding surfaces. These new adhesions could complicate any future surgery and/or lead to an intestinal obstruction years after surgery.
Bowel Injury: If the bowel is accidentally cut, clamped or sutured in the course of surgery, the intestinal contents can spill into the abdominal cavity causing infection of the peritoneum, the transparent, cellophane-like sac that surrounds the abdominal organs. The infection peritonitis can be quite serious and if not checked, fatal. More than twice as many hysterectosed women had more problems than non-hysterectomised women not nly with bowel function (chronic constipation) but with urinary frequency.
Bladder Injury: A bladder injury is easily corrected during the operation if the surgeon recognises that the bladder has been cut. If not, there will be a risk of peritonitis. If the injury results in a fistula, an opening, between the bladder and vagina, urine will leak uncontrollably into the vagina. Bladder repair must be done surgically.
Injury to ureter: The ureter is the tube connecting the kidney to the bladder. It is next to the cervix and can be damaged easily. If the ureter is nicked, sewn or kinked during surgery, the outflow of urine from the kidney to the bladder will be blocked, leading to possible kidney damage. Corrective surgery will be needed.
Postoperative bleeding: Such bleeding usually stems from the surgeon's failure to secure the major artery which can lead to haemorrhaging that could be fatal. Surgery will be needed to secure the artery. Oozing blood leads to the formation of adhesions.
Fever and infection: With vaginal hysterectomies there is increased risk of infections due to the exposure to the bacteria of the vagina.
The after effects of hysterectomy are most dramatic. With the removal of the ovaries, surgical menopause is initiated which causes more severe symptoms. In a relatively short period of time, a woman may experience fatigue, insomnia, urinary problems. headaches, dizziness, vertigo, nervousness, irritability, anxiety, heart palpitations, joint pain, weight gain, vaginal dryness, diminished physical strength, difficult or painful sexual intercourse, hair loss and a variety of skin problems.
D.H. Roberts, M.D., a British researcher examined the after effects of hysterectomy. He found that hysterectomy was much more likely to lead to postoperative physical and psychological problems described as "post-hysterectomy syndrome". These symptoms included depression, hot flushes, urinary problems and extreme post-operative fatigue. One or more of these symptoms was found among 70 percent of the patients participating in his study which was published in The Lancet in 1971.
The incidence of post-hysterectomy depression appears relatively widespread. Dr. Susan Love states that some 30 to 50 percent of women suffer from depression while some other researchers estimate the number to be as much at 70 percent. For some it is minor and short lived while for others it becomes a chronic state. Other psychological disturbances include mood change, anxiety and irritability. While there is, no doubt, that feelings of grief can be brought on from a woman's sense of loss of her womb and the accompanying mourning process, there are also biochemical reasons for this depression. The hormonal disruptions brought on by the surgery can be far reaching, affecting the nerve and hormone (neuroendocrine) interactions responsible for a sense of emotional wellbeing.
Hormonal disruption affects substances called beta endorphins which are associated with feelings of wellbeing. Recent research shows that endorphin levels are influenced by a change in levels of the ovarian hormones oestrogen and progesterone. A study at Columbia University showed that oestrogen acts to stimulate release of endorphins from the hypothalamus. This may explain why depression develops when the ovaries are removed or cease to function after menopause.7
Another troubling problem still to be accounted for is an increased risk of heart disease after hysterectomy. The risk of heart disease is greatest when the ovaries are removed. In addition, there are some data indicating that women who have their ovaries removed have higher rates of osteoporosis, even on hormone therapy.8
Since the uterus is the key pelvic organ because it holds the other organs in the pelvic cavity in place, with its removal there is a tendency for the bowel and bladder to prolapse into the open cavity leading to an eventual prolapse in to me vagina. It is also reported that after surgery the hop bones tend to widen causing the entire pelvic area, back, leg and foot problems to develop.
The Rational for Having a Hysterectomy
A Hysterectomy is offered as a treatment for several conditions. In the US, the leading cause for surgery is uterine fibroids, benign growths that, while sometimes troublesome and painful are not life threatening. Fibroids account for about 30 percent of all hysterectomies. Endometriosis ranks second and leads to about 24 percent of all hysterectomies. The third ranking indication is prolapsed, the sagging of the uterus into the vagina due to loosening of the muscular supports that hold it in place. Prolapse account for about 20 percent. (approximately one-third of these operations are performed on women past the age of fifty-five. Endometrial hyperplasia (abnormal proliferation of cells in the endometrium due to excessive oestrogen stimulation) ranks fourth. The remaining 20 percent include menstrual disorders, ovarian cysts, and pelvic inflammatory disease.9
The Australian statistics are similar with fibroids accounting for 22 percent of hysterectomies, endometriosis 6-23 percent, heavy menstrual bleeding 18 percent, prolapse 7-23 percent, cancer 1-12 percent and pelvic inflammatory disease 2-8 percent. Multiple reasons are given for the remaining hysterectomies.10
Dr. Stanley West, an outspoken critic of the gynaecology profession's unwarranted enthusiasm for hysterectomies, states that only 10 percent of all hysterectomies are done for cancer. He warns women that unless cancer is positively identified, it is unlikely that a hysterectomy is required and that they should be very sure that cancer has been found before consenting to the surgery, He says that," Chances are you are in the 90 percent, not the 10 percent ... even women with cancer of the endometrium, ovaries and cervix may have some options".11 According to Dr. West the only 100 percent appropriate reason for performing an hysterectomy is cancer of the reproductive organs.
An hysterectomy is a fairly simple operation that involves detaching the uterus from the ligaments that support it and the blood vessels. Since it is such a straight forward procedure, it should be a safe operation. However, nothing could be further from the truth. Up to one-half of all patients develop complications, some of which can be quite serious. Many of these complications are the preventable outcome of sloppy surgery and may involve damage to the bladder, bowel and ureters. Post-operative bleeding can lead to fatal haemorrhaging and an alarming statistic is that one out of 1000 patients will die.
What Women Aren't Being Told
The medical profession continues to reassure women that their uteruses are disposable organs that they can quite happily live without. In fact, the uterus -free woman, is depicted as a care-free individual released from the drudgery of uncomfortable and debilitating female problems. The 1987 editorial in the prestigious British medical journal Lancet has, no doubt, played an important part in lulling doctors and women into such false sense of security about hysterectomies when it said:
for the woman who is not interested in having children, or whose family is complete, this solution (hysterectomy) is often attractive ... (it promises) relief from her symptom., and other expected benefits - greater reliability at work, availability at all time for sexual intercourse, saving on sanitary protection, freedom from pregnancy and freedom from uterine cancer. 12
To appreciate just how ludicrous such a statement is, it is necessary to have some basic understanding of the female reproductive system. The uterus, or the womb as it is also known, is a muscular organ designed for childbearing. Far from a disposable organ that serves no further purpose after the childbearing days are over, the uterus is the main site for the production of the hormone, prostacyclin which protects women from heart disease and unwanted blood clotting. Since prostacyclin cannot be synthetically manufactured in a laboratory, the removal of the uterus will ensure its production will cease forever.13
The uterus also is an important sex organ. The ground breaking research by Masters and Johnson on human sexuality, revealed that the accelerating pitch of sexual excitement prompts the uterus to contract and rise out of the vagina. At orgasm, it undergoes a series of contractions. All the other so-called orgasms - vaginal, clitoral and nipple - are the initiators of sexual excitement but Masters and Johnson showed that uterine contractions are the end point of this excitement and that female orgasm requires these contractions.14
As a result of a hysterectomy, some of the nerves are severed which would have gone to the uterus also supply parts of the abdomen, the clitoris and the upper thigh. This can lead to a loss of tactile sensation from the waist to the mid thigh region.
Given these findings, there is no doubt that the sexual changes women report after hysterectomy are real, not imagined. Without a uterus there can be no orgasm. Other researchers have also shown than internally induced orgasm occurs when the penis presses hard and repetitively against the cervix, causing movement of the uterus and its supports. (It is also common for the cervix to be removed during a hysterectomy as a so-called preventative measure for cervical cancer).
There is another function of the uterus that is usually not given much credence by the medical profession but is none-the-less an important one. According the Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom , " The uterus is related to a woman's innermost sense of self and her inner worlds. It is symbolic of her dreams and the selves to which she would like to give birth...(and) reflects her inner emotional reality and her belief in herself at the deepest level".15 The uterus is the centre of a woman's creative self.
Aside from the ovary's important function of storing and maturing the eggs, it has another important role as an endocrine gland. As an endocrine gland it produces hormones, before, during and after menopause. Far from the popular myth that ovaries dry out, shrivel up and become completely useless at menopause, the ovaries perform a vital function during the a woman's entire post-menopausal life.
As women naturally age, the part of the ovary that shrinks is known as the theca, the outermost covering where the eggs grow and develop. The innermost part of the ovary, known as the inner stoma, actually becomes active at menopause for the first time in a woman's life.
After menopause, the ovaries continue to function, working in concert with the skin, liver and fat to produce hormones. Celso Ramon Garcia, M.D. director of surgery at the Hospital of the University of Pennsylvania, USA, is one of the many authorities saying that the hormone produced by the postmenopausal ovaries promote bone health and skin suppleness, support sexual functioning, protect against heart disease and contribute to a woman's health and well-being.16
The ovaries serve more than one function. Reproduction is their most dramatic function but it isn't the only one. These organs have as much to do with the maintenance of a woman's own life as they do with her role in bringing other lives into the world. The menopausal ovary is neither failing nor useless. At menopause it is simply beginning to shift from its reproductive to its maintenance function.
The removal of the ovaries is a great trauma to a woman's body at any age. Since the ovaries are the primary site of a woman's hormone production, surgically removing them immediately puts her into an instant menopause. The effect is so immediate that some doctors put an oestrogen patch on the patient while she is still in the operating theatre. Many women will have severe hot flushes with two hours after surgery. Unfortunately oestrogen therapy doesn't always compensate for the missing hormones since the ovary makes more than just oestrogen. When you lose your ovaries, you also lose progesterone, some of your testosterone and androstenedione (a form of androgen which is an oestrogen precursor ) as well as any other hormone the uterus and ovary might make that medical science is as yet unaware.17
The removal of the ovaries, whether or not hormone therapy is taken, makes a woman more vulnerable to osteoporosis and heart disease than women who experience natural menopause, probably because the body needs more than just oestrogen. The idea that oestrogen therapy can "replace" the work of the lost ovaries is misleading. New data on the other hormones produced by the ovary shows that it can't. Women who have their ovaries removed don't feel normal when only oestrogen is "replaced". This may relate to orgasm, libido and general wellbeing.
The female reproductive system is still very much shrouded in mystery and by no means fully understood by medical science. Dr. Susan Love postulates that, " the earlier menopause caused by ordinary hysterectomy (removing only the uterus) suggests that there may be a connection we haven't yet discovered between the uterus and ovaries - something akin to, or part of, the feedback loop of the brain, hypothalamus, pituitary and ovary. The uterus may produce a hormone that responds to the ovary. Then when the uterus is gone and the feedback ends, the ovary realises it doesn't have any place to drop its eggs, so it stops trying.18
Dr. West's concurs with this view point". Even when the ovaries are left in place, many women develop serious physical and emotional problems. Most are due to permanent ovarian failure. In up to 50 percent of women whose ovaries have been left intact, the ovaries often cease to function normally after hysterectomy. ...we can assume that at least 70 percent of all women who have hysterectomies will encounter some problems". 19
The uterus in the female equivalent to the prostate gland while the ovaries' counterpart are the testicles. The removal of the prostate and testicles results in castration for the man. When the uterus and ovaries are removed, a woman is castrated. No doctor in his right mind would suggest to a man that he have his prostate and testicles cut out unless his life was seriously endangered nor make absurd statements promising him a new and better life. Yet, gynaecologists are all too eager to suggest this serious procedure to women for many minor (and certainly less than life-threatening) complaints. No physician today can assure any woman that an hysterectomy will not affect her sex life. Dr. West warns that it is therefore imperative for women to understand that their uteruses and/or ovaries should not be willingly sacrificed except for the purpose of saving her life.
Even though, it is known that an hysterectomy has a profound physiological and psychological impact on a woman's life, why has it become the most popular non-obstetrical procedure performed women? In order to understand this anomaly, it is essential to understand the historical roots of medical science and gynaecology in particular.
Medical Science, Misogyny and Women
The Greeks invented the word hyster to explain "suffering caused by the uterus" which they believed included just about any physical or psychological malady imaginable. Hippocrates himself asked the question, "What is woman?" and answered it in one word: " disease".
By the seventeenth century, Christianity had embraced the notion that whatever was wrong with women - and this encompassed some non-medical "problems" as sinfulness, sexuality and emotionalism - was due to the reproductive organs they carried within them. Two centuries later, when modern medicine was in its unscientific infancy, physicians fixed on the uterus as the source of just about every complaint a woman might voice.
The "science" of gynaecology has its beginning in the mid-Victorian era when attitudes to women were, at their most bizarre, a curious mixture of contempt and idealism. Women were thought of as pale, delicate flowers who wilted easily. They required great care, even in small matters, preferably under medical supervision.
Women were also "proven" to be intellectually inferior to men. According to the popular 19th-century physician and medical philosopher, Charles Meigs, women's heads were almost too small for intellect but just big enough for love. 20 The prevailing theory cautioned women against developing their intellect since it would cause the uterus to atrophy! Scientific "Studies" published in 1860's demonstrated that while blacks had smaller brains than whites, women had even smaller brains than blacks.
Gynaecology's early ignoble beginnings can be attributed to James Marion Sims. Widely known as the "father of gynaecology", Sims practiced in the southern US state of Alabama in the 1840's. There he began to experiment on Negro slaves. According to Sheila Kitzinger, "This man was able legally to take possession of black women's bodies and to perform surgery on them at will. He actually bought some of the subjects for his experiments. One woman endured thirty sessions of surgery without anaesthesia before Sims was satisfied with the job he had done. Sims became a hero for generations of obstetrician gynaecologists who followed him, many dreaming of world-wide fame".21
The concept of the uterus as a "dominant organ" controlling women's behaviour has obsessed gynaecologists for more than a century, such as simple hysterical mania, nymphomania, depression and even the "uncontrollable urge to waltz", could be cured simply by removing the cause, the uterus. This left the woman passive, happy and relieved of "the cause of menstruation".22
In the years that followed the introduction of anaesthesia, a woman was likely to find herself on t he operating table for just about anything her husband, father or doctor might decide was wrong with her: overeating, painful menstruation, attempted suicide, and most particularly, masturbation, erotic tendencies or promiscuity. The doctors of the day were convinced - and managed to persuade their patients - that hysterectomy had a calming effect that would render women more "tractable, orderly, industrious and cleanly".23
Given all those centuries of misinformation about the female body, it is small wonder that so many of today's doctors continue to view the uterus as a troublesome, disposable organ. An extract from a 1987 public information booklet on hysterectomy produced by the Royal Australian College of Obstetricians and Gynaecologists reassuring states:
Women who have had an hysterectomy are delighted with the result. No longer do they have to plan their lives around their heavy or painful periods. No longer being anaemia, they gain fresh energy and life is fuller and happier than it may have been for years.24
It would be naive to think that the popularity of hysterectomies wasn't in some way related to the financial rewards on the part of Gynaecologists. Australian obstetricians and gynaecologists perform a lot of surgery and earn higher incomes than physicians, surgeons or medical practitioners. In 1991-92 the overall average annual income for full-time obstetricians and gynaecologists was $320,00 per annum with at least 25 percent of them earning more than $550,000 annually from private patients alone. Added to this is income derived from sessional work public patients. Such income is often between $100,000 and $200,000 per annum. 25 IN the Us, gunaecologists, hospitals and drug companies make more than 4 billion dollars a year fromthe business of hysterectomy and castration.
In 1994, Dr. West wrote of attending a seminar on medical economics: "The topic was how to care for women in order to maximise our fee. The experts who led the discussion reminded us that gynaecologists make the most money by doing surgery and that the highest fee we can generate come from hysterectomy. With that in mind, we were urged to 'cultivate' our patients carefully. Initially care would require advice on contraception. Then, in the normal course of events, we would supervise their pregnancies and deliver their babies. Once a patient had completed her family, we were advised to plant the idea that she might some day need a hysterectomy. The culmination of our years of care would be the hysterectomy. The culmination of our years of care would be the hysterectomy. With proper planning, our advisers suggested, each year of practice would produce a lucrative 'crop' of women ripe for hysterectomy.26
There are Alternatives
The removal of so many uteruses and ovaries would be more understandable if there were no alternatives available to deal with the problems for which the operation is performed. Fortunately there are. In fact, it is stunning how often dietary, nutritional and emotional/spiritual approaches can heal many of the problems. In many cases there are alternative procedures that while far less drastic are just as successful.
Fibroids: Fibroids are the primary reason women in their thirties and forties are recommended hysterectomies and occur in some 30-50 percent of women. Fibroids are benign, non-cancerous lumps of the muscular wall of the uterus, composed of smooth muscle and connective tissue. They are rarely solitary. and never life threatening although at times they can become uncomfortable and problematic. Most, however cause no problems and shrink at menopause when oestrogen levels decrease. Fibroids are a product of oestrogen dominance: oestrogen stimulates their growth and lack of oestrogen causes them to atrophy
Dr. John Lee, author of What Your Doctor May Not Tell You About Menopause , has successfully stopped the growth of fibroids and, in some cases, eliminated them completely by using natural progesterone creams which counter the oestrogen dominant effect.
Dietary changes are also quite effective. Dr. Christianne Northrup has found that, "A woman who...(adopts) a low-fat, high fibre, mostly vegetarian diet will often experience decreased bleeding, bloating and even decrease in t he size of her fibroids. The diet she recommends eliminates dairy products, red meat, chicken and refined sugar. It is advised to eat organically grown food as much as possible to eliminate the oestrogenic effects from pesticides and herbicides. Dr. Northrup reports that "The vast majority of women who treat fibroids though diet get rid of their pain and heavy bleeding within three to six months".27
Surgery is usually only appropriate when women have heavy bleeding or pain that cannot be alleviated in any other way, if they want to become pregnant and the fibroids are a significant hindrance or if the fibroids are interfering with the function of other organs. Even when surgery is required, however, there is usually a better choice than hysterectomy. A procedure called myomectomies which removes the fibroids while leaving the uterus intact does not cause the multitude of problems and symptoms associated with "post-hysterectomy syndrome". However, myomectomies require more skill of the surgeon.
Endometriosis: The second most common problem used to justify hysterectomies is endometriosis. Endometriosis is a condition in which tiny islets of endometrium (inner lining cells of the uterus) become scattered in areas whey they don't belong :the fallopian tubes, within the uterine musculature an d on the outer surfaces of the uterus and other pelvic organs, the colon, the bladder and sides of the pelvic cavity. While the cause of endometriosis is unclear there is no doubt that it is a disease of the twentieth century since it was virtually unknown in the earlier part of this century. Dr. John Lee speculates that this disease has been spawned as the result of the xeno-estrogens (toxic oestrogens found in pesticides and herbicides) from the environment.28
Endometriosis can include symptoms that included incapacitating menstrual cramps, heavy bleeding, nausea and vomiting. There are drug treatments but they have side effects such as using synthetic progestins and, in the end, do not always provide relief. Hysterectomies are often performed on women after the drugs have failed. Unfortunately, surgery does not always alleviate the pain and difficulties. Endometriosis, being aggravated by oestrogen excess will disappear with menopause.
Dietary changes greatly assist in reducing the symptoms of endometriosis. Dr. Northrup reports that " Endometriosis symptoms often disappear completely or lessen dramatically when women follow a low-fat, high fibre diet free of all dairy products (even low fat dairy products).29
Dr. Lee has had success by treating women with natural progesteone cream. He says that, "Since oestrogen initiates endometrial cell proliferation and the formation of blood vessel accumulation in the endometrium, the aim of treatment is to block this monthly oestrogen stimulus to the aberrant endometrial islets. Progesterone stops further proliferation of endometrial cells...the treatment requires patience".30
Pelvic Pain: Sometimes women experience chronic pelvic pain but no diagnosable pathology can be found. While hysterectomies are often done under these circumstances, they fail to relieve the pain 30 per cent of the time. Women have received benefit from using a combination of diet, exercise, natural progesteone, nutritional supplements and emotional exploration.
Menstruation: Unfortunately menstruation is often perceived to be something of a disease by many doctors and thus treat it by removing the uterus. Novak's Textbook of Gynaecology, a widely used textbook in t he 1970's instructs: "Menstruation is a nuisance to most women, and if this can be abolished without impairing ovarian function, it would probably be a blessing to not only to the woman but to her husband...Thus one can make a rather convincing case for the value of elective hysterectomy".31
Women suffering from menstrual irregularities and heavy bleeding have found great benefit from using a range of natural therapies as well as diet, nutrition, and meditation and relaxation techniques.
Cancer: Removal of the reproductive organs is clearly justified and has saved many lives when cancers have developed in these organs. Yet, precancerous changes in the uterus or cervix are often used to justify hysterectomies. This is unfortunate, because the vast majority of these changes can be arrested and reversed without major surgery and without them becoming cancerous.
Regaining control over our bodies
There is, no doubt, that there are valid and justified reasons for having a hysterectomy and that many women who have been suffering from chronic, painful and sometimes life-threatening conditions have indeed benefited immensely from surgery. It is crucial, however, that every women knows exactly what she is getting herself into. After all, it's impossible to just pluck out an organ or disturb the body's balance without paying a price.
For those women who have already undergone hysterectomies, it may be distressful to realise that the surgery may well have been unnecessary. Though nothing can bring back a uterus that has been removed, it can be healing, even years after surgery, to take a quiet moment, place your hands in your belly, thank you uterus for all it gave you and say good-bye. By choosing a healthy diet and life style along with guidance from qualified natural practitioners or complimentary medicne doctors, a woman is able to ensure and maintain her health and wellbeing.
Perhaps the best advice comes from Dr. Stanley West who has written, "The challenge informed women face is to persuade doctors to turn away from the panaceas of the past to the treatments of the future. The last few decades have shown how forceful and resourceful women can be in pursuit of the economic and political power they were so long denied. Just as basic to full autonomy is control of your body and the right to make decisions about your health and health care on the basis of all available information, free from pressure, scare tactics and outdated doctor-knows-best paternalism. It is time we doctors stopped disassembling healthy women. But nothing will change until more women look their doctors in the eye and calmly state their determination to remain intact women".32
Sherrill Sellman is the best-selling author of ":Hormone Heresy: What Women MUST Know About Their Hormones". You can contact her at or www.ssellman
HERS Foundation (Hysterectomy Educational Resources and Services) Newsletter, Bala Cynwyd, Pennsylvania, USA
Facts About Hysterectomy
1. Women experience a loss of physical sexual sensation.
2. A woman's vagina is shortened, scarred and dislocated by hysterectomy.
3. Hysterectomy's damage is life-long. Among its most common consequences, in addition to operative injuries are:
heart disease osteoporosis bone, joint and muscle pain and immobility painful intercourse, vaginal damage displacement of bladder, bowel and other pelvic organs urinary tract infections, frequency, incontinence chronic constipation and digestive disorders altered body odour loss of short-term memory blunting of emotions, personality changes, despondency, irritability, anger, reclusiveness and suicidal thinking
4. No drugs or other treatments can replace ovarian or uterine hormones or functions. The loss of permanent.
5. Most women are castrated at hysterectomy.
6. Twice as many women in their 20's and 30's are hysterectomised as women in their 50's and 60's.
HERS Foundation (Hysterectomy Educational Resources and Services) Newsletter, Bala Cynwyd, Pennsylvania, USA ____
What the Medical and Scientific Literature say about adverse endocrine effects of hysterectomy and oopherectomy:
1. The uterus is a sexually and hormonally active organ whose removal predisposes to impairment and disease.
2. Prostacyclin, one hormone produced by the uterus, is thought to have a role in protecting women from heart disease throughout life. Hysterectomised women have an elevated risk of death from heart disease over normal, intact women of the same age. this is true when the ovaries are removed or not.
3.The ovaries are biologically active glands whose removal cannot be compensated for.
4. The ovaries have systemic, regulatory functions throughout life which cannot be replicated artificially
5. Whether ovaries are removed or retained, hysterectomised women are expected to have and do have an elevated risk of osteoporosis over normal, intact women of the same age.
6. The ovaries produce a variety of hormones including several types of oestrogens, progesteone and androgens which are released by intricate natural processes into the general circulation in precise and constantly varying amounts in order to maintain the exquisite balance called normalcy. Neither pharmaceutical hormones nor medical/surgical procedures can replicate this normal balance of hormone production, circulation and continual spontaneous adjustment to the body's needs.
Hysterct Footnotes
1. Robbins, John, Reclaiming Our Health, H.J. Kramer, California, 1996, p. 125 2. Love, Susan, M.D., Dr. Susan Love's Hormone Book, Random House, N.Y., 1997 p. 173 3. Simkin, Sandra, The Case Against Hysterectomy, Pandora, London, 1996, p. 8 4. Archer, John, Bad Medicine, Simon & Schuster, Sydney, 1995, p. 193 5. West, Stanley, Dr., Hysterectomy Hoax, Doubleday, New York, 1994, p. 1 6 Op. Cit., p.21 7. Op. cit. p. 44 8. Love, ibid p. 11 9. West ibid p. 23-24 10. Dennerstein, Lorraine, Wood, Carl, Westmore, Ann Hysterectomy, Oxford University Press, Oxford, 1995, P. 15 11. Est., Ibid p. 9 12. Anon, 'Treatment of menorrhagia', Lancet , 15 August 1987, pp 375-6 13. The People's Doctor, Newsletter, October 1989 14. West, Ibid, p. 49 15. Robbins, Ibid, p. 125 16. Celso Ramon Garcia et al, "Preservation of the Ovary: A Revaluation," Fertility and Sterility , 42(4), Oct. 1984, pp 510-14 17. Love, Ibid, p. 176 18. op.cit. p. 177 19. West, ibid, pp. 31-32 20. Achterberg, J., Woman as Healer , Random Century, Sydney, 1990, p. 128 21. Archer, ibid., p. 190 22. op.cit. 23. West, ibid, p. 19 24. Hysterectomy: An Important Decision, pamphlet, Royal Australian College of Obstetricians and Gynaecologist. 25. "Birthing Issues", Review of Professional Indemnity Arrangements for Health Care Professionals, Department of Human Services and Health, Canberra, 1993, p. 11 26. West, ibid., pp. 28-29 27. Robbins, ibid, p130 28. Lee, John M.D., What Your Doctor May Not Tell You About Menopause, Warner Books, Ne York, 1996 p. 241 29. Robbins ibid p.131 30. Lee, ibid p. 242 31. Robbins, ibid p. 132 32. West ibid p. 189
Warmest regards,
Sherrill Sellman
P.O. Box 690416
Tulsa, OK USA
Ph: 918-437-1058
Fx: 918-437-1258
Author of "Hormone Heresy"


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