Menopause Mondays: Re-decorate My What? is Hysterectomy the Right Theme This Holiday?

By now, you've probably crawled into the attic or dug through the hall closet to retrieve your family's Christmas decorations to prepare for trimming your home and tree. Maybe you've picked up a few decorating tips and have decided to try out a new look this year. I know someone who has multiple trees with different themes. One is the "homey" tree with all of the kids' homemade ornaments, colored lights, and the same light-up angel that has been topping the family's tree since 1972. Her second tree is all crystal, gold, and silver ornaments set off with white lights. That one goes in front of the window of her living room. Finally, there is a tree in the front yard with blue lights and huge, globe ornaments to add some holiday pizzazz to the neighborhood. Women love to decorate, maybe not all as much as my friend, but the holidayhs are a fun opportunity to let out our inner Martha. Sometimes the best redecorating project begins with downsizing. We shouldn't be afraid to toss out faded ornaments or that 10-year-old string of lights that only lights up on one side. Getting rid of a pile of "stuff" or what's not working can feel right sometimes and is often a great way to create room for something new. However, when it comes to our bodies, we should be cautious before we start throwing out what we think is no longer working for us. Hysterectomies are a radical form of redecorating; however, doctors perform up to 600,000 of them per year. Hysterectomy is the second most common surgery among women after cesarean delivery. So, chances are that, even during the holidays, you or someone you know is considering whether this is the right thing to do. Recently, I heard an amazing life story about a woman named Carroll, a member of the sisterhood from Georgia. Carroll is 54 years old, re-married with a Brady Bunch family including 2 sons, 3 step-children, 4 children-in-law, and 2 grandchildren! She manages a medical office, so she interacts daily with doctors and lives a healthy, active life. She stays fit through diet and exercise, especially running. Recently, Carroll has had a lot to face in her personal and family life. She steered her elderly father through a divorce and relocation to an assisted care facility. Then, her step-son survived a major stroke and began a long road towards recovery. Recently, two other children were married (what she calls "happy stress events"). On top of all of this, she experienced health issues and ultimately decided to undergo a hysterectomy. Carroll: I realized I was going through perimenopause when I was about 44-45 years old. I woke up one morning with a wet nightgown and assumed a fever had broken during the night even though I felt fine. The next morning it happened again. It slowly dawned on me that it wasn't a fever, and I told my husband I was pretty sure I was having night sweats. He laughed and said he wondered when I would figure that out. Then came the sudden mood swings...I knew I was being unreasonable about stupid things, but I couldn't seem to control it!! My poor husband asked how long menopause lasts and I said it could last 10 years....you can imagine his disappointment!!!...and fear!! I had been on low dose birth control (loestrin FE) for a few years before the night sweats started. Because of that and because I was running a lot, I didn't have my period during that time even during the 7 days each month I didn't take the pill. My doctor made a change in the dosage (not taking the 7 days off), after I began having migraines about the time I started perimenopause. The migraines seemed to revolve around the same time each month. My primary care physician ended up putting me on a blood pressure medication, as a prophylaxis for the migraines. Both of those medications helped tremendously as well as me recognizing my own "triggers" for the migraines: red wine, being around a smoky fire, and running in very hot weather. The thing that most helped alleviate my menopause symptoms, though, was cardiovascular exercise, and it also lifted me out of a blue spell I had been going through. Because my symptoms were minor, I never had any hormone tests to diagnose my stage of perimenopause. I had no further problems, until recently. I had not had a period in probably 15 years. Suddenly, I began to have a continuous one. It stopped for about 6 days and began again. I've had mild and severe dysplasia twice, the last time being about 15 years ago and have been faithful about having my annual exams. My gynecologist has wanted me to have a hysterectomy for the last 10 years, but I told him that unless my annual check ups came back with dysplasia again, I wasn't planning to have one. Let's get our bearings about hysterectomy by learning the basics. By definition, a hysterectomy is the surgical removal of all or a portion of a woman's uterus. Along with the uterus, the fallopian tubes, ovaries, and cervix may also be removed. There are 3 types of hysterectomy: 1

• Partial, subtotal, or supracervical removes the upper part of the uterus but does not remove the cervix.
• Total removes the whole uterus and cervix.
• Radical removes the whole uterus, cervix and surrounding tissues, and the upper part of the vagina.

Now what part of any of that sounds like a routine procedure??? Because hysterectomies are performed so often, it's not uncommon to hear someone talk like it's no big deal. Well, hysterectomies are a big deal and require serious thought. For starters, you MUST get more than one opinion. Yes, even if the obstetrician who delivered all of your children insists this is the right solution for you. Hysterectomies can be performed either through an incision in the lower abdomen or through the vagina. Abdominal hysterectomies can require a 5-7" incision while laparoscopic hysterectomies are completed through 3 or 4 small incisions. Laparoscopic and vaginal hysterectomies usually require less time in the hospital (sometimes performed in an out-patient setting) and involve a shorter recovery time. There is also a hybrid procedure known as laparoscopically-assisted, vaginal hysterectomy. Even though the Journal of Minimally Invasive Gynecology released a position paper stating most hysterectomies should be performed vaginally or laparoscopically, more than 2/3 of hysterectomies are still being performed abdominally largely due to lack of doctor training or experience with the less invasive procedures. Carroll: Then, I was diagnosed with a benign fibroid (after a fun filled endometrial biopsy and vaginal ultrasound) and was told this was going to be a continual problem. I decided to talk to my doctor about a hysterectomy. We discussed my options, including less invasive procedures like oophorectomy (bilateral removal of ovaries) and trying to treat and remove the fibroid. However, I had already had a tubal ligation when I had my last child, so I was obviously never having any more children. I saw no reason to keep having recurring problems. I felt confident in my decision to have a total vaginal hysterectomy. It was a decision I discussed with my husband, and he was comfortable with it as long as it alleviated my problems. Otherwise, my health has always been good...no chronic problems...I exercise regularly and try to eat a healthy, low fat diet. As nervous as I was about the thought of surgery, I went into it thinking it would be no big deal. Consider alternatives to hysterectomy. Hysterectomy is prescribed as the answer to an array of gynecological issues including fibroids, endometriosis, gynecological cancer, uterine prolapse, adenomyosis, heavy periods, chronic pelvic pain, or rare pregnancy complications. Sometimes women are not made aware that, other than for advanced stages of cancer, there are alternatives for each of these conditions before reaching over them all the way to a hysterectomy. A few of the alternatives to hysterectomy include:

• Fibroids
  • Myomectomy removes the tumor(s) but leaves the uterus intact.
  • Uterine fibroid embolization shrinks the tumors by cutting off their blood supply.
• Endometriosis
  • Drug therapy.
  • Endoscopic surgery to remove scar tissue.
• Uterine Prolapse
  • Kegel and other exercises to improve muscle tone.
  • Vaginal pessary, a devise that holds the uterus in place.
  • Estrogen therapy or less invasive surgery that leaves the uterus intact.
• Abnormal Periods
  • Hormone replacement or other drug therapy.
  • Low-dosage progesterone contraceptives.
  • Endometrial ablation or D&C (dilation and curettage).

This, of course, is not an exhaustive list and is not intended to be medical advice; however, I present these options here to show that there are many options to consider depending upon your unique circumstances and medical history. Talk to your doctor and take a list of questions to your appointment! If hysterectomy is the right solution for you, there are risks specific to hysterectomy that you and your doctor should discuss in detail:

• Injury to nearby organs (bowel, urinary tract, bladder, rectum, or blood vessels)
• Pain during intercourse
• Allergic reactions to anesthesia or medicines prescribed during recovery
• Blood clots
• Infection
• Heavy bleeding
• Incontinence
• Early or sudden menopause*

*I placed an asterisk next to this risk because it warrants special attention. If your ovaries are removed during hysterectomy, you will enter Surgical Menopause immediately and risk the mild to severe symptoms that can result in the sudden disappearance of the hormones that your ovaries produce. If you elect to keep your ovaries (sometimes recommended if no medical or family history of cysts or ovarian or cervical cancer is present), your ovaries can still temporarily shut down. This may last from a few weeks to several months. In a study at Duke University, they found that women who have a hysterectomy and keep their ovaries reach menopause an average of 2 years earlier than women who do not have a hysterectomy. No matter what age or stage you are, there are benefits to keeping your ovaries. Normally, a woman's ovaries will produce less and less hormones the older she gets; however, the decrease is usually very gradual and even the smaller amounts of estrogen and androstenedione provide important protection from heart disease and osteoporosis while testosterone is important to maintaining energy and a healthy sex drive. If both ovaries are removed during a hysterectomy or if your ovaries temporarily become inactive following surgery, estrogen-replacement therapy may be necessary. Carroll: I initially planned to have the surgery on Tuesday and be back at work on Friday. I spent one night in the hospital and ended up going back to work the following Tuesday, after taking a week off. I was ok going back to work, but I was very tired. I had a spinal block which worked well for me and made my recovery much quicker. I took pain medication right after my surgery and then switched to ibuprofen. My doctor gave me a shot of estrogen and then, when I went in for my 3 week post op visit, we decided on one more estrogen shot. I am currently on oral Estradiol and was released from my gynecologist a couple of weeks ago. It has been about 8 weeks since my surgery, and I am feeling great. The worst part of the recovery was being sedentary, and I gained some weight due to my inactivity. At the moment, I am working hard to lose it. I hope to have it all off soon, although this time of the year definitely makes it more difficult! I am very happy with the results of my surgery. One of the funniest things about the whole recovery process was that my husband began taking testosterone injections right before I had my hysterectomy...and then my celibate 6 week recovery! He managed to survive...as did I...and we are both happy and relieved it is all behind me!! I am more than thrilled to never buy another tampon again!!! Decorating Rules for a Happy Hysterectomy

1. Get a 2 nd opinion.
2. Try alternative treatments first.
3. Understand the risks (taking into consideration your personal and family medical history).
4. Opt for the least invasive procedure if you choose hysterectomy.
5. Opt to keep your ovaries if possible.

Recovery can include a 1 to 2 day stay in the hospital after surgery followed by rest and restricted activity for 4 to 6 weeks for an abdominal hysterectomy or 3 to 4 weeks for vaginal or laparoscopic. After 6 weeks, you can begin to lift heavier objects again, take tub baths, and resume sexual activity. Carroll: As far as my health and all the family things, I am very lucky to have a wonderfully supportive husband. Also, when you're going through that many things at once, you have to handle one day at a time. The weddings were happy stress. My son's stroke and Dad's divorce were some of the most upsetting things I've ever been through. I found those tough times brought my husband and I closer and made us (and me) stronger. Hopefully, my experience will be helpful to someone else. Above all, make sure the decision for a hysterectomy is one you are very sure of!! Educate yourself about all your options. I trust my doctor and ultimately, it was my decision to make. Thank you, Carroll, for being so open and sharing your story with us! A hysterectomy is a major redecorating project. You may think that a totally new "look" is just what you need. The two main points to remember are (1) get a second opinion and (2) consider alternative treatments first. Maybe new throw pillows or a change of wall color will do the trick before you go for a complete "gut" renovation. Before you decide whether a hysterectomy is the right choice for you, take your time and learn about your condition and your treatment options. Don't rush into anything that you don't understand or doesn't feel right. Like Carroll said, it's your decision to make. Have you had a hysterectomy? Share your experience in the comment section. Remember … Reaching out is IN! Suffering in silence is OUT! More on the big "H":

• Woman-to-woman site for hysterectomy information, support and recovery at HysterSisters.com. (Free registration required to access some features.)
• Hysterectomy, Ovaries, and Hormones.
• If You Have Uterine Fibroids, from FibroidSecondOption.com and up to date, evidence based, information and news from Endometriosis.org.
• Review this info from HealthyWomen.org to help decide if a hysterectomy is the right procedure for you.
• Hysterectomy Fact Sheet from WomensHealth.gov
• 2011 Women's Health Stats and Facts from The American Congress of Obstetricians and Gynecologists, Hysterectomy, stats on p. 19, hysterectomy alternatives by diagnosis on p. 20.
• CDC's Women's Reproductive Health: Hysterectomy Fact Sheet.

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