Breaking down the barriers of the hysterectomy conversation

Breaking down the barriers of the hysterectomy conversation

Key takeaways:

  • Every year, over half a million women in the U.S. have hysterectomies.

  • Most hysterectomies performed are elective as a treatment to address painful and abnormal menstruation.

  • There remains a stigma associated with hysterectomy.

  • A woman can choose a minimally invasive hysterectomy procedure that doesn’t require an incision.

[4 MIN READ]

Every year in the United States, over half a million women have a hysterectomy. By age 60, approximately one in three women in the U.S. have had one. If you’re surprised by the numbers, consider some key reasons for most hysterectomies: 

  • Endometriosis affects up to 10% of U.S. women between ages 25-40.
  • Up to 80% of women develop fibroids by age 50.
  • According to the American Cancer Society, cancer of the endometrium (the lining of the uterus) is the most common cancer of the female reproductive organs.

These startling statistics reveal how many women suffer from gynecological health disorders. Endometriosis, for example, can cause severe pain and heavy, irregular bleeding during menstruation, as do fibroids and hyperplasia, a condition that can lead to uterine cancer. In one study, researchers reported that a tenth of all women in the U.S. between ages 18-50 had one or more chronic gynecological conditions. The most common disorders were associated with menstruation.

Although a hysterectomy is not always the only option for treating these health issues, “A significant number of women who have a hysterectomy do so because of abnormal bleeding,” said Emma Grabinski, M.D., FACOG, system chief, OBGYN & Perinatology at Swedish OB Gyn Specialists and Swedish Midwifery in Seattle.

Even though most women who choose a hysterectomy are in their 40s and have children, Dr. Grabinski says she is seeing a wider age group requiring the surgery because of gynecological cancers and also other serious conditions.

Even though most women who choose a hysterectomy are in their 40s and have children, Dr. Grabinski says she is seeing a wider age group requiring the surgery because of gynecological cancers and also other serious conditions that affect quality of life. “Some women who choose a hysterectomy have inherited clotting or bleeding disorders, or significant issues with heavy menstrual bleeding or abnormal periods. Having a hysterectomy, is a huge relief for them.”

Given how common hysterectomies are, why is it still so hard to talk about, both in society and with your provider?

Fearing the stigma

For some women, the uterus defines who they are, their gender and cultural desirability. It may symbolize motherhood and family, ensuring a legitimate place in society. Some women will even suffer through extreme menstrual pain instead of having a procedure that alters their reproductive organs because of the societal stigma associated with infertility.

Throughout history, society’s expectation of fertility as a requirement has put an unnecessary burden on women. Even today, fertility remains a status symbol. For many women, this social pressure combined with their own fears or discomfort around the subject is a deterrent to seeking help or even talking about it with loved ones.

Even though the uterus is not a visible organ, society associates your being able to have a child as being a woman and I think there can be a lot of emotions that go along with that.

“It can definitely be complex,” says Dr. Grabinski. “Even though the uterus is not a visible organ, society associates your being able to have a child as being a woman and I think there can be a lot of emotions that go along with that.”

Dr. Grabinski encourages any woman considering a hysterectomy to keep an open dialogue with their doctor to address the emotions involved in the decision.

Is a hysterectomy the only option?

If you suffer from a gynecological disorder such as endometriosis or fibroids, a hysterectomy is an option if you’ve tried other non-invasive treatments without success. Dr. Grabinski recommends her patients try other treatments first, such as the birth control pill, a vaginal ring, hormone therapy or an intrauterine device (IUD). Other types of nonsurgical options include radiofrequency ablation or uterine artery embolization to help shrink fibroids. All of these non-invasive treatments can help reduce pain and heavy bleeding.

Some women may choose to have a hysterectomy if they’ve inherited a cancer syndrome, such as BRCA or Lynch syndrome, or have uterine prolapse, which is when the uterus drops into the vaginal canal. Uterine prolapse is the result of the weakening of pelvic muscles and supportive tissues, sometimes caused by pregnancy, being overweight or lower estrogen levels after menopause.

It’s important to talk with your provider about all of the options available and to go to your appointment knowing what is most important to you for improving your quality of life.

Dr. Grabinski says it’s important to talk with your provider about all of the options available and to go to your appointment knowing what is most important to you for improving your quality of life. “Think about what you want to get out of any treatment,” she said. 

She also recommends having someone with you at your appointments. “The conversations with your doctor can be pretty emotional with a lot of information involved. Having somebody else there with you can help. Also, ask for a written summary from the doctor of the things that you discussed. You want to feel comfortable with whoever is doing your surgery and to really trust that person. If you're not completely comfortable with your doctor, don't ever feel that you can't seek a second opinion or see somebody else.”

Surgical procedures

A total hysterectomy, which is the removal of the whole uterus and the cervix, is the most common type of surgical procedure. “You will not need your cervix if you don't have a uterus since the purpose of the cervix is to help keep a pregnancy inside of the abdomen. And with a cervix still in place, you still have a risk of developing cancer,” explained Dr. Grabinski. This is why many women choose to remove both at the same time.

Other types of hysterectomies that are less common include:

  • Total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy) are removed
  • Radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue

Now, a woman can choose to have a minimally invasive procedure, which lowers the risk of infection, blood loss and scarring. Unlike the early surgical procedure that required an incision in the abdomen (like a C-section), with a vaginal hysterectomy, the surgeon removes the uterus through the vagina without an incision.

A laparoscopic hysterectomy requires a small incision in the belly button where a tiny camera is inserted. The surgeon watches the image from this camera on a screen and performs the procedure, sometimes with robotic assistance. Two or three other tiny incisions are made in the lower abdomen for the removal of the uterus.

What to expect after surgery

With minimally invasive procedures, the recovery time is much faster. Most women can plan on 4-6 weeks for a complete recovery, and in most cases will leave the hospital the same day as the procedure. Within a day, most women are able to get up, walk around, take a shower and use the bathroom without any trouble. “But you’ll be exhausted for a week or two,” said Dr. Grabinski. “That’s your body working to recover.”

There are some myths about what to expect after a hysterectomy that continue to circulate:  You will gain weight, grow facial hair, become depressed and have a greatly diminished love life. “Not true,” says Dr. Grabinski.

Women who may be having these chronic ongoing disease symptoms, oftentimes they feel really relieved, are happy and feel more at ease with themselves. 

Some women may feel a sense of loss. But many of Dr. Grabinski’s patients who choose to have a hysterectomy have made peace with their decision. “Women who may be having these chronic ongoing disease symptoms, oftentimes they feel really relieved, are happy and feel more at ease with themselves. I think it's harder for those who have an emergency hysterectomy after a birth or for cancer because that's not a choice that they've made to improve their lifestyle.”

If you’re experiencing painful menstruation or heavy, irregular bleeding, talk to your provider about treatment options.

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This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.