Hysterectomy: The Basics

A hysterectomy is a surgical procedure meant to remove your uterus.

You would be surprised how many women do not know where the uterus is located or that removing it means that they can no longer have children or get periods.

There are four different ways of performing a hysterectomy:

  1. Vaginal Hysterectomy:  the uterus is removed through a vaginal incision.
  2. Laparoscopic Hysterectomy: the uterus is removed via the aid of a tiny camera and small openings in your belly.
  3. Robotic Hysterectomy: similar to a laparoscopic hysterectomy except that the tools are attached to the DaVinci Robot which is then controlled by your surgeon.
  4. Abdominal Hysterectomy: the uterus is removed via a horizontal or vertical incision on your belly.  This may need to be done if the uterus is too large to remove safely via a minimally invasive approach.

Why would I need a hysterectomy?

There are many reasons why a woman may need a hysterectomy.  The most common are uncontrolled bleeding, large tumors (fibroids), herniation or prolapse of the uterus, cancer and severe pelvic pain due to endometriosis or adenomyosis.

Alternatives to hysterectomy:

Removing your uterus should be the last resort (unless you have cancer) because of the risks involved with surgery.  If your issue is heavy bleeding, you can try hormonal options (birth control pills or progesterone), tranexamic acid (Lysteda), Progesterone containing IUDs, GnRH agonist (Lupron).  Other surgical options like endometrial ablation, uterine artery embolization, or myomectomy (removal of the fibroid/s.

Pregnancy:

Many women need a hysterectomy but are concerned about child-bearing.  You have options and each case is unique.  Having a hysterectomy does not take away your ability to conceive.  We just need to be a little more creative.  Advanced reproductive technology now allows women to preserve their eggs and if need be have a child via a surrogate.

What other organs are removed during a hysterectomy?

Typically we recommend removing the cervix and fallopian tubes because both are attached to the uterus.  In the past it was believed that preserving the cervix helped with sex and support however multiple studies have shown that this is not the case and that preserving the cervix only places you at risk for cervical cancer in the future.  New studies have shown that the fallopian tubes should be removed to avoid a rare type of cancer that is found in the tubes.

Do my ovaries need to be removed?

Yes if you are in menopause.  No if you are not in menopause or feel very strongly about preserving them.  Ovaries make our hormones and our hormones are vital to prevent osteoporosis, Alzheimer’s, dementia, hot flashes, night sweats, mood swings, insomnia, weight gain….the list is endless.  So if your ovaries are still functional…meaning you are not in menopause, you should try to preserve them.  If you have gone through menopause, the recommendation is to remove them because of the risk of ovarian cancer and the fact that they are no longer functional.

Am I still going to be woman if I get my uterus taken out?

Absofuckenlutely!!! Please do not let anyone tell you otherwise.  In fact, most women who need a hysterectomy have had such debilitating disease for so many years that once they have this procedure done they realize how amazing their life can be.  You will be even more of a woman because you will now be able to enjoy all of the “womanly” things that you missed out on because your uterus got in the way.  Almost 99.9% of my patients report such an improved quality of life that they are upset they didn’t do the surgery sooner.  My advice is talk to your doctor.  Each case is unique and they will help you figure out what is the best approach for you.

October is Breast Cancer Awareness Month

Most women are already aware of a sobering fact: 1 in 8 of us will be diagnosed with breast cancer over the course of our lifetimes. October is breast cancer awareness month, so let’s take the opportunity to learn more about this disease and how it can be detected. Breast cancer is the most frequent cause of cancer death among women worldwide and the second most frequent cause of cancer death in the United States. Most breast cancers are detected by screening mammography but many are brought to a physician’s attention after a self-breast exam.

You have probably heard a lot of confusing information about when or even if you should get a mammogram and whether self-exams are helpful or can potentially lead to unnecessary biopsies. Seemingly every time we turn on the television, the nightly news reports on a new breast cancer study with conflicting information and changing recommendations.   While new research is important and makes for interesting newscasts, try to keep a level head about it. Watching the news is not the same as having a conversation with your doctor.

When should you be tested? Mammograms in women under the age of 40 are generally not very helpful because young breast tissue is very dense and can lead to further testing and unnecessary radiation exposure. The American College of Obstetrics and Gynecology recommends that mammograms be offered to women starting at age 40 and be continued every 1-2 years thereafter until at least age 75. This recommendation might change based on a patient’s unique medical history.

It is important that everyone understand that individual risk varies based on multiple factors. Now there are several models that allow you to calculate your individual risk. These models take into account the following: your current age, age when you first started your period, age when you had your first child, whether or not your have been diagnosed with breast cancer in the past, whether or not you have had radiation therapy to your chest wall for other cancers like Hodgkin’s Lymphoma, whether or not you are positive for BRCA 1 or 2 (hereditary breast cancer gene), whether or not you have had a previous breast biopsy and how many first degree relatives (mother, father, brother, sister or daughter) have been diagnosed with breast cancer.

Several factors you can control to reduce your breast cancer risk are actually very intuitive, but sometimes difficult to acknowledge. The truth is that the same principles that should guide our health in general also apply to breast cancer risk. Try to follow some simple guidelines:

  1. Don’t consume more than one alcoholic beverage per day. Women who consume more than 2-3 alcoholic beverages per day have a 20% greater chance of breast cancer compared to women who don’t drink alcohol.
  2. Being overweight or obese also increases your risk factor for breast cancer. Fat cells make estrogen, which in turn stimulates the growth of a breast cancer if it is present. Being overweight and consuming processed sugars increases insulin levels which elevates breast cancer risk. Consuming red meat and processed or cured meats (hot dogs, bacon, ham, sausage) also make you more likely to someday be diagnosed with breast cancer.
  3. Leading a sedentary lifestyle has also been linked to increase risk of breast cancer. Women who exercise regularly have lower rates of breast cancer according to multiple studies.

On the other hand, breast feeding, having a child before the age of 30 and minimizing your use of synthetic hormones has been linked with a reduction in breast cancer.

In summary, although the vast number of women affected by breast cancer is daunting, enough information exists to be aware of how to potentially avoid the risk being any higher than it has to be. A healthy lifestyle and a thorough dialogue with your doctor are the

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