Hysterectomy – is it necessary?

Hysterectomy

In a normal adult female, the uterus is roughly the size of her fist and is located in the lower abdomen ( belly ). Hysterectomy is the surgical removal of the uterus or womb. It is done for many reasons, such as uterine prolapse, multiple large fibroids, and diseases such as cancer. Unless the ovaries are diseased, they can and should not be removed with the uterus as they produce hormones even after menopause.

When is the surgical removal necessary – when both you and your gynecologist decide it is necessary.

This is my story. I started having problems with super heavy bleeding during periods about 7-8 years ago. I  didn’t think much of it – lots of people have heavy periods. I considered myself lucky that I had had very light and very regular periods for my whole life since periods began. Then, they just got really heavy – like bleed all over the bed type heavy. How embarrassing! Still, that wasn’t too bad, or so I thought. Just get on with it. Then, about 4  years ago now, I started having trouble going for a pee in the toilet. The flow seemed blocked somehow. I couldn’t explain it. It wasn’t right. At around the same time, or soon after, I found I didn’t have any energy. Found it hard to get out of bed, which is not like me at all. So, long story short, I went to the doctor, he did an examination, found what he called a bulky uterus ( just means bigger than normal ) and he sent me for an ultrasound scan. He also sent me for a blood test. The scan showed lots of fibroids inside the uterus, some of them really big, bigger than golf balls, which made the uterus bigger than normal and also caused my heavy bleeding. More surface area of the lining of the uterus = more bleeding. So then, my doctor referred me to a gynecologist. His first suggestion was to have a hysterectomy – which didn’t go down too well. He did perform a procedure which checked the lining of the uterus, which turned out to be normal.  So, then I thought I would try some other things to get rid of the fibroids. I tried Chinese herbs for a couple of years and fasting ( both water fasting and juice fasting ) and while both of these did make me feel a lot better, they didn’t get rid of the problem – the fibroids.

Back to the blood test, which showed a very low ferritin count ( iron in the blood ). Really low. So low, the doctor almost freaked. Caused by the heavy bleeding. I tried iron tablets, they do have side effects for some people – such as cramping and feeling nauseous and that was me, so I didn’t take them for long. I had 2 iron infusions instead, about 8 months apart. They did make me feel a lot better, certainly able to get out of bed but I really didn’t want to keep having them. To me they were just a bandaid, a temporary fix that didn’t get to the cause of low ferritin count, which was those pesky fibroids. I did keep taking an oral iron supplement, called Maltofer , it was easier on the stomach than the others but felt the time was coming to make a big decision.

Picture of the ovaries, falopian tubes and uterus

So then in January 2020, I did it, I made the decision, the time had come to get rid of those unwanted passengers in my uterus. In some cases, just the fibroids can be removed – and this is an option worth exploring if you can. I had too many fibroids, so my only option was removal of the uterus. Having said that – even I had the option to keep my cervix and so I did. This is called a subtotal hysterectomy. I also had the option of keeping my ovaries and I did. Depending on the reason for the operation, a hysterectomy can be removed through the vagina and thereby leave no abdominal scarring. This has been done, very successfully for more than 30 years. My mother had it done this way. However, she had it done for a different reason – uterine prolapse. I did not have this option, nor did I have the option of keyhole surgery. The sheer size of my uterus meant I had to have the same cut as a normal cesarean section, low down on the belly.

Near the end of March, 2020, I had the subtotal hysterectomy and salpingectomy done. Salpingectomy is the correct word for surgical removal of the fallopian tubes. As they are attached to the uterus, it would be pointless to leave them behind. The ovaries were left, that was always the plan – lots of hormonal issues if they are removed and I already have enough of those! I had the good old fashioned cesarean section, with a big cut nice and low on the bikini line. I literally gave birth to a uterus full of about 40 fibroids – or as the surgeon put it ”a Christmas tree full of baubles”.

The operation was a success and healing has been steady, although not as rapid as I would like. Time in hospital was 2  1/2 days, it was a private hospital and the care given by all staff was incredible. One of the risks of a surgical procedure is the chance of DVT, ( deep vein thrombosis ) a very painful and possibly life threatening condition, so several measures are given to avoid it. Several injections of an anti-coagulating agent are given and also compression stockings for the lower legs are worn, both day and night for several days.

So far, even though the healing is quite painful, it has proven to be a good decision and the right decision for me and my personal circumstances. There is life after a hysterectomy! As I still have a cervix, I still have to have pap smears. Cervical cancer is still a possibility. Why did I keep my cervix, then? My choice. One of the reasons I did not want to have a hysterectomy in the first place is because I felt the uterus would have connective tissue that would support and hold other organs in place, rather like the cross beams in a house or building – there for structural integrity.  To a certain extent, this is true – and the connective tissue that supports and holds other things in place is on the cervix. So as far as I was concerned, that had to stay.