FAQ'S ABOUT HYSTERECTOMY
HOW DO I KNOW IF I NEED A HYSTERECTOMY?
Some women may need a hysterectomy (removal of the uterus) for benign reasons such as pressure from large fibroids, pain or bleeding that can't be managed by natural methods, pills or hormones. Some have a leaky bladder when coughing, laughing or sudden motion. Some have adenomyosis. How do you know you need a hysterectomy or removal of your ovaries? The answer is: If there is no other way to manage the symptoms, and the symptoms bother you. Hysterectomy and removal of the ovaries have gotten a bad reputation ever since some doctors performed them unnecessarily or failed to help their patients feel their best afterwards. Extensive research tells us that 98% of women who have a hysterectomy are actually very satisfied or happier than before; and breast, uterine, and ovarian cancers are significantly reduced. Read the research on satisfaction after hysterectomies.
WHY IS LAPAROSCOPIC HYSTERECTOMY BETTER?
If you need a hysterectomy, have it done by laparoscopy! Recovery is quicker with four tiny incisions. There is less blood loss, less pain, shorter hospital stays and speedier return to work than with large, open-incisional surgeries. Complications are not higher. We perform nearly every hysterectomy by four tiny half-inch incisions, using a camera and long instruments, called Total Laparoscopic Hysterectomy. We do not ever leave the cervix in. I have performed well over 1.300 total laparoscopic hysterectomies (TLH) since 1996 and have a very low complication rate. TLH is used for all benign surgeries and most malignant surgeries. Women with masses suspicious for cancer, uterine cancer, massive uteruses from fibroids (size of a 24 week pregnancy), women in their 90s, and women who have very high body mass tolerate this procedure better than the long incisions. I presented my data about laparoscopic surgery for endometrial cancers and ovarian tumors, or taught these procedures at the annual international meeting of the Society for Gynecologic Oncologists yearly for the past five years.
HOW DO I DECIDE ABOUT REMOVING THE OVARIES OR NOT?
You should keep your ovaries unless there is a benefit to removing them. Removing pelvic masses, preventing ovarian cancer, treating and preventing pain from endometriosis or adenomyosis, stopping disabling monthly mood changes or monthly migraines, reducing risk of a new breast cancer, reducing risk of breast cancer recurrence, are all very good reasons. You will need estrogen afterward if the ovaries are removed. Estrogen replacement therapy (ERT) is 100% safe according to the large 10,000 woman-strong Women's Health Initiative (2004), at least until age 60, but you will likely not need estrogen past that age. Read more...
WHAT DO I NEED TO KNOW ABOUT SURGICAL AND NATURAL MENOPAUSE? IS ESTROGEN REPLACEMENT SAFE?
After 50 years of hormone use, our field of medicine has finally produced the most definitive and reliable data for women over age 50 making decisions about use of estrogen and/or estrogen with progestins. We now have information for women having bothersome menopausal symptoms, whether they have had a hysterectomy and need only estrogen, or have their uterus and need the two hormones. Read more...
WHY DOES DR. O'HANLAN ALWAYS REMOVE THE CERVIX?
The cervix is the opening of the uterus. A supracervical hysterectomy removes the top of the uterus. No fewer than four randomized prospective trials comparing outcomes of women who had a supracervical or total hysterectomy confirm that urinary leakage, bowel symptoms, enjoyment and frequency of sex and of orgasm were the same whether the cervix came out with the uterus or was left inside. While there is no benefit to leaving the cervix in, there are definitely added risks and costs to women. Various doctors will offer you supracervical hysterectomies because they are easier to perform, and because they have not learned to remove the entire uterus laparoscopically. Read more...
WHY DOESN'T DR. O'HANLAN PERFORM ENDOMETRIAL ABLATIONS?
Endometrial ablation is a major operative procedure that: is ineffective because 40% still need a hysterectomy, one third have no change in bleeding and two thirds have no change in pain; and does not prevent the most common gynecological cancer: endometrial cancer, but it may obscure the early diagnosis of it, preventing or delaying spotting by the intended internal scarring. In fact, distant and fatal spread of endometrial cancer has been reported because the cancer can be trapped within the scarring, and escape only through lymphatic or vascular spread. Finally, the typical woman who has excessive bleeding, (an overweight woman with excess estrogen in her blood from the fat cells) is the same woman at risk for uterine cancer. Read more...
ARE YOU EXPERIENCING A LOW LIBIDO?
Many women complain of low libido. This can be for lots of reasons: too hectic a schedule, tension between partners, tiredness from childrearing or work, depression, poor physical fitness, low estrogen in the menopause, or because they are tired of having sex that was never really very rewarding to them before. The remedy for the first three causes is to fix your schedule and keep your relationship in good repair, perhaps with counseling for either or both of you. Hormones are addressed below and extensively in other sections of the website. Read more...
HOW'S YOUR VAGINA?
Many women in the menopause notice that their vaginas become dryer, smaller, less responsive the what used to make us copiously moist and joyful. This is usually due to one reason: low estrogen. Estrogen tells the vaginal walls to grow to its full thickness. Without it, the surface layers of the vagina don't remain strong and resilient, so sexual activity can be scratchy, painful, dry and, shall we say, unsuccessful. The solution is to use tiny doses of estrogen twice a week, by cream or pill that can be easily inserted, and create their good effects after a month of use. And, they are 100% safe, and require no progestins. Read more...