Frequently Asked Questions
HOW DO I KNOW IF I NEED A HYSTERECTOMY (removal of the uterus)?
Some women may need a hysterectomy because of pressure from large fibroids (overgrown benign whorls of uterine muscle), causing pressure, pain or bleeding that can't be managed by natural methods, pills or hormones.
Some women cannot accomplish their activities of daily life during their periods and need relief long before menopause will naturally occur at age 50.
Some have a leaky bladder when coughing, or laughing or after sudden motion and want an improved quality of daily life without urinary leakage.
Some women’s uterus begins to droop down the vagina causing bothersome pressure and distraction.
If there is no other way to manage the symptoms, and the symptoms are significantly distracting from daily life: do it.
Removal of the uterus stops all vaginal bleeding, relieves pressure from fibroids.
Hysterectomy and removal of the ovaries have gotten a bad reputation ever since some doctors performed them unnecessarily in the 1970’s or failed to help their patients feel their best afterward the surgery. Extensive research on large numbers of women tells us that 98% of women who have a hysterectomy are actually very satisfied and happier afterward than before. It goes unnoticed that after hysterectomy with removal of ovaries and tubes, breast cancer risk is halved, and uterine, cervical and ovarian cancers are reduced to zero.
WHY IS A LAPAROSCOPIC APPROACH BETTER?
If you need a hysterectomy, have it done by laparoscopy (tiny incisions)! With Total Laparoscopic Hysterectomy (TLH) recovery is complete in two weeks. There is far less blood loss (a half cup versus two cups), less pain (most use no narcotics post op), shorter hospital stays (overnight versus 3-5 days) and speedier return to work (two weeks versus 6 weeks) than with large, open-incisional surgeries. Complications are the same. The only reason NOT to use these tiny incisions is when the doctor DOES NOT KNOW HOW to perform TLH, or does not preform many of them.
I perform nearly every hysterectomy through four half-inch incisions, using a camera and long instruments, operating about 6-8 times per week. I have performed over 2,200 TLH’s since 1996 and have a very low complication rate. TLH is used for all benign surgeries and most malignant surgeries. There is NOT a uterus that is too big, a patient who is too large or too old, a prolapse that is too far down or adhesions that are too widespread that TLH cannot be done. Women with masses suspicious for cancer, massive uteruses from fibroids (size of a 24 week pregnancy), women in their 90s, and women over 400lbs tolerate this minimally invasive procedure better than the long open incisions. I have presented my data about laparoscopic surgery for and taught my technique at the annual international meetings of the Society for Gynecologic Oncologists and the American Association for Gynecologic Laparoscopists for many years.
HOW DO I DECIDE ABOUT REMOVING THE OVARIES?
There are three age groups with different priorities:
Young fertile women seeking to maintain or enhance their fertility: keep the ovaries, of course.
Women who are finished with fertility: Remove the ovaries if they are part of the problem or at high risk for future problem. This includes women with BrCa mutations, endometriosis, severe premenstrual mood changes, women from families with high rates of breast or ovarian cancer. Once the ovaries are removed, menopausal symptoms are avoided by meticulous hormone therapy. We now know from the Women’s Health Initiative Trials that hormone replacement therapy works very well and is stunningly safe under age 60. Removal of the ovaries, with estrogen replacement, reduces breast cancer by half, dropping the lifetime risk from 12% to 6%.
Women near or past the age of menopause having any gynecologic surgery should have their ovaries removed, period. If they are near menopause or soon after, hormones are safe and easily administered and are safer than leaving the ovaries in place. Estrogen replacement therapy (ERT) is 100% safe according to the large 10,000 woman-strong Women's Health Initiative (2004)
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 “Surgical and Natural Menopause”.
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. Exercise and energy is important for a good libido. Hormones are addressed below and extensively in other sections of the website. Read “About Maintaining your Libido”.
HOW'S YOUR VAGINA?
Many women in the menopause notice that their vaginas become dryer, smaller, less responsive than what used to make them copiously moist. 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, generally, 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...
WHY DOES DR. O'HANLAN ALWAYS REMOVE THE CERVIX?
The cervix is simply the opening of the uterus. A supracervical hysterectomy removes only 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 if left in place. Some doctors will offer you supracervical hysterectomies because they have not learned to remove the entire uterus laparoscopically. This is never the best choice. 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 it does not prevent the most common gynecological cancer: endometrial cancer, while it may actually obscure the early diagnosis of it, preventing or delaying spotting by the intended internal scarring of the uterine lining. In fact, distant and fatal spread of endometrial cancer has been reported because the cancer can be trapped within the scarred uterine lining, and escape only through lymphatic spread to nodes or vascular spread to lungs. What is more, the typical woman who has excessive bleeding in her forties, (an overweight woman with excess estrogen in her blood from the fat cells) is also at risk for uterine cancer in her 50’s and 60’s. Read more...
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