Are Hysterectomies Always Necessary? Part 2

“Really, I don’t think women ask enough questions of their doctors. But the reason they don’t ask enough questions is that they don’t know what to ask. It’s an unfortunate predicament,” West said. “You look at our bodies, we have complementary biology. Your ovaries are our testicles. Our prostate is your uterus. I have seen men who have prostrate cancer, when faced with the diagnosis say: ‘But doctor, isn’t there something else?’ Women don’t do that. They have a lot of trust in their doctors.”

What West believes women should ask their doctors would seem obvious:

Why do you want to do a hysterectomy?

What are my alternatives if it’s not cancerous?

What are the side effects?

How will this change me?

What kind of follow-up care will I require?

Should I have hormone replacement therapy?

According to researchers at the University of Pennsylvania Medical Center, 9 out of every 10 hysterectomies performed in the United States are intended to treat benign gynecologic diseases, such as fibroids, pelvic pain and excessive uterine bleeding. Recent trends for treating those conditions appear to be shifting toward a more conservative approach, in which hysterectomy is still an option — but not the first or only choice. Alternatives may include drug treatments to reduce fibroids, myomectomies achieved through laparotomy, laparoscopy or hysteroscopy to remove fibroids, or pelvic exercises for pelvic prolapse.

For Connie Smith, a 35-year-old homemaker in Charlottesville, Va., who underwent a total vaginal hysterectomy in August after doctors diagnosed her with micro-invasive cancer in her cervix, “the scary part of the whole thing was I didn’t have any symptoms.”

Smith’s doctor referred her to an OB-GYN who specializes in oncology. The specialist performed a cone biopsy, which showed that there was micro-invasive cancer in Smith’s cervix.

“I didn’t know what to think. I wondered whether it was spreading throughout my body — and if so, how fast was it moving,” she said. Her surgeons laid out all of her options, questioning whether she was sure that she might want to have more children. She already has two small children.

“I certainly knew what my choices were,” Smith said. After her vaginal hysterectomy, which left her ovaries intact, doctors at the University of Virginia Medical Center biopsied her uterine tissue. “There was no sign of cancer there,” Smith said. “Should I be angry because there was no cancer there? No, I don’t think so. It just shows they got everything [cancerous] with the cone biopsy of my cervix.”

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