Elective hysterectomy (most likely TMI)

Factual Questions
1

Ever since I started my period when I was a teenager, it’s been horribly unpredictable. Sometimes I menstruate once every couple months and sometimes I wait for six months to a full year before it happens again. I carry around a full supply of feminine products just in case I start while I’m away from my house.

I know I ovulate because my nine-year-old was conceived during a six month menstrual drought.

I’ve done the hormonal birth control thing, but the pills make me gag and the hormones make me sick to my stomach. I quit using hormonal BC because my husband had a vasectomy.

Now I want my uterus removed. I’m 31, and I don’t want any more kids. I could have my tubes tied, but that doesn’t do me any good as far as unpredictable periods. I’ve asked my doctor if I can elect to have my uterus removed (leaving the ovaries for hormonal balance), and he’s looked at me as if I just asked him to help me murder someone.

Why won’t doctors perform elective hysterectomies? Does the uterus serve a real purpose other than to house a fetus? If so, what happens to people like my mother, who had a hysterectomy (removal of only the uterus) because of endometriosis or my stepmother, whose uterus was removed to combat uterine cancer? .

2

Have you Googled “elective hysterectomy”
(including the quotation marks)?
I came up with some pretty informative
links there.

Good luck.

3

Not too many docs are going to be anxious to remove a non-diseased, functioning, low risk organ without good cause. Most insurance companies won’t pay for it, any surgical procedure carries risks, and the more body bits you remove, generally the riskier it becomes, and there are always complications of anesthesia to worry about.

Sure, one can live without it, and if it is causing problems it may be better to do just that. But one can say the same for one’s appendix, a kidney which forms occasional stones, or for ovaries which occasionally throw out a painful cyst. Yet you don’t see too many folks having those out electively before trouble arises.

And don’t forget buyer’s remorse! The consent form might not stand up if the patient later complains “I was mentally under stress, and didn’t know what I was doing when I told him to remove my perfectly functional uterus”.

Especially since docs took a lot of heat back in the 70’s and 80’s for doing ‘unnecessary hysterectomies just to line their pockets’.

Still, if you have enough money and make enough noise, I’m sure you’ll find someone willing to take it out for you. But then you’ll have to decide “ovaries stay or go” and if they go, do you use hormone supplements with their attendant risks, or do you skip them and enjoy menopause early?

And if you keep the ovaries but ditch the uterus, you still could have pelvic pains if endometrial tissue remains behind in the pelvis or the abdomen, and responds to those cyclical hormone releases by the ovaries. Voila! Endometriosis.

Good luck with that. But I’d urge you to keep your bits unless there’s a clear, logical reason to remove it, with a track record of removal resulting in better outcomes.

4

How early is early? My mom was near 50 when she started hormone replacement therapy, and she was in her late thirties (I think) when she had her hysterectomy. Is a mother’s experience a good indicator of her daughter’s future? If so–and I am not soliciting medical advice here…just posing a rhetorical question–isn’t it possible I may end up having it removed anyway because of some form of endometriosis just like she did? In the eyes of a doctor, why not do it now, and save myself the very real frustration of never knowing when Aunt Flow is going to pay a visit? Will it be when I’m on a cruise with my husband? Will it be when I’m at a funeral? Will it happen when we’re on a particularly long leg of a road trip with no rest stop or truck stop for miles?

The reason I don’t understand a doctor’s unwillingness to do it is because plastic surgeons do elective, high-risk procedures all day long including removing the breasts of women who are scared of getting breast cancer (which I know can be successful). I know insurance won’t pay for any surgery I choose to undergo, and I know I’d have to foot the entire bill and all. This is something I’ve thought about for a long time. I’ve been on birth control off and on from the time I was sixteen. It has always made me sick, but it was the ONLY way to regulate my cycle. I’ve been in a heated debate with hormonal birth control for fifteen years: do I continue to take it and live each day on the verge of puking my guts out or do I stop taking it and carry pads and tampons around wherever I go?

Also, is there a more legally binding document–to allay a doctor’s fears of future lawsuits–that could be drawn up should I decide I really do want the procedure? Such as, “I, cruel butterfly, being of sound mind and body, do hereby absolve Dr. So-and-So of any future repercussions from taking out a functioning part of my body at my request…”

5

I had my simple hysterectomy at age 27 after having one child. I too, had irregular periods, but they were long and heavy when they did happen. They were also quite painful, even after child birth.
The first two doctors I saw, told me I was too young to be sterilized. They wouldn’t even discuss tubal ligation.
I finally found a doctor who worked me up for pain and excessive bleeding and did the procedure. He found was that my uterus was folded back on itself.
A simple hysterectomy(only the uterus is removed) is usually done vaginally, so there are no external scars.
Because my ovaries were spared, so I had no menopause symptoms until age 45. He told me that even with ovaries in place, I could start menopause early.

I’ve never regretted the decision.

6

I had an endometrial ablation last month. I wasn’t keen on a hyst because I wanted to avoid a “surgery”. An ablation is more like a “procedure”.

I have some friends and aquaintences who have had this done and been very happy with the results.

My experience was more difficult than any of the folks who shared their stories with me, so my opinion of the results of the ablation are still pending.

I found out during my (delayed) post-op interview that my uterus was almost too large for the Novasure procedure (I’m sooo womanly!), and that they had to sew my cervix closed around the instrument because I “leaked”. I also suffered a post-op pyelonephritis (UTI to kidney infection), and am still bleeding.

I’m a gynecologic mess and always have been.

But, I’m still hoping that I can give the whole thing a good review soon!

Technically, the ablation will jsut stop the menstrual cycle and is not a form of birth control. I was told, however, that pregnancy following ablatioon is extrememly rare.

7

I won’t go into details about when/if/how about hormone replacement; I’m too far removed from that aspect of practice.

As for comparing your proposed style of hysterectomy to removing a healthy breast, most of those types of breast removal surgeries are done on women who are at significantly increased risk of getting breast cancer. Risk of cervical or ovarian cancer is far, far lower.

And as I said earlier, if you look, I’m sure you can find a doc who will remove your uterus because you don’t want to have irregular periods. Just don’t be surprised when you’re turned down by a lot of docs. They are under no obligation to do whatever a prospective patient wants them to do.

I understand why you would want to have this done. And I believe that women should not be prevented legally from having this done, as long as all the risks, benefits, and obligations are clearly laid out to them. Just understand that finding someone to do it will be tough.

Heck, I support your right to do it, but if I did perform hysterectomies (I first assisted in a lot of hysts back in the day), I doubt I’d take a case like yours on. Primum non nocere and all that.

8

If the only aspect of your reproductive system that’s bothering you is highly irregular periods, have you talked with your doctor about one of the forms of birth control that eliminates (or nearly eliminates) menstruation? If you can get things down to moderate spotting at bizarre intervals rather than gushers sneaking up and ambushing you, that just might be enough without the risks of removing anything.

9

flodnak, the OP already noted side-effects from hormonal therapy.

10

Oops! Missed that somehow. Just ignore that, sorry :o