Few doctors fully explain hysterectomy procedures

NEW YORK (Reuters Health) – Less than 20 percent of doctors discuss the pros and cons of total versus subtotal hysterectomy with their patients, according to a report published in the August issue of Obstetrics and Gynecology. Most gynecologists appear to favor total hysterectomy, the findings show.

Given that there is no clear-cut evidence that one procedure is better than the other, doctors probably should discuss the pros and cons of each with the patient, lead author Dr. Nadine Zekam and colleagues, from Georgetown University in Washington, DC, note.

Proponents of total abdominal hysterectomy favor this procedure largely because the cervix is removed, eliminating the cancer risk and preventing cervical stump problems. In contrast, those who support subtotal hysterectomy contend that leaving the cervix in place avoids adverse effects on urinary, bowel, and sexual function and results in shorter operations with easier recoveries.

The new findings are based on surveys mailed to 1647 gynecologists in Washington, Maryland and Virginia. The response rate was just over 50 percent.

Forty-five percent of respondents said they always performed a total abdominal hysterectomy. The most common reason for performing this procedure – cited by 39.9 percent of respondents – was to eliminate the risk of cervical cancer.

The number-one reason why respondents performed a subtotal hysterectomy was due to unexpected findings during surgery that made total hysterectomy difficult.

Nearly 18 percent of respondents said they always counseled women about the pros and cons of both procedures. In contrast, 63 percent of doctors said they rarely or never discussed the pros and cons of both. In line with these findings, 19 percent of doctors always offered women a choice between the procedures, while 61 percent rarely or never did. None of these results were influenced by doctor gender or year of residency completion.

“This, to our knowledge, is the first survey to be carried out in the United States of views of gynecologists regarding removal or conservation of the cervix at hysterectomy for benign disease,” the authors note.

Because hysterectomy is the second most common abdominal operation in the US, further studies are needed to examine the pros and cons of total and subtotal procedures. Until it can be definitively shown that one is better than the other, both should be discussed with patients and they should be allowed to choose between them, the researchers conclude.

SOURCE: Obstetrics & Gynecology, August 2003

Doctors and artificial drugs

Sometimes your doctor and the drugs she prescribes in the treatment of hormone balancing can be the contributing factor in the decision to go forward with a hysterectomy. Catherine’s experience bears this out.

In 1995, Catherine made an appointment with a local GP specialising in women’s hormonal health after she grew concerned that her period had stopped. This was to say, Catherine, at this point in her life, knew absolutely nothing about her reproductive health, or why, at age 36, she felt so unwell, other than it might have something to do with the tubal ligation she underwent in 1989.

Her treating physician prescribed The Pill, and when this failed to offer relief, Catherine was then prescribed estrogen patches coupled with a synthetic progestin (to protect her uterus). Now, by this time, Catherine’s period HAD returned … with a vengence! She couldn’t move without passing clots, and the hemorrhaging lasted weeks. Yet her condition (that is now understood to have been estrogen dominance) worsened, prompting Catherine’ GP to insist she comtemplate estrogen and testosterone implants. Like a lamb to the slaughter, Catherine conceded, only because she did not know any better.

As bad luck would have it, inside an eighteen month period, Catherine found herself facing some hard choices that made ‘a missed period or two’ look like a walk in the park. Wherever Catherine sat down she left a trail of blood behind. An overnight stay in hospital was scheduled by her GP to investigate and rule our cancer, and perform a D&C for excessive thickening of the endometrium. Catherine was also reporting the show of blood after intercourse, and this too needed to be screened for possible links to cancer. Catherine counted her blessing it was only cervical erosion, requiring another trip to the hospital. And then, as if all that wasn’t traumatic enough and a very real financial burden, her doctor discovered a lump in her breast and scheduled a mammogram.

During discussions with her GP about possible outcomes, Catherine says she will never forget, as long as she lives, her doctor’s callous remark during one particular consultation in which they were discussing how to best manage Catherine’s bleeding problems while on HRT. Putting aside the fact this GP and her synthetic HRT got Catherine into this fix in the first place, she commented, “We can always bin it if we need to.” Translated: “we can cut out your uterus and throw it in the bin if it causes us too much trouble”! Catherine also recollects how she was totally prepared to comply with her GP’s recommendations because, by that time, she was so over the sight of her own blood, the embarassment, the apparent liability her reproductive organs had become.

Fortunately for Catherine, Dr John Lee hit town and, during his conference on natural progesterone, she discovered how far off the mark she’d stumbled. He may well have saved her life! Once Catherine introduced natural progesterone back into her body, it quite literally negated most, if not all of the resultant damage synthetic HRT drugs had caused. She was able to save her uterus, oppose estrogen to the point the lump in here breast disappeared, her perods once again became regular and light, and she subsquently got her life back on track. Any attempts, however, by Catherine to provide her GP with some honest feedback on how conventional HRT screwed up her life and how bioidentical progesterone turned her life around fell on deaf ears.

Progesterone cream keeps Catherine free of gynaecological problems to this day.