When is a hysterectomy appropriate?

[pinecone]

I have a developmentally disabled sister who is 47 and lives independently. She is her own guardian, has a helper for things like grocery shopping, and a social worker who manages her heath care. The social worker contacted me to say that my sister's OB-GYN is recommending a hysterectomy to help her as she approaches menopause. The doctor will be meeting with my sister, myself and the social worker to discuss the reasons for this treatment plan and to discuss options. This is not yet set in stone and my sister has asked for me to be her medical power of attorney. From my initial research it seems there are only a few reasons that a hysterectomy is a good idea, and I don't believe she's got cancerous cells, fibroids or endometriosis, but I'll know the whole story after meeting the doctor tomorrow.

I'm creating a list of questions to take with me to this doctor appointment and was hoping this MDC list of professionals could comment on when a hysterectomy might be feasible and anything specific I should be asking about when I meet the doctor.

I was not sure if this is the right place to post this, so please forgive me if it was not. I did not intend on interrupting this forum.

Thanks!
Denise

[Rockies5]

I don't know why they would recommend this?

[ZoeyZoo]

I can't see why either based on what you say here...

I'm not a medical professional but I thought I would post because I just read something about this subject. I think it was in The Thinking Woman's Guide to a Better Birth by Henci Goer but it may have been in another pregnancy book. It said that in most cases it is not necessary except for cancer and should be considered for issues like Fibroids.

[Romana]

HERS may be able to give you some information: http://www.hersfoundation.org/

Maybe if you call the toll-free number, they could find someone for you to talk to who is familiar with the cirumstances the doctor is describing?

All I know about hysterectomies is that they're overdone. Most women I know who've had one have said to me, "If I knew then what I know now, I never would have had a hysterectomy." They generally complain about side effects and other problems the doctor didn't tell them about, or about how actually unnecessary they discovered the surgery to be. And I know recovery isn't exactly a piece of cake. I would think long and hard before putting a healthy person through surgery just for a hysterectomy. I'm not sure how removing your sister's uterus would make things easier for her. After all, the toughest part to "take care of" would be, I'd think, having periods. But thats all about to end, so I'm having a hard time imagining why she should go through surgery.

I'm sorry, I'm not a medical professional either. Mostly I just wanted to share the link.

[pinecone]

Thanks for the responses. Romana that link is EXACTLY what I needed. I'll post again once I know what the doctor says is the problem.

[Ruthe]

http://www.time.com/time/health/arti...0.html?cnn=yes
OP... please read this; Coincidentally enough I was just reading it earlier this evening...

[pamamidwife]

this is appalling. I'm glad Romana posted that link. I just think it borders on abuse.

[wifeandmom]

That just sounds bizarre, unless she is having some symptoms that you don't know about or didn't mention.

Taking the uterus alone is only going to stop her from bleeding. I suppose that would be nice, but if she's already approaching 50 years old, I can't imagine she'd have too many more years of bleeding anyway. If, however, she is having lots of bleeding, that's something that could potentially be addressed. I believe ablation is being used a lot more, and likely will become even more common as an alternative to hysterectomy in women who have excessive/irregular bleeding and are finished/not having any/any more children.

Taking the ovaries in addition to the uterus is going to put her in full blown menopause immediately. How is THAT going to 'help' her deal with menopause? Seems like if menopause is basically your ovaries shutting down production of hormones, thus all the effects of menopause, it'd be better to deal with it GRADUALLY vs. all at once.

Even with HRT, symptoms of surgical menopause aren't just poofed away for most women. It takes time, sometimes quite a bit of time, to adjust doses and such. Not to mention that HRT carries its own set of risks.

If the *only* reason for a hysterectomy is 'to help with menopause', I'd likely find myself another doctor. Fast.

[turtlewomyn]

I have to agree with the other ladies. If the only reason he is recommending the hysterectomy is because she is going into menopause, that is quite ridiculous. I am a bit jaded about the medical system since my c-section, but a mainstream publication just came out with a list of surgeries that are over prescribed, and hysterectomy was one of them.
With just the information you have given here, it sounds like this doctor is taking advantage of your sister. He could make some money, and she could lose her uterus for no medical reason.
Thank goodness she has someone like you looking out for her. Keep doing that research!
I can't wait to read your followup, I hope the appointment goes well.

[pinecone]

Update - Follow up to Dr appt.

What I learned at the OB-GYN appt for my sister is that it wasn't the OB suggesting the hysterectomy but the Hemotologist (blood doctor) which my sister sees every 3 months because she was suspected of having Leukemia a couple of years ago. The Hemo monitors her blood counts and while her white count has been normal he said she was showing signs of low iron. After some testing, they could only conclude that she was anemic because of my her extremely heavy periods. The Hemo brought this to the attention of the OB. When we met with the OB she agreed that the anemia was a concern, but she's no where near suggesting a hysterectomy. Her treatment plan was to first put sis on iron supplements and Depo-Provera quarterly. The reaction to first dose of Depo would determine if a 2nd option was needed. Apparently Depo can cause bleeding beyond spotting and if that were the case then it would not be a good choice. So far, sis hasn't had anything but spotting as far as we know. In an attempt to gauge blood loss while on the Depo the OB has asked sis to keep track of the number/kind of pads she goes through between visits. As my sis has some disabilities and may not be able to articulate what kind of flow she has this is the best the OB can do to monitor the situation. If the anemia is in check by my sis taking iron pills and the Depo then there is no additional treatment. If not, the next step would be to do abletion as a pp mentioned. This is a method of removing the lining of the uterus while under anesthesia but done in an outpatient setting. In the big picture much less invasive than a hysterectomy.

So, we're going to monitor the situation and stay in touch. The OB said that her intent in getting us together (my sis, me, the social worker) was to make sure we all talked about the treatment options BEFORE there was a serious/urgent need to address them. I really respected that.

Thanks to everyone for your repsonses!
~ Denise

[MsElle07]

Wow, I'm surprised they would recommend Depo shots. Depo has a black box warning on it, meaning that it's one step short of being removed from the market -- it causes irreversible bone damage, and the FDA says it should only be used in extreme cases when the benefit far outweighs the risks. What about one of the newer low-dose hormone BCPs to help keep her periods lighter?

[pinecone]

Just want to say thanks MsElle, I didn't know about the black box on Depo. That's why I'm posting here--to gain knowledge! I'll definitely look into it further and pose the question to the OB.

[storychick]

I wonder if a Mirena IUD would do the same thing without the risks of the Depo? It often lessens or eliminates periods for many women, for the same reasons (progesterone) but without as high a dose or as many systemic side effects. It also would last her most likely through menopause now.

[wombatclay]

Here's a link to the FDA info on Depo...

http://www.fda.gov/bbs/topics/ANSWER.../ANS01325.html

I second Mirena as an option...I have anemia linked to irregular cycles with heavy bleeding and once I'm a little more pp I'll be getting a Mirena to help control the situation. I'm not thrilled with the hormones, but it seems to be the best option...

[mysticmomma]

noooooooooooooooooooooo depo. irreversible. i bled for six months... probably wont help anemia. look into black strap molasses for the supplement.