Hysterectomy fears are normal

By Ginger Manley | Posted: Wednesday January 30, 2013

Dear Ginger:

Well, my worst dreams are coming true--I have found that I have to have a hysterectomy. My doctor does not think I have cancer but she is still going to do all those tests (frozen sections) while I am on the operating table and I am feeling really scared. I know many other women my age have faced this and worse in their lifetimes, but for me right now it is pretty overwhelming. My husband is being as supportive as he knows how to be, and my doctor assures us there most likely will not be any long-term changes in our intimate relationship, but frankly at this point, I am just worried about whether I will live a long life. Worrying about our sexual experience will have to come further on down this road. Wish me luck!

Marianne

Dear Marianne:

You have had a lot on your plate these past few months, with the successes you have written about in your intimate life and now with a major surgery looming in front of you. I can really empathize with where you are. About this time last year, I was on the same road as you and I had a hysterectomy done in the spring of 2012. Although I have had many surgeries (11 in all) over my adult life, I really felt more emotions about this one than about many of the others, probably because this really meant the end of my reproductive functions (which had actually ended many years ago with the early onset of menopause). Almost all of my girlfriends told me it would be one of the best things I had ever done but that did not help allay my concerns as much as they would have liked.

For me, the surgery was needed because of endometrial hyperplasia--a buildup of tissue in the lining of the uterus (the endometrium). This kind of buildup is normal for all women to have during the years they are having menstrual periods--it is what causes the cramping that often precedes the actual start of a period when the tissue passes out as the menses takes place. This is natural in younger women whose bodies are producing the combination of estrogen and progesterone that provides for the monthly buildup and then the sloughing off that we call a menstrual cycle, but it is unnatural in an older woman who still has her uterus but has non-functioning or under-functioning ovaries.

In my case, I had been on replacement estradiol (by patch) for many years and had taken the opposing hormone, progesterone, on a somewhat regular basis. My body had always been very sensitive to progesterone and even when I began using a compounded preparation that I rubbed on my wrists twice a day, I often developed symptoms that felt like I was premenopausal. PMS is uncomfortable enough for women (and their families) when a woman is still having periods, but it is truly unwanted and unwelcome after menopause. UGGH! So for me, I often under-administered the progesterone and that may have contributed to the now bigger problems.

Over the years, my gynecologist had watched me for signs that the endometrium was overgrowing--I had undergone regular endometrial biopsies (done in the doctor's office and not any fun) and uterine ultrasounds (not too bad). On a few occasions, we had used short bursts of extra progesterone to jar the endometrial tissue into sloughing off and we both felt safe enough that there was little danger of more serious issues, like cancer, developing. Last year however, the ultrasound showed much more thickening and the biopsy showed many polyps and atypical cells. Whenever doctors see these atypical or unusual cells, they worry about pre-cancer growth.

On a follow up visit with my doctor, she gave me several options for dealing with this--a D&C (dilatation and curettage) to scrape out the overgrowth, a massive blast of progesterone followed by withdrawal to mimic a monster menstrual period, an endometrial ablation using one of several methods to literally burn off the lining, or a hysterectomy (removal of the uterus) with or without removal of the ovaries and fallopian tubes. (If the latter is done it is called a total hysterectomy with bilateral oopherectomy.) This was not an emergency but was urgent, meaning I needed not to wait more than a few months to have it done. Because of work and other scheduling conflicts I had to postpone the surgery for several months and by the time the date actually came around, I was eager to get it over with since by then I was in a great deal of pain in my lower abdomen.

I considered all the options and my decision came down to, "I'm way past my reproductive years and doubt that I've been getting much benefit from my ovaries anyway, so let's take everything out and then I won't have to worry in my later years about possibly getting ovarian cancer." My doctor agreed and I got in line to have the surgery done early one morning, with an overnight hospital stay and then home to recuperate for about six weeks. Like many women I know, I have always thought that I could bounce back quickly from most anything, but in actuality the bouncing took me about four months. I had more pain and discomfort than I expected and my energy was longer in returning to normal than I had anticipated. Then I also started having night sweats and hot flashes again, and it took a few trial and errors to get the hormones regulated again. Now, nine months from surgery I am feeling top notch again. There have been a few adjustments in the sexual area (like needing to add vaginal estrogen twice a week to help keep the tissues moist) and a natural concern about tenderness and/or bleeding the first few times we engaged in activity. Those have improved with time and patience, and overall nothing else has changed, except I don't constantly feel like a young woman with PMS. And for that I am very grateful!

So, Marianne, I am keeping my fingers crossed that you will have a positive outcome from this upcoming surgery. By the time this article appears in January, it will be behind you and I am hoping you can start the new year on a more optimistic note. As you have done in the past, please let us know how things develop.

Happy New Year to all my readers and thanks for your ongoing support and questions.

www.gingermanley.com

 


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