Never in the history of women’s health care have there been as many alternatives to hysterectomies.
Obviously we are not talking about life-saving hysterectomies that are performed for cancers or acute hemorrhage following the birth of a child. But many—and possibly most–hysterectomies can now be replaced with other modalities that include:
- Careful observation and non-surgical monitoring of the condition.
- Hormonal medication and Intrauterine Devices (IUDs) to control heavy vaginal bleeding
- Non-hormonal medication to control heavy vaginal bleeding
- Endometrial ablation and Endomyometrial Resection
- Myomectomy (removing fibroids that reside inside or outside of the uterine cavity)
- Uterine artery embolization or uterine fibroid embolization
In addition, if you and your physician decide that hysterectomy is an appropriate choice for you there are still many choices that include the following:
- Does the hysterectomy involve the removal of the entire uterus or can the cervix remain?
- Does the hysterectomy also include removal of the ovaries?
- Will the hysterectomy be done laparoscopically?
- Will the hysterectomy be done robotically?
- Will the hysterectomy be done vaginally (with no abdominal incisions)
- Will the hysterectomy be done with a large abdominal incision (laparotomy)
- If I keep my ovaries should the fallopian tubes be removed?
WHO IS BEST SUITED TO PROVIDE A SECOND OPINION?
Years ago a colleague of mine entertained the idea that he would open a “second opinion” practice in Rochester. He envisioned a practice in which he was paid for his opinion only—in other words he would not use his position of knowledge or authority to siphon patients from other physicians only to enrich himself.
This would be the “ideal second opinion.” Under the best of circumstances you can visit a physician with your medical records in hand, allow for an examination (if necessary) and a thorough history so that the physician can get to know your particular needs and expectations and together reach a decision about hysterectomy—whether it is necessary. Perhaps you might decide that no therapy is required or that a less invasive method is appropriate. If a hysterectomy should prove appropriate for your condition you would be referred to a physician (who had no financial relationship with your “second opinion doctor”) with an excellent reputation and superior skills.
A QUESTION YOU SHOULD ALWAYS ASK YOUR DOCTOR—WHETHER IT’S YOUR “FIRST OPINION” OR YOUR “SECOND OPINION”
A question you should always ask your physician who is proposing an invasive treatment is simply this—“if I was your family member, daughter, wife, sister or other loved one would you recommend this surgery?” This is a legitimate question. Most physicians are honest, well-meaning and want the best for you. But this question may have them think a little harder. It’s a worthwhile question and you should strongly consider asking it no matter who is proposing surgery.
WHY DON’T WOMEN GET A SECOND OPINION?
There are many reasons women choose to not get a second option. Here are a few to consider. There are others as well.
- I don’t want to offend my doctor
- I trust my doctor and another doctor is just going to tell me the same thing anyway.
- It may cost some extra money to get a second opinion.
- A second opinion may mean that I have to delay my surgery and I can’t live with the problem any longer
- My friend had the same problem and she had a hysterectomy and she’s happy.
- My mother had a hysterectomy and so I knew I would eventually have one anyway.
- “I just want it out!”
- I did my on-line research and a hysterectomy seems the best way to go!
This will begin a multi-part series in which we begin to explain what might be gained by a second opinion. This article may not answer all of your questions but you will likely learn that there are a vast array of options available today that were not available only 10 years ago. You may learn that some of the “latest technologies” such as “robotic hysterectomy” do not offer results that are superior to other forms of hysterectomy—and they are not “less invasive” that other treatment options.
REASONS HYSTERECTOMIES ARE PERFORMED
Hysterectomies are the second most commonly performed surgical procedure performed on women today—over 600,000 annually in the United States. In general, the reasons for which hysterectomy is recommended fall into one of 3 categories:
- To save lives. This is not why the vast majority of hysterectomies are performed. This group includes women with various cancers and women who have rare life-threatening hemorrhage that may follow the birth of a child.
- To correct serious problems that interfere with normal function. This group includes women with very large pelvic masses (including some uterine fibroids), serious and incapacitating endometriosis as well as some other uncommon issues related to urinary and bowel function.
- To improve the quality of life. This is the largest group of women who eventually undergo hysterectomy and includes women with heavy, irregular or painful periods. Many of these women have fibroids (though not as large as in the previous group). Other women in this group may have uterine or pelvic organ prolapse while some have moderate amounts of endometriosis or adenomyosis.
With the exception of group 1 – there is generally both time and reason for a second opinion.
I have been a practicing gynecologist in Rochester since 1980. Like most gynecologists I trained to perform hysterectomies and was among the first to perform laparoscopic hysterectomies as far back as 1989. Frankly, our practice took off in a different direction and approximately 10 years ago I stopped performing them. They are still necessary and I still refer patients for hysterectomy. However, after years of looking for alternatives to hysterectomy I no longer performed enough of them to feel that I was the best person to offer them. I feel that women who should undergo hysterectomies should be referred to the best physicians I know.
Under no circumstances, should you require a hysterectomy, will I personally perform one—but I will refer to the very best talented surgeons available.