Question for njbmd re: hysterectomy

I have used this website as a source of valuable information and inspiration. This question, however is unrated to my premed studies. My wife is scheduled for a TAH Hysterectomy and I was hoping njbmd could explain what is involved in the surgical procedure. I would be gratefull for any knowledge you could extend.

While you’re waiting for Natalie, go to the Hystersisters Web site for information for women and their families. It’s a little whimsical with the princesses and ladies in waiting and stuff, but the information on surgery and recovery and what you can do to help is absolutely priceless.
TLH March 2001

I’m not Nat, and I can’t begin to give you an explanation like she could, but I am doing my ob-gyn rotation and we just did a total abdominal hysterectomy today. The one question I would ask is are they doing simply a TAH or are they also doing a BSO (bilateral salpingo-oophorectomy).
Here’s the difference as I understand it after today.
With the TAH, they will open the abdomen and remove the uterus and cervix. The ovaries and tubes will remain. If they do the TAH with BSO, the ovaries and tubes will be removed as well.
I know Nat will have a lot more to add, but I wanted to give you the info I have.
Good luck to your wife!

Thanks for the link to Hystersisters. The site was less clinical and more patient oriented.

Some clinical history about my wife. She is 46yrs old, has had a history of fibroids her entire adult life. Over the past 10 months the fibroids have increased in size exponentically. According to her ob/gyn, her belly is the size of a women four months along, carrying twins. Given her age, her doctor suggested a TAH/BSO. This will of course thrust her immediately into menapause. My only concern is that her ovaries are healthy. Her doctor seems to feel the potential cancer risk, at her age, is to great not to perform a BSO as well. Again any insight would be helpfull. Thanks all.

One more uneducated opinion from the laywoman and then I’ll try to shut the heck up and let the doctors have a turn. Some questions I’d suggest you ask:
What does the second opinion doc say about the ovaries? Don’t have the BSO without a second opinion. Does she have particular risk factors for cancer? Would those risk factors preclude hormone replacement therapy? Does the doctor favor compounded bioidentical or oral hormones? Does he spend a lot of time and effort tweaking dosages to get them just right?
Okay, shutting up now. Really. Good luck with it all; it’s a big decision.

I really appreciate all the advise. Her ob/gyn has presented HRT as an option, post-op, if needed. I also feel a second opinion is warrented in regard to the BSO. It seems that the surgical options hinge on the patients age in regard to the type of hysterectomy performed. And she does not have a family hx of cancer. I am not in medical school yet, so I can only guess what impact this surgury must have on ones sexual and emotional well-being.

Thanks for the information in regards to the surgical procedure. What is the recovery time?.

The total abdominal hysterectomy with bilateral salpingo-oophorectomy that we did Wednesday morning will go home tomorrow or Friday so long as no complications arise. This woman is in her mid-70s with some medical history that makes it necessary for her to stay a day or so more than other cases might.

We had a total VAGINAL hysterectomy (TVH) with BSO that went home today after her surgery yesterday. It sounds like your wife’s uterus may be fairly enlarged which might make the TVH difficult, but you might want to ask her doctor’s opinion.

I was talking your question over with the ob-gyn I am working with, and she said she ALWAYS recommends a second opinion be obtained as to the procedure itself and whether or not to do HRT postsurgically. This helps to put the patient’s mind at ease as to their decision to have the surgery. Most of her patients trust her implicitly and don’t bother, but the option is always there.

As to full recovery time, patients usually feel better in a few days, with full recovery taking about 6 weeks. Until then no heavy lifting or strenuous exercise.

Give your wife my best.

Thanks for the detailed information about the procedure itself. My main concern is post-op and long-term recovery. I don’t really think my wife understands the full impact of being thrust into menapause. What are the physical, psychological, and sexual side-effects of being without your reproductive organs?.

HRT can relieve the physical manifestations of menopause. The psychological issues need to be met head on. Losing your uterus, especially when you have reached a point where you really don’t desire to have any more children, need not be a disruption to your life. The purpose of a uterus is to implant an ovum and let it develop into a fetus. That is it’s main purpose. The ovaries serve to provide the egg for fertilization. Of course, it also effects hormone levels, and that’s why HRT is used.

As long as your wife is on hormone replacement therapy, and receives any psychological counseling she might need, she shouldn’t notice any sexual side effects to speak of. If there are any, it might be vaginal dryness, which can be treated with an estrogen cream.

I have to tell you that I have spoken with several women the last week who have had total hysterectomies, and they are all glad to have done so. They do not miss the bleeding, cramping problems that they once had. And several of them said that because they no longer worried about these things, they actual found their sex life to be improved.

Most of all, let her know there is always counseling available. If she has questions, she should openly and honestly communicate with her doctor. She/he is more than prepared to discuss these issues with both your wife and yourself.

Au contraire. While some women do not find a difference in their sexual response following hysterectomy, others do. The uterus contracts during orgasm in a way that is noticeable to some women, and missed by some women who’ve had a hysterectomy. While the main function of the uterus may be reproductive, it absolutely is part of the sexual response.
There was a time when hystereectomy was done in a truly cavalier fashion for every imaginable gynecologic complaint - when virtually all doctors were men, not coincidentally. Women who found that they had physical, psychological or sexual difficulties after hysterectomy were not respectfully treated. Things are better now, and hysterectomy isn’t suggested as casually as it once was, and there are certainly good reasons to have a hysterectomy in many instances. And as much as I value my sex life, if I needed a hysterectomy for a medically-indicated reason, I would do it and figure out how to improve my sex life later.
TMI from me!!!

Before you do anything, go read some Christiane Northrup stuff. I pushed off surgery for a long time. There are other options that may work for her.

Thanks all!!!. We finally meant with the OB/GYN surgeon. She is young and very knowledgeable. Her physical examination revealed a 14 week uterus and multiple fibroids. The largest being 8.3cm. according to the ultrasound, her ovaries appear normal. Given my wifes age (46), she felt a BSO was indicated in addition to a TAH. My wife has no family history of cancer whatsoever. I understand there is still a remote possible of ovarian cancer(1%), but is this worth thrusting her immediately in to surgical menupause?.

If you’re askin’ me, NO. Not if age is the only reason. They don’t go around pulling ovaries out of healthy 46-year-old women who are NOT having hysterectomies, so unless there is some additional risk factor that makes your wife different, I don’t see the point. That whole, “As long as we’re in there anyhow” logic makes sense for cars, but not for people.
Surgical menopause is no joke, and hormone replacement doesn’t work out well for everyone.

I agree, the surgeon presented the BSO as a precautionary measure. She explained that there was not a reliable way to screen for ovarian cancer once the TAH was performed. In addition, there is a high probability the ovaries will fail after surgery. I’m personally against the BSO, but how can I refute the advise of someone who has completed an OB/gyn residency?.

Get a SECOND OPINION from someone ELSE who has completed an OB/Gyn residency. I was a bit younger when I had my hyst (38), but my doctor never remotely suggested BSO.
Also add more questions for THIS doctor. What exactly is the statistical difference in ovarian cancer detection rate after TAH? What, if anything, could you do to make up for that? What is her approach to hormone replacment? Does she ever work with compounded bioidentical hormones for HRT (not that everybody needs them, but some people do better with them)? Does she have patients coming to her with complaints after the surgery that they think are related to hormones, and she doesn’t, such as headaches, sexual dysfunction, etc.?
Ovaries DO sometimes fail a few years after hyst; mine are doing it right now. But it’s a gradual thing and I’m able to take my time getting the hormone replacement just right.
Doctors are not infallible and they don’t always agree about everything on issues like this.
And don’t let me scare you. Some women come out of this surgery with an estrogen patch on their behinds and never have to change a thing about their HRT.

I completely agree with your logic, a second opinion is needed before she makes a final decision. Nomally, my wife would elicit a second and even third opinion. But,I fear her reasoning may be flawed because the situation has make her an emotional wreck Now, she simply wants the procedure over. It is hard to even begin a dialogue about the subject. I just need her to give more thought to the potenial life-changing after-effects. Thanks for the questions, I will address them with the surgeon. Her response should prove interesting.

She can probably schedule the surgery AND get her insurance company to hook her up with a second opinion while she waits for her surgery date. I remember from my own surgery that the waiting was definitely the worst part, so I understand how she feels!

Hopefully, she will have time to get a second opinion as her surgery is scheduled for 12/1/05. Her view is “let them take all my plumbing”, so they won’t have to open me up again. I have tried to explain that this procedure is not reversible. My main concern is that she has major issues with depression and can appear bipolar at times( under stress). Sudden menopause can only make matters worse. I can see this is not going to be a walk in the park. Again,thanks for all your input