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Mary Davenport
At the age of 29, my doctor put me on Premarin, subsequent to my total hysterectomy. For the following 20 years of my life, I felt rotten, had very little energy and a general overall loss of interest...
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Indications for Hysterectomy
The following article covers indications for Hysterectomy and a few technical terms you MUST know to protect yourself

As I was addressing the use of natural hormones in women who have undergone hysterectomies and the importance of starting the hormones before the surgery and staying on them for as long as needed afterwards, I realized how much more information I need to share with you about the topic of hysterectomy.

As a physician I have been working with women who have undergone hysterectomies for almost 30 years. It never seemed strange to me, a conventionally trained physician, that so many women: 500,000 a year, undergo hysterectomies.

That is until I started to hear from my patients about their horrible experiences with hysterectomies and life without uterus (and often ovaries).

It suddenly became appalling to me that a woman should have to give up her uterus and then suffer.

I thought I’d write to you about the indications for hysterectomy, what you should ask your physician before consenting to go through it, and how to prepare for the surgery (see previous post).

While indications for hysterectomy have become quite loose in the clinical practice of gynecology, there are only few times when you should have a hysterectomy without doubts.

Even then, do get at least three opinions, and not all from gynecologists (the surgeons who perform the procedure are more likely to advice you to get it, then an internist or primary care physician who might be more objective and caring toward you).
Here are the indications:
1. Cancer- endometrial, cervical, ovarian, breast cancer with BRC positive gene.

2. Uncontrollable bleeding (after having tried natural hormones for 6 months) leading to anemia in spite of continuous treatment with iron.

3. Large fibroids that are growing in spite of treatment with natural hormones.

The fibroids are causing significant bleeding, and/or severe discomfort.

No other conditions require hysterectomy as a first line of treatment.

Fibroids are not dangerous and do not turn to cancer, so removing them is not necessary.

They usually decrease as we get older. It would be best for us to think of fibroids as variations on normal.

If they don’t bother you, do not bother them. Also, natural hormones in correct combinations and doses help shrink them in time.
Before allowing any doctor to go ahead and take out your uterus, please make sure you have the following questions answered:

1. The number of hysterectomies the doctor has performed last year. ( This is a trick question. You want an experienced surgeon, you don’t want a doctor who performs hysterectomies on everybody over 35 who has already had 2 kids) You want a doctor who has performed 50-100 and you want to know the demographics of the patients he/she has performed the surgeries on. ( Age, indications)

2. Detailed information about what to expect form the surgery, not only during, but especially after. ( a good doctor will go into the post surgical menopause and the suddenness of it and how to prevent it)

3. How to best prepare for the surgery. (see previous post). Your doctor should know you and be able to guide you to excellent preparation for the surgery so you will heal fast and be at low risk of post surgical complications.

4. Explanation of the procedure in detail. (Don’t let him/her rush you, it is your life and it should be treated with respect.

5. A detailed ( I mean at least 1 hour of the surgeon’s time) explanation of how you should prepare for the surgery so as to minimize the recovery problem.

Do not accept a Premarin pill thrown at you; it is synthetic and will not make you feel better.

Make sure you ask if the medication offered is synthetic or natural.

Finally, we are in the 21st century after all so we must take hysterectomies out of the dark ages.

While sometimes we do need hysterectomies, we certainly have the knowledge and wherewithal to prevent symptoms and provide preoperative and postoperative support to make the procedure less traumatic and life after hysterectomy livable and of high quality.

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