Nexus - 0406 - New Times Magazine-pages

Page Content (OCR)

However, according to Dr West, "...the consequences of losing your ovaries cannot be overstated. Premenopausal women will undergo an ‘instant’ menopause, complete with symptoms that are far more severe than those that accompany normal menopause which follows a gradual decline in hormone production. The rationale for removing the ovaries during hysterectomy is to pre- vent ovarian cancer, a terrible disease that is often deadly because it cannot be diagnosed early. But statistically, a woman who has had a hysterectomy is at no higher risk for ovarian cancer than a woman who has not had surgery. ...without her ovaries a woman will forever be at higher-than- normal risk for both osteoporo: and heart disease, both of which represent a far greater statistical threat than ovarian cancer."" Dr West told me in a recent phone conversation that there is still some risk of ovarian cancer even if the ovaries are removed because some ovarian tissue may remain in place in that area; thus it is impossible to eliminate the danger completely. Hysterectomy is, by definition, the removal of a vital female organ, the uterus. Sometimes the ovaries, Fallopian tubes and cervix are removed along with the uterus. Technically, hysterectomy refers only to the removal of the uterus, while a "bilateral salpingo-oopherectomy" is the removal of the ovaries and Fallopian tubes. However, it is now common for both doctors and women to use the term "total hysterectomy" to describe the removal of the uterus, ovaries, Fallopian tubes and part of the cervix. The majority of hysterectomies are performed on women between the ages of 20 and 49. In the US, 76.4% of hysterec- tomies are done on women in this age group.’ When undergoing hysterectomy, the older the woman is, the more the likelihood that she will have her ovaries removed. The removal of a woman's ovaries is described as "surgical menopause". It creates a radical physiological and psychological change in a woman. Hysterectomy is major surgery, usually done in a hospital under general anaesthesia. Typically, women are hospitalised for sever- al days and are generally told that it will take anywhere from six weeks to three months to recover. However, most women say recovery takes almost a year, and some spend many more years tinkering with their hormones in an attempt to feel normal again. ony > Typically, women are hospiti ised for sever- | SURGICAL PROCEDURES AND COMPLICATIONS general anaesthesi: al days and are generally told that it will take anywhere from six Technically, hysterectomy is a fairly simple operation that weeks to three months to recover. However, most women say involves detaching the uterus from the blood vessels and the liga- recovery takes almost a year, and some spend many more years ments that support it. Since it is such a straightforward procedure, tinkering with their hormones in an attempt to feel normal again. it should be a safe operation. However, nothing could be further from the truth. RATIONALE FOR SURGERY Fifty per cent of all patients Hysterectomy is offered as a treat- develop complications from hys- ment for several conditions. In the US, terectomy surgery—some of them the leading cause for surgery is uterine quite serious.'' Many of these com- ois eng growths hat we | Fifty per cent of all patients sons ne meyonale nt not life-threatening. Fibroids account develop complications from involve damage to the bladder, fo aot pect of atipstees | hysterectomy surgery— —f fvstanduie,Fosnwat ond and is the reason for about 24 per some of them quite serious. rhaging, and an alarming statistic is cent of all hysterectomies. The third- ranking indication is prolapse, the sag- ging of the uterus into the vagina due to loosening of the muscular supports that approaches to hysterectomy. hold it in place. Prolapse accounts for Abdominal hysterectomy, the most about 20 per cent of hysterectomies, and approximately one-third common method, requires an eight-inch incision across the lower that one out of 1,000 hysterectomy patients will die. There are three surgical of these operations are performed on women past the age of 55. abdomen, just above the pubic hairline, to remove the womb Endometrial hyperplasia (abnormal proliferation of cells in the (and/or ovaries) through the abdominal wall. endometrium due to excessive oestrogen stimulation) ranks fourth Vaginal procedures comprise about 20 per cent of hysterec- and accounts for six per cent of hysterectomies. The remaining tomies. Instead of opening the abdomen, the surgeon approaches 20 per cent include menstrual disorders, ovarian cysts and pelvic the uterus through the vagina, detaches it and pulls it out. The inflammatory disease.’ severed tissues are drawn out through the vagina and the wound is The Australian statistics are similar, with fibroids accounting sutured internally using a minute stitching gun. for 22 per cent of hysterectomies; endometr: , 6-23 per cent; The newest approach to hysterectomy involves the use of a heavy menstrual bleeding, 18 per cent; prolapse, 7-23 per cent; viewing device called a laparoscope, which is inserted via a tiny cancer, 1-12 per cent; and pelvic inflammatory disease, 2-8 per abdominal incision near the navel. Other surgical instruments are cent. Multiple reasons are given for the remainder. inserted through similarly small incisions. Any organs to be Dr Stanley West, an outspoken critic of the gynaecology pro- removed, such as the uterus, ovaries or tubes, are detached and fession's unwarranted enthusiasm for hysterectomy, states that pulled out through the vagina. The main advantage of laparo- only 10 per cent of all hysterectomies are performed to remove scopic surgery of any type is that a small incision means a shorter cancer. He warns women that unless cancer is positively identi- hospital stay (one to four days), less pain and more rapid recov- fied, it is unlikely that hysterectomy is required, and that they ery. Because laparoscopic surgery involves less physical strain should be very sure that cancer has been found before consenting than conventional surgery, it has become very popular, although it to the surgery. He says that, "Chances are you are in the 90 per is more expensive than abdominal surgery. Unfortunately, how- cent, not the 10 per cent [and] even women with cancer of the ever, not all surgeons are as proficient as they should be before endometrium, ovaries and cervix may have some options..."° attempting this procedure, thus increasing the incidence of According to Dr West, the only 100-per-cent-appropriate reason botched operations and surgical mutilation. for performing hysterectomy is to remove cancer of the reproduc- There is considerable risk of surgical complications arising tive organs. from hysterectomy. These complications include: Fifty per cent of all patients develop complications from hysterectomy surgery— some of them quite serious. 30 + NEXUS WHAT IS HYSTERECTOMY? OCTOBER - NOVEMBER 1997