hysterectomy or not

Hysterectomy or Not?

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Should I Have a Hysterectomy?

I had some spotting once that led to the OBGYN to do an ultrasound test. The test showed that the endometrial lining was thicker than normal. I am on hormone replacement therapy (HRT) and have been on it for 5 years. Prior to that, I was on birth control pills for 10 years. So from the ages of 40-50 years, I used birth control pills and then from 50-55 years, I used HRT, first a cream form of bioidentical hormones and then I switched to a patch (estradiol-combination of estrogen and progesterone). Both at the very lowest dosage.

The OBGYN said that if by ablation he could remove the extra lining then I would be safe for the next 10 years from getting endometrial cancer. But because he was not able to perform it, he said that the uterus should be removed to prevent this from happening. I do trust his opinion. He has been my gynecologist for 15 years, but I really do not want to do this surgery. I am fully aware of the consequences. On the other hand, the possibility of the lining developing cancer is also scary. Also, I am not sure if he was able to get the endometrial tissue for pathology since the cervix was too tight for ablation. If it’s not possible to get the tissues from the lining for testing, then I do have a big problem?

I do not have any other symptoms. I am overweight, but I have been like that for the past 20 years with no major changes up or down.  My fasting sugar is at 110-120 most of the time, which is considered pre-diabetes, so I do take Metformin 500 once a day at night. Other than that, my blood tests are perfect. There are no other issues.

I do not have any family history of any female organ cancers that I know off. None of the females in my family, including grandmothers, aunts, cousins, had any type of cancer. My family history is full of heart disease (heart failure on both sides of the family and heart attacks) and there is some diabetes in the distant family (great-aunts) but NO cancers of any female organs (that includes breast cancer also).

The only reason my doctor suggests the hysterectomy is because he could not do an ablation and my endometrial lining was thicker than normal for my age (55) and menopausal stage. He could not perform the ablation since I have cervical stenosis and the cervix could not be opened wide enough even with dilation.

He says that in order to keep me safe from possible endometrial cancer I must get the hysterectomy. I do not want to do that, but I have no idea how to check the endometrial lining tissue for pathological changes if the tight cervix will not allow to get samples of the tissue. There were tissues taken for pathology at the procedure, which came back negative (no cancer of pre-cancer cells). I am just not completely sure if the tissue was also taken from the endometrial lining or not. He is being evasive and not specific.

What should I do? Any suggestions would be greatly appreciated.

Thank you.

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  1. I will chime in here with a possible solution to your excessive lining. I have used estrogen without progesterone for 13 years. Just cannot tolerate the progesterone. You can have a D&C to remove the lining. I have had 5 over 13 years. You can also investigate and I stress YOU, using additional progesterone to produce a heavier bleed to clear out the lining. There is also an option of using an IUD with progesterone that will keep the lining thin and lasts between 3-5 years. Good luck! I have been holding onto my uterus and after reading sites like this am willing to continue to avoid a hysterectomy.

  2. Get embolized using a procedure called UFE. Performed outside the GYN speciality in a field called Interventional Radiology. My 9 cm intramural fibroid has shrunk over 90%. It’s a great alternative to start. Ablation is an indirect path to hysterectomy and should be avoided.

  3. Im 44 and recently in for ultrasounds due to heavy bleeding and spotting between periods. They found my wall lining growing into the muscle, 3 marble sized fobroids. A polyp and a cyst in the overy. I was goven the option of an Ablatiin or hysterectomy, biopsy came back negative. My mother went through uterine cancer in her early 60s. Im leaning toward the hysterectomy due to all the issues and what my mothet had gone through… Im just wa fraid of early menopause.. I have also heard from others and read in these colums that the ablation did not work. This is such a tough decision . Just looking for some guidance.

    • Erica – Read my comment to this article. The fibroids (and possibly the polyp too) are likely the reason for your heavy bleeding and spotting. If you are also perimenopausal, then the hormone changes could be a contributing factor. These are not valid reasons for a hysterectomy which causes a whole host of other problems which are permanent and progressive (unlike the bleeding which is a temporary problem). Have you been offered any medications to improve the bleeding? Tranexamic acid (brand name Lysteda) is a non-hormonal med that can reduce bleeding as much as 55%. Ablation is also damaging and can mask hyperplasia and endometrial cancer as well as cause chronic debilitating pelvic pain as explained here – https://www.hormonesmatter.com/endometrial-ablation-hysterectomy-alternative-or-trap/. You can read my 16 articles on hysterectomy and ablation here – https://www.hormonesmatter.com/author/ws/. The HERS Foundation also has some good info on the lifelong functions of the female organs and the many negative effects of hysterectomy. Ovaries for Life is helpful for understanding the importance of our ovaries our whole lives.

  4. Hysterectomy is one of the most overused surgeries. Only about 10% are necessary. And gynecologists are not forthcoming about the many permanent negative effects of hysterectomy (even when the ovaries are not removed / castration). If they were, most women would decline the surgery. I too trusted my gynecologist since I had known him for 20 years. But he, like yours, was evasive when I questioned his treatment recommendation. I ended up having an unnecessary hysterectomy as well as oophorectomy (removal of ovaries / castration). That was 12 years ago. Every day, I live with regret for trusting him (versus listening to my barely audible inner voice). Everything about me changed after my organs were removed. The hormonal changes are just the tip of the iceberg. Hysterectomy destroys anatomy and our figures. I and many other women are also devastated by the loss of sexuality. You can read my 16 articles about hysterectomy here – https://www.hormonesmatter.com/author/ws/.

    A big red flag is that your gynecologist was going to do an ablation and told you that it would thin your lining and prevent cancer. Ablation should NOT be done if there is concern of hyperplasia or cancer since it can mask endometrial changes. This leads me to believe that he does not suspect hyperplasia or cancer. Also, ablation has other adverse effects which can cause chronic, debiltating pelvic pain. We must keep in mind that gynecology is a surgical specialty. And there is a lot of money to be made in doing procedures.

    Do you even know if you are in menopause especially having been on birth control or HRT for a number of years? Some women don’t go into menopause until after age 60. Also, birth control and HRT can cause bleeding or spotting even after menopause but that does not necessarily mean anything sinister is going on. How thick did your doctor say your lining was? And at what point after bleeding did you have the ultrasound? Women on HRT typically have thicker linings than those who are not on HRT. If he really is concerned about the thickness, did he ever discuss taking medication to thin it out? That, I would think, would be the first step IF you even need intervention.

    There are definitely some red flags here – your doctor’s evasiveness, his push to do an ablation, recommending hysterectomy as a first line treatment when you may not need ANY treatment. If it were me, I would get a copy of all my medical records. You may also want to check out the non-profit HERS Foundation at hersfoundation.org.

    I wish you the best in researching this subject and determining if you need any treatment.

    • Thank you for your feedback I dud tell him I’m nitvrwady fur hysterectomy unless there’s an eminent risk to my life. I also asked him for medication to think the lining he gave me progesterone pills but said he is not sure they will do the job. I said that’s ok I well try anyways. He was not happy. I felt very strong push from him for the surgery but I stood my ground. For now. Let’s see what happens next hunk exam.

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