Fibroids Archives - Hormones Matter

Conquering the Uterus – Trends in Hysterectomy

Published on October 26, 2022

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Every 10 minutes, 12 American women lose their reproductive organs, every day of every year. Hysterectomy is second only to cesarean in common surgeries. Approximately 660 women die each year in the United States from complications related to hysterectomy. Thousands more suffer long term side effects associated with oophorectomy – removal of the ovaries. The most common reasons for hysterectomy include: uterine fibroids or rather the menorrhagia, heavy bleeding associated with the fibroids and endometriosis, an incredibly painful condition where uterine tissue grows outside the uterus. Both conditions are hormonally modulated, plague millions of women and take years to develop.

One would think that with such extended period of disease progression, 5-10 years, researchers and clinicians would have ample opportunity to develop innovative treatment protocols, long before the surgical removal of the uterus was necessitated. One would be wrong. Despite the cost of long term care leading to, and as a result of the hysterectomy; despite the outcry from the hundreds of patient associations, some with high profile members; despite the billions of dollars spent annually on performing what should be last resort surgeries, there has been no innovation in diagnostic tools for these conditions and no new therapeutics for women’s reproductive health developed in over 50 years, unless you call the re-purposing of old meds innovation.

Instead, innovation in women’s healthcare, much like American healthcare in general only magnified exponentially, comes at the end of the disease progression – when no other choice but surgery exists. Let’s build a cool robotic tool to remove even more uteri. Sure it will cost significantly more and have a higher complication rate, but the technology is so impressive that does not matter. Forget about developing early diagnostics and less invasive, more effective therapeutics, just take it all out and look cool doing so. Who would not want to perform surgery remotely with a million dollar piece of medical technology? Women don’t need their uteri anyway – a win win for all involved.

Robotic Assisted Hysterectomy

The robotic, joystick controlled, remote surgical tool is an impressive piece of engineering. With a price tag of over a million dollars per, it provides the cutting edge stature that all top-notch hospitals strive for. An added bonus, it makes gynecology, the long derided medical profession, the cool kid on the block. But does it work?

Well, not really. Sure it removes a woman’s uterus more quickly and with less scarring; a single ½ inch belly button scare versus two or three ½ inch abdominal scars, but it costs more and doesn’t reduce complications – may even increase them a bit. Compared to the minimally invasive laparoscopic hysterectomy, the robotic assisted hysterectomy costs $2000 more per procedure. As of 2010, about a quarter of all hysterectomies were performed robotically. That’s about $300 million dollars per year more to perform a robotic hysterectomy with no added gain health. When combined with the costs multiple hospital stays, ineffective therapeutics and possible other surgeries that often led up to the hysterectomy, it is clear why women’s healthcare is so expensive.

Perhaps we could use our health dollars a little more wisely. Maybe we should spend some of those many billions of dollars or even a fraction of the $300 million spent annually on robot surgery, on prevention, early diagnostics or more effective therapeutics.

Update

Since this article was originally published in 2013, additional reports of complication rates for robotic surgery have been published. In a study of 298 patients undergoing robotic hysterectomy published in 2015, the complication rate was 18%. In 2017, a study of complication rates of a single surgeon using the robot, was 5.5% suggesting that some surgeons are better with this tool than others. In comparison, a study looking at 4505 hysterectomies performed by the same team between 1990 and 2006 (3190 were performed by laparoscopy, 906 by the vaginal route and 409 by laparotomy) saw the complication rates below 1%, significantly lower than that of the robotic surgeries, but again demonstrating that the skill of the surgical team is paramount.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Photo by Sander Sammy on Unsplash.

This article was published originally on March 18, 2013.

Periods from Hell

by Stacey Miller

Published on January 21, 2014

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Even from the beginning, my periods have been a little off. My first period was light but it lasted two weeks. Some years later I had bouts of nausea and vomiting on the first day of my period. I was eighteen then and I thought God was punishing me for losing my virginity, until I realized that perhaps God had better things to worry about.

Period during Pregnancy

My period even made an appearance when I was pregnant. At about nine or ten weeks into the pregnancy, I started to bleed at work. It was darker like at the end of a period. I panicked, as any woman would. I thought I was having a miscarriage. The emergency room could not tell me any different. I was put on bed rest until it stopped. It went on for two weeks and then stopped just as mysteriously as it began. My son was born about six months later after an emergency cesarean. Two years later, my daughter was born also by cesarean. Perhaps those two c-sections and the tubal ligation are what caused a nightmare that lasted more than a decade.

Tubal Ligation and Heavy Periods

Soon after my tubes were tied, I began to have heavy periods. They would last over a week. I would seem to have to change tampons every hour and a half. When I went to my Ob/Gyn, he put me on birth control pills to snap my hormones back in line. It worked for a while. I took them for about three or four months and then stopped. My periods returned to normal length and flow for a short span of time. Then, it would start again and I would begin the hormone roller-coaster again. Every time I went on birth control, I had to take it longer for it to work. I became frustrated with the fact that my tubes were tied but I was still taking (and paying) for birth control pills. After six or seven years, my body had become immune to the pills. They no longer worked. Worse than the heavy periods was the increasing pain.

Heavy Periods plus Searing Pain

My lower back pain stayed with me since the birth of my children, but it got worse as the years went on. I also developed ovarian cysts and other lower pelvic pain. I had moved and was seeing a new Ob/Gyn. This one seemed to make it a race to see how quickly she could get me out of her office. She didn’t listen to my family history when I told her that every woman in my family had a hysterectomy due to fibroid or endometriosis. She would send me for ultrasounds and other tests that always came back inconclusive. But she never attempted to find out why I was in so much pain or why I had to use two tampons just to be vertical. Her answer was Depo-Provera. It was a shot to stop my ovulation, and therefore, my period. Perfect answer, she said. My periods stopped. My weight shot up forty pounds. After two shots, I decided I would never take any hormones again. So a year later my period came back worse than ever. I lay on the bed for four days straight with back pain that made me want to punch a nun in the face. The bleeding would be bad to normal, but it was the pain that was the unbearable.

Fighting to Be Taken Seriously

I changed doctors again. This time, I went in prepared. I did my research. I knew that if it was a fibroid tumor, the scan would have picked it up. I also knew that many of the suspected conditions could go undetected on such scans. In fact, that was the problem. Endometriosis and adenomyosis can go with symptoms and no real answers for years. As I read the lists on the internet, I recognized signs that I did not even think were linked to my period. Perhaps my back pain had nothing to do with strained muscles. Perhaps my UTI symptoms that seemed to appear around the time of my period had more to do with my period than ill timing.

With a list of symptoms and searing pain to remind me exactly where my backbone was, I walked into the office. I was not going to be bullied or pushed out of the office. She sent me for the same tests: ultrasound and transvaginal ultrasound. The back pain following the exam almost made me pass out. This was not normal, I said to myself. One of the nurses called to try to refer me back to my primary physician. I told her that this pain came with my period and left when it left. This was not a primary physician issue. It was a gynecological issue. She scheduled another appointment and I saw another doctor that was too quick to push me out. “The tests were normal, so I don’t know why you are here. I thought they called you.” She ‘there there’d’ me and handed me a brochure while she encouraged me to think about getting the inside of my uterus singed or taking something to throw me into menopause. As I walked into the office for my next appointment, I overheard one of the nurses comment, “yeah, her ultrasound was fine. I don’t know what she’s complaining about.” That was it. The doctor came in like nothing was wrong so I flipped my bitch switch and let it go. “I know this is new for you but this is old for me. I am tired of going on and off hormones. Every time I go off them, it is worse. I don’t want to do ablation because 40% of women end up needing hysterectomies anyway. I don’t want to chemically force myself into menopause. I do not want to stick a band aid on this. There is something wrong. And while I may not know exactly which bleeding problem it is, I know that ablation is not a definitive answer for any of them. I’ve had my babies. It’s time to solve the problem and stop throwing a pill at it.” She gave in and set up the referral for a surgeon.

Flipping the Bitch Switch

Truth is that I am not sure exactly what it is that I have. On January 24th, I go in for surgery. It was not a quick decision by any means. It came after almost fifteen years of increasing pain and problems. It came when I decided that I was not going to shut up and fill a prescription. So please, if you are out there and still struggling with pain and periods that seem like they are in competition with Niagara Falls, find your own bitch switch and let it go. Because despite what the medical community would rather have us believe, a person can make it all the way through med school and still be a moron. You know your body better than anyone. Take care of it.

Adhesions – the Pain, Suffering and Frustration

by Roxie Fiste

Published on July 30, 2013

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My personal struggles with adhesions began shortly after a partial hysterectomy at age 33. Our daughter was just a toddler but there would be no more babies now that my uterus, riddled with growing tumors, had been removed. For over a year I had fought with my body, suffering with double menstrual cycles, pain, even having contractions as my body thought I was pregnant again! It took five pregnancy tests to prove to the doctors that I didn’t have a tube pregnancy going on. The first surgeon I had tried to save my uterus but the fibroids had grown inside as well as through its walls. He carefully cleaned off the endometriosis gathered around my ovaries believing they would function normally after surgery. It took about six weeks, but my energy levels eventually picked up to the point I actually felt good again.

My husband gave me a membership to a nearby health center as my healing process was ending. Being a full time mother and housewife did keep me very busy so working out gave me a couple of hours a week to clear my mind. Don’t get me wrong, I loved being a new mom, watching our daughter grow and change each day, but those few hours were greatly energizing. Eventually, I was even able to return to a little stargazing in late evenings after our daughter would go to bed. Life seemed to actually return to normal.

Six months later something began happening to the Me inside. Outwardly, I was unchanged, but emotionally and mentally I was becoming lost. The feelings were strange, frightening, as the real me seemed to drift off into the distance. It was after a rigorous workout that I felt something flopping around in my lower abdomen. It wasn’t painful until my GYN did a check which nearly caused me to pass out. Another surgery was scheduled which resulted in my left ovary, the size of a small orange, being removed. The surgeon reassured me that once I healed everything would be “normal” again. He had cleaned up my right ovary and removed some tiny adhesions. Life improved for about a month. For six months after that I began experiencing mood shifts, panic attacks, night sweats and two episodes of convulsions. My GP sent me to see a specialist to see if anything could be done for my mental state. This new doctor immediately set up an appointment with my GYN again. Something was physically wrong with me which was causing a disruption in my emotional and mental states. Surgery was once again scheduled. This time the doctor found endometriosis, adhesions and a dead ovary. After its removal I was placed on estrogen which completely righted the mental and emotional states. My family thought I was home free!

While working out about seven months after my previous surgery, I felt a burning sensation deep in my lower back. I tried various exercises, massage, whatever would help my back improve. Nothing worked. It became a rather tedious nightmare just trying to do laundry, chase a toddler, cook a meal, etc.! How frustrating to have the deep, fiery pain continue to spread from my back to all the way around my lower abdomen! Someone we visited suggested it might be adhesions. She suggested that I go back to my GYN. By the time this fourth surgery came I could barely stand up straight. It had gotten hard to breathe and I could no longer sing in the choir. My surgeon found so many adhesions a laser could not be used. It took him 45 minutes to remove the enormous number of adhesions using a scalpel. He was worn out and frustrated by the way my body was producing them so before closing me up he placed special mesh along my abdominal wall, while trying to protect my intestines. To complete his attempt he added small implants of cortisone pellets into the areas covered by the mesh. Upon waking after this particular surgery I was quite nauseous. Multiple muscle spasms hit within hours of coming out of the anesthesia as well. The nurses were quite good at keeping me set up with Phenergan and piroxicam! One stopped the nausea and the other stopped the muscle spasms. It was not my normal way of dealing with pain – I preferred to take a couple of Tylenol 3’s, not injections of strong meds. Thankfully, after a couple of days in the hospital I went back to taking tablets instead of shots. My breathing returned to normal as well as the ability to take deep breaths to sing within a few days of surgery. This time my husband and I fully believed my life would get back on track.

For about a year I remained free of adhesions, going about normal activities, mommyhood, spontaneous adventures with my family. Within weeks of the anniversary of that last surgery the ring of fire returned. This is what my GYN called the ring of adhesions rapidly growing in my body. Over the next ten years I would have six more surgeries for adhesions. There were years I barely weighed 84 lbs before surgery. Other times I weighed as much as 105 lbs – my body just couldn’t adjust to the physical intrusions of the scar tissue.

In 2002 I had what would be my very last surgery for adhesions. There were a couple of complications which made healing more challenging – a hematoma in my abdomen caused searing pain and a near double surgery, (thankfully a specialist released me saying the hematoma would resolve on its own), and a serious bout with Epstein-Barr virus slowed healing to a snail’s pace. It took over a year to recover from the EBV. Looking back it is quite clear that my immune system was worn down, plus my vitamin D3 levels were very low, most likely from all of the surgeries I had starting, with my first surgery mid-pregnancy through 2002. Twelve altogether – not a world record, but definitely ENOUGH!

Controversy, GMO Research & Women’s Health

by Chandler Marrs, PhD

Published on October 8, 2012

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If you’ve been on the internet at all over the last several weeks, you’ve likely come across these pictures- the white rats with grotesquely large mammary tumors warning of the dangers of GMO foods. A controversial and not yet even officially published study out of France on the Long term toxicity of Roundup herbicide and a Roundup-tolerant genetically modified maize is responsible.

In this 2 year study (compared to the 90-120 days for most previous protocols) researchers purportedly demonstrated the ill-effects of glyphosate (active ingredient in Roundup herbicide) and its adjuvants (putatively inactive ingredients that enhance the absorption, distribution or metabolism of the active ingredient), but also inadvertently, and despite the rampant criticism of the study, may have identified a mechanism of action for the growth of these tumors; a disruption of the estrogen pathway perhaps linked to primary kidney and liver damage. Moreover, and again perhaps inadvertently, the research points to a possible player in the development of fibroid type tumors.

How GMO Research is Conducted

There is great debate over the safety of herbicide rendered or engineered, genetically modified organisms (GMO) within the food and water supply. Studies on the side of industry, suggest no major ill-effects, while those on the side of environmentalist indicate differently. Research design likely contributes to the disparate findings. Much research to date has been short-term (90-120 days) and/or has limited the analysis to testing or manipulating only the active ingredient in the herbicide (glyphosate) and not the variety adjuvants found in the total herbicide formulation and that would be dispersed into the natural environment (food, water) post herbicide use.

The current study sought to remedy some of those short-comings and approximate what humans might be exposed to with current regulatory standards in place and in an ‘natural environment’ where exposure rates and types would necessarily vary. (Whether lab rats can approximate human physiology or the lab can be considered a ‘natural environment’ are debates for another day).

The Seralini GMO Study

Using healthy male and female Sprague-Dawley rats, the researchers evaluated the long-term (two years), across a life-span effects, of eating Roundup treated foods (maize) and water with Roundup residue at levels below the currently parts per billion standard and consistent with what humans might be exposed to in the current environment. Control rats were fed non-GMO diets and the test rats were fed varying levels of GM maize (11%, 22% and 33% of the total diet) and water with Roundup – well below the approved levels found in the environment.

Tumors, Toxicity, Death and the GM Diet

Compared to control rats fed a non-GM diet, those fed the GM-maize and Roundup water, died five times sooner and developed huge tumors, often greater than 25% of their body weight and requiring euthanasia to reduce suffering. There were distinct differences between the male and female treated animals. The females died more quickly and developed primarily mammary tumors, followed by a lower percentage of pituitary tumors and kidney and liver toxicity. While the males, demonstrated more severe kidney and liver disease along with skin tumors. The females were more susceptible to the Roundup in the water and both groups were equally susceptible to both the lower and higher percentage (11% and 33%) exposure to GM food, suggesting a threshold effect for disease initiation rather than a cumulative or additive effect.

Endocrine Disruption

The endocrine effects were also telling and pointed to sex-dependent differences in the tumor and disease expression. The ratio of testosterone to estradiol was disrupted in both males and females. Males in the highest Roundup treatment group (33% of total feed maize), demonstrated double the levels of circulating estradiol (see Evolution or Extinction of Men for details on male endocrine disruption) when compared to the control group. Whereas the exposed females showed increased testosterone levels.

Potential Fibroid Connection

The explosive growth of tumors in the female treated rats is notable both because of the large size and location of the tumors (mammary and pituitary) but more so perhaps because of the nature and physiology of the tumors themselves. In all but two cases, the tumors were non-cancerous, non-infective or non-metastatic. The tumors were benign adenomas and fibroadenomas, those commonly found in human women as they age (also common in this strain of lab rat as it ages). Fibroadenomas are comprised of fibrous and glandular tissue located in the breast. Fibroids are similar in tissue composition, but are found in the uterus. In the present study, fibroadenomas were found in the mammary tissue and adenomas in the pituitary gland. There was no mention of uterine fibroids or adenomas in other female reproductive regions. Similarly, although, the authors make no such claim regarding the expression of fibroid type tumors, relative to hormone changes and concurrent liver dysfunction (where the enzymes and proteins involved in the hormone regulation reside), I surmise that perhaps there is a connection there as well. It is conceivable that the combined insult of aging and environmental toxins on liver function alters hormone pathways sufficiently to promote this type of tumor growth.

Controversy and Criticism

As this study was released both pro- and anti-GMO factions got their pants in a bunch. On the anti-GMO side, this study represented proof-positive that GMO foods were bad. The results of this study, and in particular, the pictures of the tumor-ridden rats went viral on the internet. On the pro-GMO side, the criticism was as swift as it was vitriolic, with claims ranging from poor methodology, to outright scientific fraud. I suspect the truth lay somewhere in between.

My Take

Releasing to press first. This merited all sorts of criticism, most of which has no bearing on the actual study but does suggest a less than forthright approach to media relations. However, given the politics surrounding this topic, one can understand this PR approach.

Sprague-Dawley rats are prone to tumors. Yes, they are and as they age, tumors become more frequent. But here we have a little pot and kettle action going on. Sprague-Dawley and other outbred strains of rats and mice, all have predilections for certain diseases and tumors, but are nevertheless what is used in all industry supported (even the studies supporting the safety of GMO) and academic research. The choice of lab rat/mice is important, but even within specific strains there is huge variability. Nullifying the study because the researchers used the same strain of lab rats that other researchers also use, is a weak criticism at best and more than a little disingenuous. Perhaps a better criticism would be the use of lab rats in general to extrapolate human physiology.

Sprague-Dawley rats are prone to tumors as they age. Well guys, so are women. By the time a woman reaches age 50, upwards of 70% of women have fibroid type tumors. And frankly, aging, whether in animals or humans, increases disease expression. Our bodies just don’t work as well when we are older. Simply measuring the effects of a toxin for a short period of time in youthful animals does not, in any way, mirror the real life of the animal or a human, where effects are cumulative over time and sometimes even multiplicative and synergistic.

The study was too long and the control rats were dying too. Life is longer than adolescence. If one wants to evaluate how a treatment or toxin affects an organism over time and as it ages, one has to evaluate across that life span. This study compared tumor progression, disease and death rates between the non-GM controls and the GM fed groups, across the rodent’s life span, which is about 2+/- years. As the rodents aged, both groups developed tumors and some died, but there were more tumors and earlier deaths in the experimental group.

Failure to observe or measure is not synonymous with non-existence. Neglecting to measure a particular toxin or analyte, a specific symptom or disease process, or failing to evaluate long term effects does not mean that the toxin, analyte, symptom or disease process in question did not happen or does not exist. It simply means that you chose not to measure it. So claiming that a 3-month study in youthful rodents nullifies results from a longer study, regardless of any other methodological issues with either study, is an utterly false, and more than a little dishonest argument.

The dose response-curve was not linear. Damn it, how dare our complex physiology not conform to the simplicity of linear statistics. A common dose-response reaction is highly linear, where a small dose elicits a similarly small response and a larger dose increase the response size. This is not case when dealing with endocrine disruptors. Hormone systems are complex and highly non-linear. Hormone reactions occur at extremely low doses and often interact synergistically with other factors and respond differently over time and with cumulative exposures. This was the case in the current study.

In spite of the flaws with this study and contrary to the criticism, the Seralini study represents one of the only, if not the only, long term evaluation of the effects of Roundup and GM feeding on health. Long term studies, even in rodents, are not common place. They should be.

The next long term study (and there should be many more) should include different strains of rodent, measure additional hormones and steroidogenic proteins altered with liver disease and if they want to be really ingenious, look at the estrogen, androgen and progesterone receptor densities in the tumors.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Fibroids

Robotic Assisted Hysterectomy

Update

We Need Your Help

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You might be interested in

Period during Pregnancy

Tubal Ligation and Heavy Periods

Heavy Periods plus Searing Pain

Fighting to Be Taken Seriously

Flipping the Bitch Switch

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You might be interested in

Related posts:

You might be interested in

How GMO Research is Conducted

The Seralini GMO Study

Tumors, Toxicity, Death and the GM Diet

Endocrine Disruption

Potential Fibroid Connection

Controversy and Criticism

My Take

We Need Your Help

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