gynecology Archives - Hormones Matter

Hysterectomy: Bad for the Heart and Much More

by WS

Published on May 16, 2022

27081 views

A Mayo Clinic study has shown that hysterectomy without removal of ovaries increases the risk of heart disease. Women who had a hysterectomy before age 35 are at a particularly high risk. Specifically, their risk was 4.6-fold for congestive heart failure and 2.5-fold for coronary artery disease. But this association is not new. This 1981 study showed a 3-fold increased risk of heart disease after a premenopausal hysterectomy. This would include most women who undergo hysterectomy. This 1982 study and this one from 1985 cite the uterine substance prostacyclin as the likely factor in women’s heart health. Since about 45% of women have a hysterectomy, it is no wonder heart disease is the #1 killer of women!

Heart Disease: Just the Tip of the Iceberg

Hysterectomy is bad for much more than the heart.

Hormone changes. Hysterectomy impairs the function of the ovaries which are part of the endocrine system. Multiple studies have shown this including this one and this one. This would logically predispose hysterectomized women to the same increased health risks and accelerated aging of ovary removal (castration). According to numerous studies such as this one and this Mayo Clinic one, the risks of ovary removal include heart disease, stroke, metabolic syndrome, osteoporosis, hip fracture, lung cancer, colorectal cancer, dementia, Parkinsonism, impaired cognition and memory, mood disorders, sleep disorders, adverse skin and body composition changes, adverse ocular changes including glaucoma, impaired sexual function, more severe hot flushes, and urogenital atrophy. Wow, what a list for such a common and rarely necessary surgery!
Figure changes. The uterus and its ligaments are key to the integrity of the pelvis. The cutting of those ligaments, the pelvis’ support structures, destroys pelvic integrity. As a result, a woman’s figure changes. The hips widen and the torso collapses until the rib cage sits directly on the hip bones. This causes a shortened and thickened midsection, protruding belly, and loss of the curve in the lower back making the derrière appear flat. These changes lead to back, hip, and leg problems, chronic pain, and impaired mobility. These effects are discussed here. Back pain after hysterectomy is one of the (many) “dirty little secrets” of Gynecology.
Organ dysfunction. The uterus sits between the bladder and bowel and keeps them where they belong. Hence, these organs drop and are adjacent to each other after hysterectomy. These changes can cause dysfunction as discussed here and here.
Sexual dysfunction. The uterus is a sex organ. Many hysterectomized women report a loss of sexual function – libido, arousal, and ability to orgasm – with or without ovary removal. Many also report feeling asexual and emotionally empty. This may explain why a renowned gynecologist referred to the uterus as a woman’s “heart center.” How ironic that the uterus is also essential to heart health!
Cancer risks. Last but not least, removal of the uterus increases the risk of some cancers. These include thyroid, renal cell (kidney), bladder, rectal and brain cancers.

The Devastating Toll of Hysterectomy

Women’s experiences are also compelling evidence of the devastating effects of hysterectomy. It can affect every relationship and aspect of life having far-reaching societal repercussions. Here, here and here are some heartbreaking stories of shattered lives. The Bleeding Edge documentary chronicles the stories of a few women who were harmed by Essure (tubal sterilization coils) and subsequently had hysterectomies. The HERS Foundation’s recently launched “In My Own Voice” project includes some women’s stories. Hopefully, more will come forward and share their experiences.

The uterus and ovaries are essential to a woman’s whole life. Female organ removal has been proven over and over again to be incredibly harmful as far back as 1912. Yet 45% of women end up having a hysterectomy. And over half are castrated at the same time which further increases the risk of heart disease. Additionally, more women have ovaries removed during separate surgeries. It is no wonder heart disease is the #1 killer of women.

Female organ removal is the biggest healthcare con as discussed here. Lack of informed consent is standard. And even worse, gynecologists commonly use unethical tactics such as instilling fear of cancer and intentionally misinforming women about the consequences. If women knew the facts, very few would consent to hysterectomy or oophorectomy.

In conclusion, the medical industry can no longer put its head in the sand or deny the horrific harm of these surgeries. Only 10% are done for a cancer diagnosis. Yet, it appears that they are gearing up to do even more. The Graduate Medical Education (GME) hysterectomy minimum was recently increased from 70 to 85. When will the ethical medical professionals or authorities address this intentional harm and sexual assault of almost half of U.S. women?

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, and like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Image from PxHere; CCO public domain.

This article was published originally on February 12, 2019.

Hysterectomy: Greed and Ignorance Reign

by WS

Published on May 29, 2018

7084 views

Hysterectomies and C-sections are two of the most overused surgeries. One in three women has a hysterectomy by age 60 and about half eventually have one. Approximately 600,000 women undergo hysterectomy annually, 50,000 to 60,000 of which are for a cancer diagnosis. This graph (figure B) depicts the number done for cancer (which are typically done as inpatient). However, the graph misrepresents total hysterectomies as it depicts only inpatient figures. In 2014, 70% of hysterectomies were done as outpatient – in ambulatory surgery centers or in hospitals with discharge in less than 24 hours. So one could say that ~90% of the ~600,000 are unnecessary. ACOG says that 76% do not meet ACOG criteria.

The Greed Factor

What is driving the high rate of hysterectomies? The more cynical among us would argue that money or greed is a large contributing factor and there are certainly data to back this up. In this article, a gynecologist talks about attending a seminar where gynecologists were coached on how to cultivate patients for hysterectomy to maximize fees. The healthcare dollars wasted on unnecessary medical procedures, especially hysterectomy at $17B, is discussed here. Another factor contributing to this gross overuse is the failure to properly diagnose and inform patients of treatment options and their risks and benefits. This failure may also be due, at least in part, to greed.

Ignorance at Play?

Still yet another variable may be at play: ignorance. For whatever reason, there is a huge disconnect between the perceived benign nature of the procedure and its reality. The research here, here and here are just a few examples of the compelling evidence of the damaging effects. These effects are affirmed by the thousands of comments on the various hysterectomy articles on this blog and others.

A Gynecologist’s Defense of Hysterectomy

A comment by a gynecologist on one of my articles reflects the ignorance and arrogance regarding the many aftereffects of hysterectomy (with or without ovary removal / castration).

Here is the May 3, 2018 comment by gynecologist Yvonne Treece, MD, FACOG:

There is no or minimal evidence to support many of these claims particularly in regards to pelvic ligaments providing support to the entire torso, loss of sensation, loss of sexual pleasure, fatigue, joint and ligament pain. There is some risk of nerve damage, but it is very small and does not result in loss of sensation over the whole vulva and vagina. There is a small risk of damage to bowel or bladder, with the ureters at highest risk. The percentages given in the YouTube video are grossly exaggerated, and most have no proven correlation with hysterectomy. The uterosacral ligaments are preserved in supracervical and most laparoscopic hysterectomies. The vast, vast majority of hysterectomies are uncomplicated. Most of the YouTube video is false. The false and misleading information is a disservice to patients. Where is the evidence for these claims?
I disagree that 70-90% of hysterectomies are unnecessary. Source? As alternative treatments become available, hysterectomy rates are falling. I am an OB/Gyn, and certainly do not do unnecessary hysterectomies, especially not for profit! That is a very hurtful, and malicious thing to say. It is not true of any one I know. Certainly someone may be performing unnecessary surgery for profit, but that is highly unethical, and illegal. Not mainstream.
Please look at an anatomy book (like the slides on the YouTube videos). A lot of your claims are physiologically nonsensical. It makes me sad that people have bad outcomes sometimes, but it saddens and frustrates me when patients are given misinformation attributing physical symptoms to a hysterectomy when they are unrelated.
I would be happy to have a dialogue with you about hysterectomy. I’m sure we could both learn from each other.

Here is my rebuttal comment:

Yvonne – As a doctor in a specialty (gynecology) whose training and livelihood is entrenched in doing hysterectomies (as well as oophorectomies), it’s natural to deny and defend. I don’t know how much of your misinformation is due to lack of proper medical training (including intentional omission by medical schools) and how much is in defense of your profession and livelihood. But regardless, I will address your points:
1) The severing of the ligaments that run from the uterus to the pelvic wall cause a collapse of the torso. It’s an anatomical fact. To use an analogy – If you cut through bridge supports, the bridge will collapse. A woman can still be “fit” after a hysterectomy but her figure / skeletal structure will be altered. Her midsection will gradually shorten and thicken (even absent weight gain). Women’s comments corroborate this. Further evidence of this can be seen as an indentation at each side of her back (one woman referred to it as a “plane” across her back) where her rib cage is now sitting on her hip bones. Another telltale sign is a crease / line that starts a couple inches above the navel and then gradually lengthens across her midsection as her rib cage drops. I doubt you typically observe patients before their surgeries and a few years after in their underwear to be able to observe these changes. And it seems many women end their relationships with their surgeons. They certainly don’t need birth control or any other reproductive services.
2) Another anatomical fact – The uterus separates and anchors the bladder and bowel. Its removal displaces them increasing risk for dysfunction in the short and long-term including incontinence and prolapse. With so many women having had hysterectomies, it’s no wonder incontinence is so prevalent.
3) Another anatomical fact – A shortened and sutured shut vagina lacks the bundle of nerves at the bottom of the cervix as well as the tip of the cervix that heightens sexual pleasure for both the woman and man.
4) How can you truly believe that severing of nerves and blood vessels, including those running through ligaments that are severed, does not cause loss of sensation and sexual pleasure? It is basic physiology that innervation and blood flow are vital to sensation. Many women even report loss of nipple sensation. And furthermore, uterine orgasms cannot physically happen without a uterus. This is a HUGE loss for many women. And many women who still have ovaries (the lucky ones whose ovaries haven’t “died” due to loss of blood flow and feedback with the uterus) report loss of libido and sexual function. There are PLENTY of women’s stories of shattered lives on the web if you really care to know.
5) Most hysterectomies may be (in your words) uncomplicated (absent the “surgical” errors of ureter, bladder, bowel damage, nerve damage, blood clots, hemorrhage, infection, morcellated / upstaged tumors, anesthesia harms, death). But the after effects are forever (as are the after effects of some complications when they occur). And shockingly, 55% of hysterectomies include removal of ovary(ies) (equivalent of a man’s testicles) despite the average woman’s lifetime risk of ovarian cancer being a measly 1.3%. More ovaries are removed as separate surgeries.
6) According to Obstetrics & Gynecology August 2013, ~50,000 hysterectomies are done for cancer. That is less than 10% of all hysterectomies making over 90% unnecessary. Media reports of declining hysterectomy rates are misleading in that they typically report only inpatient hysterectomies and the large majority are now done outpatient / ambulatory as I’m sure you’re aware. In 2014, 70% of commercially insured hysterectomies were outpatient.
7) I’m concerned that you also fail to inform your patients of the many increased health risks associated with hysterectomy (with ovarian “conservation”) – cardiovascular disease (3-fold), metabolic syndrome, increased Body Mass Index, increased BP, renal cell cancer, colorectal cancer, thyroid cancer. Ovary removal (castration) or post-hysterectomy ovarian failure is also common and is associated with another whole list of health risks such as cardiovascular disease (7-fold), stroke, lung cancer, osteoporosis, hip fracture, dementia, parkinsonism, impaired cognition and memory, mood disorders, adverse ocular and skin changes, sleep disorders, more severe hot flushes. Even unilateral oophorectomy (with or without hysterectomy) is associated with increased risk of cognitive impairment, dementia and parkinsonism.
Needing CME credits? You may have just earned some although you should have already known all of the above since this is your specialty.
Let the women who have had unnecessary hysterectomies (and those who love them) decide who is doing a “disservice to patients.”
Alternatives to hysterectomy are great but some of those also cause permanent harm. Ablation has been shown to increase risk of hysterectomy due to Post Ablation Syndrome. The blood can get trapped in the uterus (behind the scarred lining or due to a stenotic cervix) and/or back up into the tubes causing chronic and debilitating pelvic pain. Although procedures are the money makers, they should only be used as a last resort especially when they can do more harm than good. That applies to any specialty.
You said you “certainly do not do unnecessary hysterectomies, especially not for profit!” You mentioned you’re an ob/gyn so I assume not a gynecologic oncologist. In that case, all hysterectomies you do should be for benign conditions which makes them unnecessary.
If “performing unnecessary surgery for profit” is not “mainstream” then how do you explain the high rate of hysterectomies when less than 10% are done for cancer? And why do residents have to do so many hysterectomies yet ZERO myomectomies when many hysterectomies are done for fibroids? Yes, it’s very unethical but it’s the “standard of care” so it continues.

It’s no surprise that she did not respond to my rebuttal even though she stated “I would be happy to have a dialogue with you about hysterectomy.”

It Comes Down to Money

Gynecologists are supposed to be the experts on female anatomy and physiology. There is an abundance of medical literature on the harms of female organ removal. So how can they not know the consequences of removing the uterus and/or ovaries? As Upton Sinclair said:

“It is difficult to get a man to understand something when his salary depends on his not understanding it.”

You can read all my articles about three of gynecology’s destructive procedures – hysterectomy, oophorectomy, endometrial ablation – here. They include citations to medical literature.

For the truth about female anatomy and the lifelong functions of the female organs, check out this video:

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.

Image by Sasin Tipchai from Pixabay.

Reflections on Becoming a Woman

by Jordan Davidson

Published on December 7, 2012

2456 views

Endometriosis Symptoms began with Menstruation

I remember that day perfectly. I was eleven, in the sixth grade, 4’8 with brown frizzy hair – in the midst of that awkward transition from girl to woman. It was the first time that my Dad had taken me to the doctor (the pediatrician to be exact). My dad – a sympathetic and caring man – quite naturally hated seeing his daughter in so much unsubstantiated pain. Usually both he and my mother would accompany me to the doctor, but today that responsibility was left solely to him. As we sat in the examination room, him in a plastic chair and me on the examination table – feet dangling off the side, I remember hoping not for an answer but for validation, validation that my pain was real.

When I was ten I started getting these mysterious ‘stomach aches’ they’d come and go and with each one I’d go to the nurse and the nurse would tell me I had to stop avoiding recess, or gym, or whatever activity I decided to skip that day. To be somewhat fair, I would usually go to the nurse during gym. My doctor sent to the gastroenterologist several times, with no luck. The gastroenterologist suggested that maybe I was lactose intolerant and that I should take lactaid. No tests were ever run – I was told; “take lactaid and if it helps, your problem is solved.” My problem wasn’t solved but I still took the lactaid hoping that eventually it would work.

So there I was – at the doctor, missing yet another day of school, with my Dad in his suit, missing yet another hour of work. The door opened and in walked my pediatrician, disapprovingly muttering my name at the sight of me yet again, in her office. We went through the steps, her feelings my abdomen, asking me about my eating and bathroom habits, the works… Except this time she seemed more exasperated than usual “Jordan” she said emphatically “You are like the little girl who cried wolf, there is no reason for you to be in this much pain. If you keep ‘crying wolf’ one day you might actually be very sick and no one will believe you. Don’t make me send you for a sonogram!”

How I wish I wasn’t 11 years old at the time and absolutely petrified of a sonogram; which I assumed to be some gigantic needle that would be placed through my forehead or some other awful place. Needless to say, I never got that sonogram until about a year later, when I rushed into emergency surgery for a problem that a sonogram could have picked up a year earlier.

Endometriosis

The average endometriosis diagnosis takes 7 years; fortunately, mine only took 2 ½. The day I found out I needed surgery I had an appointment with an endocrinologist to discuss why I was so short. I was born with a Ventral Septal Defect (VSD) – a hole in my heart- which took longer to close than expected. For some reason, unbeknownst to my doctors, I failed to thrive as a child. I was mentally advanced but physically I was in the 1st and 3rd percentiles respectively for height and weight. I was very small.

I had gotten my period for the first time 6 months prior to that appointment. My period would come every 7 days and last for about 11 days. When I did have my period, I would be incapacitated for the first several days, writhing in pain, unable to move from fetal position. My doctor told me “Welcome to being a woman, you must have a very low pain tolerance; it should get better within a year.” Well, it didn’t. So there, at the endocrinologist, I laid on the examination table, curled up in more pain than usual. I was sweating and barely coherent. My mom stood there wiping my forehead with a cold paper towel. The doctor walked in took one look at me and her face contorted with horror. “What’s wrong” she exclaimed as she made her way over to examine me. As she made her way towards me I jumped up and ran across the room, barely making it to throw up in the sink. My mom followed after me; “she has her period” she nonchalantly conveyed to the doctor, since this had become the normal routine in my house. My doctor took another look at me, shook her head at the insistence that I had been lead to believe this much pain was normal and called for an orderly to escort me to the emergency room.

Uterine Didelphys: Two Uteri

Less than three hours and one morphine shot later, I was being prepped for surgery. Turns out my periods were so out of sync because I have uterine didelphys – two uteri (aka the plural of uterus). One of my uteri, was blocked and so when I would get my period, the blood wouldn’t drain, rather it would collect in my uterus. Every time I got my period my uterus would contract and try to push out the 6 months worth of blood that had collected in my uterus – to hold all of this blood and uterine matter my uterus had filled to what was analogized as the equivalent of being 3 months pregnant. They removed the blockage and told me that was it, the pain would be over.

Except the pain wasn’t over and six months later, I was back in the hospital for exploratory surgery to try and find the cause of my pain. After an hour long procedure, it was discovered that I had mild endometriosis. My surgeon told me they removed all of the endometriosis and that was it, the pain would be over.

Except, the pain wasn’t over and still isn’t. There is no cure for endometriosis. While surgery has alleviated some of my pain, it has not cured the disease. I am 21 now; I have had 5 surgeries for what is now stage IV, recto-vaginal endometriosis that is working its way up towards my liver. Altogether I have had 15 surgeries – 9 for my eyes and one to remove a cyst unrelated to my endometriosis. I know pain better than I know my best friend but not once have I let pain get in the way of my life. I went to prom with a 103 degree fever, half delirious from morphine, with my clutch overly stuffed with pads and tampons. In addition to my endometriosis, I have a lot of auto-immune and digestive issues. I am highly sensitive to yeast, I have thyroid disease, glaucoma, and I suffer from migraines.

I have a secret though, a secret for dealing with my pain. Even though on paper, I might not be healthy; I live my life as if I were healthy. I decided that I wasn’t going to let myself (or rather my body) stop me from doing the things I love to do. Some days that is harder than others but it is all about positive thinking and motivation. Your body is your temple; you need to take care of it. I am a vegetarian, I do yoga and I try to love my body, even when it doesn’t love me back. My rough road to womanhood has taught me strength and has given me the ability to stand up for myself and what I know to be right; and for that I am thankful.

Are We Marks? The Greed and Chicanery of 21st Century Corporate Culture

by Chandler Marrs, PhD

Published on October 12, 2011

2493 views

Corporate Culture has Run Afoul

By now everyone is aware of Bank of America’s latest in a long stream of fee gouging practices- the $5 debit card fee. This is on top of an endless array transaction fees charged to customers that generate billions in profits annually, and of course, the billions from the bailouts and the foreclosure crisis. Although blatantly evident on Wall Street, the shift in corporate ideology that rewards chicanery pervades every aspect of American life, especially healthcare and most especially women’s and children’s healthcare.

We’re at a place in time where corporations would rather spend billions lobbying favorable regulations and billions more fighting and paying out consumer or patient lawsuits for faulty products than build a quality product or provide a quality service in the first place. How else does one explain the medical marketing of dangerous drugs to otherwise healthy women– think HRT, Yaz and Yasmin, Prozac, Wellbutrin and other anti-depressants to pregnant women (and to rest of the un-depressed population for that matter)? How else does one explain why incredibly dangerous products like Yaz/Yasmin are still on the market despite having more serious adverse events than drugs already off the market because of safety issues (VIOXX) (see comparison of Yaz side effects below, from www.adverseevents.com or click on the graphic below). How else do we explain why it took so many years to remove DES from the market place despite evidence of both teratogenic and carcinogenic effects from the onset or why HRT, was allowed to be marketed as the magic pill that cured all, without any evidence whatsoever? How else do we explain why we not only bought these drugs but demanded them (besides the fact that many are addictive)? How else does one explain that in the 21st century only 30% of practice guidelines for obstetricians and gynecologists are evidence based? Thirty-percent!!!

I guess one really doesn’t need evidence if the treatment choices are limited to bad and worse. Indeed, it’s probably a good thing that more people, patients and doctors alike, don’t question the prescribing practices, the medical efficacy or the very real risk some of these meds pose. Maybe we are marks.

Where did this racket of corporate miscreance come from? I would argue it came from us, or rather because of us. For some reason, we the consumer, the citizen, the patient, the physician, the politician, checked our common sense and personal responsibility at the door of mega-marketing. Somehow we convinced ourselves that we deserved everything, but had to pay for nothing. We abdicated our personal responsibility for our own health, happiness and financial stability to others. And now we are facing the consequences: ill-health, physical and economical, personal and global.

The economic crash exposed the fealty of our financial system and is exposing the very real flaws in our corporate, insurance-based, medical system. The system has taken medical decision-making away from the physician and the patient and placed it squarely in the hands of pharma marketing engines and insurance companies. We’re at a juncture in time, where the sheer economic reality of buying pills to solve all medical problems, is contrasted by the fact that many simply cannot afford their meds anymore and must look to alternative solutions for health.

With all crises comes innovation and change, maybe with this one, we can get back to the “first do no harm” principle of medicine. Maybe we can get back to personal responsibility for health. I think Bill Maher said it best “We’ll stop being sick,when we stop making ourselves sick.”

For a laugh-out loud assessment of modern healthcare by Bill Maher click here.

To look up or report adverse reactions to common medications go to: www.adverseevents.com

Warning: This site does not offer medical advice. If you have questions about your medications or your health, please consult your physician. Do not attempt to discontinue any medication without physician approval and supervision.

Are We Not Worth It? OB/Gyn Decisions Driven by Consensus not Evidence

by Chandler Marrs, PhD

Published on October 7, 2011

3343 views

A recent study by researchers at Columbia University uncovered what many women have suspected for years, that the clinical practice of obstetrics and gynecology (Ob/Gyn) is steeped in tradition and opinion but lacks data and evidence. The study, Scientific Evidence Underlying the American College of Obstetricians’ and Gynecologists’ Practice Guidelines authored by Dr. Jason D. Wright and colleagues found that only 30% of Ob/Gyn clinical practice guidelines were based on hard data or scientific evidence. Rather, the vast majority of practice guidelines (70%) were based on observational studies, consensus or expert opinion. Perhaps this is why it takes 5-10 years to diagnose common Gyn conditions, why oral contraceptives are the first line of treatment for every women’s health conditions or why most pregnancy complications are still, in the 21st century, considered idiopathic. Without data, it sure is difficult to sway expert opinion. What do you think?
Link to the press release: Ob/gyn Guidelines Often Based Opinion Weak Data

Reference
Wright JD, et al. Scientific Evidence Underlying the American College of Obstetricians’ and Gynecologists’ Practice Guidelines. Online in press version, September 2011, Obstetrics and Gynecology 118 (3).

gynecology

Heart Disease: Just the Tip of the Iceberg

The Devastating Toll of Hysterectomy

We Need Your Help

Related posts:

You might be interested in

The Greed Factor

Ignorance at Play?

A Gynecologist’s Defense of Hysterectomy

It Comes Down to Money

We Need Your Help

Related posts:

You might be interested in

Endometriosis Symptoms began with Menstruation

Endometriosis

Uterine Didelphys: Two Uteri

Related posts:

You might be interested in

Corporate Culture has Run Afoul

Related posts:

You might be interested in

Related posts:

You might be interested in