( 1.) HYSTERECTOMY

From: Helen Dynda (olddad66@runestone.net)
Thu May 17 10:50:38 2001


There is an image of the reproductive organs as well as 2 charts at: http://www.tampabayonline.net/health/ar-hyste.htm -- which provide information about the:

1.) Number of hysterectomies in the United States (1975-1992) --Source: National Center for Health Statistics

2.) Major Diagnostic Indications for Hysterectomies (1988-1990) -- Source: ACOG

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||| HYSTERECTOMY

Last year, almost 550,000 American women had a hysterectomy. Yet it's estimated that around 30 percent of these operations are unnecessary. Before you consent to a hysterectomy, find out what alternatives are available. Hysterectomy, the removal of the uterus or womb, is the second most frequently performed operation for women, topped only by cesarean section. Seventy-four percent of hysterectomies are done when women are between the ages of 30 and 54; by age 65, more than 37 percent of all women in the United States will have had one. Although the number of such surgeries performed annually has dropped by about 160,000 in the past decade, many experts believe that isn't enough.

One fact that substantiates their claims is that hysterectomy rates vary greatly geographically. In fact, compared with women living in the Northeast, women are 78 percent more likely to have a hysterectomy if they live in the South; 41 percent more likely if they live in the Midwest; and 20 percent more likely if they live in the West. An American College of Obstetricians and Gynecologists ( ACOG ) task force attributed the geographical disparities partly to regional differences in gynecologists' training. Some patient advocates believe that inappropriate hysterectomies are done because some physicians believe that removing the womb is the best solution for many different gynecological problems, doctors have grown so accustomed to doing the operation that they often fail to consider less extreme treatments, or they recommend hysterectomies for their own convenience or profit.

Whatever the reasons, cutting these high rates requires a better understanding by both doctors and women of more conservative possibilities. In fact, a new study from the University of North Carolina suggests women can cut their chances of having a hysterectomy by making their feelings clear to their doctors and by choosing younger gynecologists, who are less likely to think surgery is the best treatment.

What is a Hysterectomy

In order to remove the uterus, a surgeon usually makes a vertical or horizontal incision in the abdomen. Or the doctor can perform a laparoscopically assisted vaginal hysterectomy (LAVH), a type of surgery that requires less extensive incisions, making it less traumatic. In this technique, tiny incisions in the abdomen serve as entry ports for a camera and operating tools. Once the uterus is severed, it is then removed via the vagina. But LAVH is still experimental and questions have been raised about its safety. For example, it appears to pose a higher risk of bladder damage than traditional surgery. One of the most controversial issues surrounding hysterectomy is the simultaneous removal of healthy ovaries (oophorectomy). This procedure, which can cause extreme side effects, is done in about 50 percent of women who have a hysterectomy. Older women are more likely than younger women to have their ovaries removed.

The Organs Affected

This figure illustrates the woman's reproductive organs that are affected by hysterectomy. The uterus, or womb, is a hollow, muscular organ that nourishes the developing fetus for the nine months of pregnancy. The endometrium is the tissue that lines the uterus. The ovaries produce the female sex hormones estrogen and progesterone, and store the ovum (eggs), releasing one a month. The fallopian tubes then carry the egg from the ovary to the uterus. If fertilized, the egg implants itself in the uterus. Otherwise, it is expelled through menstruation.

What Are the Side Effects of a Hysterectomy?

ACOG estimates that 25 to 50 percent of hysterectomy patients will have one or more complications, although they consider most to be minor or reversible. First, a hysterectomy ends a woman's ability to become pregnant. Other postoperative complications may include severe vaginal bleeding, injury to the bowel or bladder, infection, persistent pain and diminished sexual response. As with any type of surgery, hysterectomy carries some higher risks: more than 500 women die each year as a result of the operation. Also, since the uterus produces prostacyclin, a hormone that inhibits blood clots, removal of the organ may make blood more likely to clot and could be a factor in the increased risk of heart attack among women who have had a hysterectomy.

If the ovaries are taken out, a woman loses her supply of the female sex hormone, estrogen. Women who cannot take estrogen replacement therapy, will experience instant menopause and may have a greater chance of developing heart disease and osteoporosis. Whether or not they have had their ovaries removed, many women also report fatigue, weight gain, aching joints, urinary tract disorders and depression after having a hysterectomy.

When Is Hysterectomy Necessary?

In a few instances, a hysterectomy may be the only way to save a woman's life. Such life-threatening conditions usually require having a hysterectomy because no alternative treatment effectively combats the problem. These include:

* Cancer of the uterus and possibly of the ovaries

* Uncontrollable hemorrhaging after delivery

* Severe pelvic infection

** SEE ( 2.) for the ALTERNATIVES to a HYSTERECTOMY


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