Maggie McKay (Host): There are different kinds of
hysterectomies. But when you hear that term, it's a scary prospect. What does
it mean for your future, having children and so many more questions. Our guest
today is gynecologist, Dr. Scott Bovelsky, with Health First, who will tell us
what you should know before your hysterectomy.

Host: Welcome to Putting Your Health First, a podcast
from Health First. I'm your host, Maggie McKay. Welcome, Dr. Bovelsky. Thank
you so much for making the time to be with us today.

Dr Scott Bovelsky: Absolutely. Thank you for having me.

Host: So to start off with, what is your role as a
gynecologist and what are the conditions you specialize in treating?

Dr Scott Bovelsky: So, I do gynecology only. I stopped
obstetrics about four to five years ago to focus on office gynecology as well
as surgical and more advanced robotic surgical procedures.

Host: And today, we're going to focus on all things
surrounding hysterectomies. So, can you tell us about this procedure and the
various reasons why it's performed?

Dr Scott Bovelsky: Sure. It is probably the most common
gynecologic surgery that's done in the countries, hundreds of thousands a year.
And a hysterectomy means taking out the cervix and the uterus. The uterus is
the womb. It is also the part that can cause problems as women get older with
heavier bleeding or fibroids, which are non-cancerous tumors of the muscle of
the uterus. So, there are different ways to do the hysterectomy, but the most
common reason we do them is for heavy bleeding.

Host: And can you talk about what other preoperative
steps might be taken before a hysterectomy?

Dr Scott Bovelsky: Sure. So when a woman comes in and
they complain of heavy bleeding, there's just kind of an algorithm you need to
go through. You need to see what the cause is, if you can find one. So, we
typically would do a history, a physical exam, lab work, checking blood counts
and some other things like thyroid functions to make sure that's not causing a
bleeding problem. And we'd also get a pelvic ultrasound. And depending on the
woman's age, we may also do something called an endometrial biopsy, and that's
because rarely you can get pre-cancer or cancer of the uterus that presents as
heavy bleeding. Once we get all that information together, we can then make an
educated decision about how we can deal with heavy bleeding. And there are
other options other than hysterectomy.

Host: And what factors need to be considered when
choosing to undergo a hysterectomy?

Dr Scott Bovelsky: So, I think surgery should be the
last resort. It's a low risk surgery, but it's obviously more risk. So, I think
really understanding the different options, including medical management,
intrauterine device, procedure called an endometrial ablation. If a woman is a
candidate for that, those are probably easier, quicker recovery, less risky
procedures that should be tried first. And when you're talking about a
hysterectomy, I mean, it is a major surgery and so it does have an inherent
risk even though that risk is low. And obviously, if you have your uterus taken
out, you're not going to have any more children. So, that's a big step for a
lot of women.

Host: And why is it that some women right after
childbirth have to have a hysterectomy or is that in the past mostly?

Dr Scott Bovelsky: So,

Maggie McKay (Host): So

Dr Scott Bovelsky: a procedure called a cesarean
hysterectomy or emergent hysterectomy right after childbirth. That's for a
completely different reason. That is because after you give birth, in order for
that uterus to stop bleeding, it has to contract down and block off the blood
vessels. There are rare occasions where a woman won't stop bleeding and becomes
life-threatening, and that would be an emergency hysterectomy. Those are rare.
I mean, I've probably done four in 15 to 20 years, those are pretty rare.

Host: Oh, okay. Dr. Bovelsky, what are the advantages
and disadvantages of the various surgical approaches?

Dr Scott Bovelsky: Traditionally, 30 years ago, 40 years
ago, all hysterectomies were done called open, meaning a big incision in the
belly, like a bikini incision, or sometimes even for big uterus and up and down
incision, all the way from the belly button down. That's the traditional way.
It's really out of style now and the vast majority of hysterectomies should not
be done that way. When you do an open hysterectomy, it's a much bigger
procedure, it's a much bigger recovery. You're in the hospital for two to three
days, you're really out for six weeks. There's higher blood loss, the pain is
much higher, so it's much harder to recovery.

So, a lot of GYN surgeons in the past are very proficient in
vaginal hysterectomy, so doing hysterectomy all through the vagina. You will
meet a lot of older surgeons who are excellent at this procedure. The problem
we have is in residency training, even when I was in residency, the rate of
competency in my mind for vaginal hysterectomy has gone down and we've really
transitioned to laparoscopic and robotic hysterectomy. What I mean by those is
small little incisions in your abdomen and then make a pocket of gas in your
abdomen to do the surgery. So, the vast majority of hysterectomies I do, over
99% are laparoscopic or robotic.

Host: Wow. So, post-surgery, what's the recovery process
like?

Dr Scott Bovelsky: So from my hysterectomies, patients
go in, have it done and go home the same day. So, it's an outpatient procedure
now instead of an open hysterectomy where you're in the hospital for three days
or so. It depends on what the patient does for work. So, what I tell people is,
if you have a desk job and you drive into work and you sit at a desk, you're an
accountant, you're back to work in two weeks. If you're working from home,
you're going to be doing probably limited work in the next couple days. The big
thing is you don't want to do any heavy lifting or straining for six weeks. So,
somebody has a job that involves heavy lifting. If they work at like an Amazon
factory or steel factory or something like that, they're going to be out for
six weeks.

Host: And what are the potential complications?

Dr Scott Bovelsky: Anytime you have surgery, and I tell
people, take every surgery you do very seriously. I tell everyone I love to
operate, but you got to take it seriously. Anytime you go into somebody's
abdomen, there are risks. The main risk would be bleeding or infection, that's
rare. But you do have things that run around your uterus, your bowel, bladder,
arteries and veins, the tube that runs from your kidney to your bladder called
the ureter. And there's always a potential to get things like that damaged. So,
it is very important for patients to ask how experienced their surgeon is. I
will tell you, in 20 years, I have been asked if I was board-certified maybe
five times. And I also almost never am asked how many of these have I done.
Almost never. I think those are

Maggie McKay (Host): are

Dr Scott Bovelsky: questions that every patient should
ask.

Host: I'm so surprised that people wouldn't ask you
that. I guess they don't know what to ask may be. So, speaking of, what are
some of the common questions patients ask before they choose this procedure?

Dr Scott Bovelsky: The biggest question I have, and it's
just a misperception in understanding in the lay public, is they think having a
hysterectomy is going to put them through menopause and stop having estrogen,
and that's not the case. All of the female hormones are developed out of the
ovary. So, the current recommendation is if you're under 50, 51 and you're
having a hysterectomy, we would leave your ovaries. And so, that means you go
through menopause at the normal time, no change in hormones, no change in
sexual function. So, there's this term out there called partial hysterectomy,
and that's actually a layman's term. When people use that, they mean, "Oh,
leave my ovaries." The true term is a total hysterectomy. but people in
the public interpret that as taking the ovaries. So, I always have to clarify
that with people that, "Hey, we're not planning on taking your
ovaries," or "You're 55 years old, we're going to take your
ovaries."

Host: Okay. I probably should know the answer to this,
but why keep the ovaries? Because if you're not going to have children, do you
need them? So

Dr Scott Bovelsky: I were to take someone's ovaries out
at the age of 40, that would actually decrease their life expectancy. So, the
ovaries and the estrogen do a lot of things for heart health, cholesterol and
bones. So, one of the other big issues for postmenopausal women is osteoporosis
and hip fractures. There's a very high mortality rate within a year after
breaking a hip. So, you want to get women's bones as strong as possible, and
that is accomplished through estrogen. So, premature menopause, whether it's
natural or surgically-induced, can increase some problems like heart disease
and osteoporosis.

Host: Wow. Who knew the ovaries played such a big part
in other areas?

Dr Scott Bovelsky: Yeah, they're pretty important.

Host: Wow. Is there anything else you'd like to add that
we didn't cover?

Maggie McKay (Host): No, I think

Dr Scott Bovelsky: thing that I would want to tell
patients is make sure your doctor sits down and talks to you, explains all of
your options. You ask the questions that you want. Don't ever feel rushed. And
make sure you find out how experienced they are. I think that's a really big
issue that's not addressed.

Host: Absolutely. This has been so informative. Thank
you so much for sharing your expertise. We appreciate it and the work that you
do.

Dr Scott Bovelsky: Well, thank you so much for having
me. I appreciate it.

Host: Again, that's gynecologist, Dr. Scott Bovelsky.
Thank you for listening to Putting Your Health First. To learn more about
Health First's integrated and compassionate gynecology services designed to
support women through every stage of life, please visit hf.org/women. If you
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out our entire podcast library for topics of interest to you. This has been
Putting Your Health First, a podcast from Health First.