Deciding to have a hysterectomy can be a difficult decision for many women. A hysterectomy may be necessary for certain unresolvable conditions in the female reproductive system. Fibroids, endometriosis, uterine prolapse and cancer may necessitate surgical removal of the uterus. How do you decide if a hysterectomy may be right for you?
Obstetrician/ gynecologist, Dr. Nigel Campbell shares what you need to know about hysterectomies to make this very important decision, and how the experts at Pullman regional can help guide you through this unique part of a womens life.
Selected Podcast
How do You Decide if You Should Have a Hysterectomy?
Featuring:
Learn more about Nigel Campbell, MD
Nigel Campbell, MD
Nigel Campbell, MD is an OB/GYN at Pullman-Moscow OB/GYN and member of Pullman Regional Hospital medical staff.Learn more about Nigel Campbell, MD
Transcription:
Melanie Cole (Host): Each year more than half a million American women have a hysterectomy. If you're thinking about having the procedure, having questions is normal, and the best way to be your own best health advocate. My guest is Dr. Nigel Campbell. He's an obstetrician gynecologist at Moscow Pullman OB/GYN, and a member of the Pullman Regional Hospital medical staff.
Dr. Campbell, women have heard this term 'hysterectomy.' They don't know exactly what it entails, or what it means, or why they should even have one. So tell us what a hysterectomy is and what conditions might necessitate this procedure.
Dr. Nigel Campbell, MD (Guest): Yeah, so to answer the first question first, when we say the word 'hysterectomy,' what we are talking about is the removal of the uterus itself, the body of the uterus. The uterus, of course, is the part of the woman's body that carries the baby if she's pregnant, and there are other words that we sometimes attach to 'hysterectomy' that indicate removing more than just the uterus, but when we say 'hysterectomy,' we're referring to just removal of the uterus itself.
In terms of conditions that might cause a woman to choose to have a hysterectomy, there are essentially four main ones that bring most of our patients to choose to have a hysterectomy when they decide to do so. The first one is abnormal bleeding, and so a woman who's had problematic bleeding, either heavy bleeding during her period or heavy bleeding between periods, something that's very problematic to her and disruptive to her life, and something that we've not been able to control in another fashion. Those are women who are candidates for a hysterectomy.
The second reason that we frequently do it, and it kind of goes hand-in-hand with the heavy bleeding, are uterine fibroids. Now uterine fibroids are a benign muscle growth inside the uterus, they're tough balls of muscle cells, and they too can cause some discomfort, some pressure, some symptoms inside the abdomen. They also could cause trouble with heavy bleeding. They also form a large proportion of the hysterectomies that we do.
Another large portion of the hysterectomies that we do, we do for pelvic pain. And so women who develop pain related to their cycle, or pain in the pelvis related to the uterus, again after usually attempting other methods to control the pain, some of those women will choose to have a hysterectomy to relieve their symptoms.
And then last of all, in terms of reasons that we would perform a hysterectomy locally is prolapse. And so when the uterus is falling downward and coming a little ways- coming out of the vagina causing trouble when a woman is trying to do her daily activities, and the sorts of things that she's wanting to do, we frequently do a hysterectomy together with a vaginal repair at the same time to restore her normal functions.
Melanie: Dr. Campbell, are there alternatives to hysterectomy? You mentioned total hysterectomy, what organs that you're dealing with, but in other words are there some conditions which might indicate a hysterectomy, but may not be urgent or even medically necessary? You mentioned if it's affecting a woman's quality of life. How do you determine that? And what might some of those alternatives be?
Dr. Campbell: Yeah, so the biggest thing that I tell all of my patients, is we love doing surgery, that's why we got into this profession, but no one should have surgery unless it really makes a lot of sense for them to do so because there are some risks that go along with it. And so things that are frequently tried and lead up to a hysterectomy are primarily hormones delivered in some fashion. If a woman's primary symptoms are related to pain, sometimes pain medication to go along with hormones.
And so for example, if a woman is having trouble with heavy bleeding, we frequently will start with trying to control that bleeding using estrogen and progesterone in some form to help them out with that. If our hormones fail in cases of heavy bleeding, we also sometimes utilize a procedure called an endometrial ablation, which is where we use microwave energy to destroy the lining of the uterus, again a procedure that makes it so we don't have to proceed all the way forward with a full hysterectomy.
With regard to the pelvic pain, the same way as bleeding, we frequently have some success with administering hormones to control pain and discomfort, and most women with heavy bleeding or with pelvic pain actually do not have a hysterectomy. We're able to control it with other methods.
Melanie: Let's talk about the procedure itself. Are there different kinds of hysterectomy surgery, and how are they performed? Is there an advantage to the different methods; laparoscopic, robotic assisted? Just give us a little overview of the actual procedure.
Dr. Campbell: Yeah, that's the most common question that we get asked. And so for many years, the two options for doing hysterectomy were vaginal or abdominal. And so vaginal hysterectomy is when the only incision that is made, is made inside the vagina, it's made around the cervix, and then we proceed to clamp and tie off the different attachments to the uterus and remove the uterus completely through the vagina. So the only incision is inside the vagina, at the end of the case we sew up that incision.
Abdominal hysterectomy, for hysterectomies that cannot be performed vaginally, either because the uterus is too big, or because of some other reasons that would make it more challenging, abdominal hysterectomy is where we make an incision in the abdomen in a similar spot to where a C-section incision might be. And again, we clamp and tie off the attachments of the uterus and remove the uterus through the abdomen. And again, sew of up the top of the vagina.
In more recent years, the laparoscopic hysterectomies have grown in popularity. It's where make usually three small incisions in the abdomen, one in the belly button and two down to either side, and then again remove the attachments to the uterus, seal off the blood vessels that go to the uterus, and then we using our laparoscopic instruments make an incision at the top of the vagina and then remove the uterus through the vagina. So what you're left with is three little incisions on your abdomen, and then the incision, again, at the top of the vagina that we've sewn up.
An adjunct to the laparoscopic hysterectomy, and what we perform at Pullman Regional Hospital, is the robotic assisted hysterectomy, and that is where we again make three little incisions in the abdomen, we set up the da Vinci robot next to the patient, then we enter a console and complete the remainder of the hysterectomy using laparoscopic instruments with the assist of the da Vinci robot.
It's a little troublesome over a podcast to go through all the details of how that's performed, but essentially it enables us with very large uteri or complex hysterectomies to again perform the surgery in a minimally invasive fashion.
Melanie: What should a woman expect after having a hysterectomy? What is it like? Do they then go through menopause? Do some of the symptoms- they're not quite as severe? I mean what's that like for a woman after the fact?
Dr. Campbell: Yeah, so that's probably the second most common question that I get on a routine basis. The biggest thing that I tell all of my patients, doctors are very good about listing out all of the complications that can happen, and that's important to understand though. But the biggest thing that I want all my patients to understand about a hysterectomy, about 96% of women are very satisfied with the results after the fact. It's a surgery that really has the opportunity to improve the quality of life in many ways for our patients.
And so again, a big question that always gets asked is, "Will this put me into menopause?" And the answer is in almost every case that it will not. So when we remove the uterus, when we perform a hysterectomy, we almost always leave the ovaries behind unless there's compelling reason to remove them, and the ovaries are what supply the hormones to your body. And so we remove the uterus that has caused the problems either with pain or with fibroids or with the heavy bleeding, but we leave behind the ovaries that are providing the hormones that benefit your heart, that benefit your bone health, that help mood, and those sorts of things.
It is important to know that there are studies that show that a hysterectomy will decrease what we call a woman's ovarian reserve, and there are some studies that show women may go through menopause at a slightly younger age after a hysterectomy, even when we left the ovaries behind. But again, even with that, the improvement in their life, and the symptoms that they were looking to get rid of, is significant enough that those women are again, very, very satisfied that they've chosen to undergo a hysterectomy.
All of the other things that women will talk about in terms of pain, discomfort after the procedure, those sorts of things, given enough time to heal, all of these things appear to improve significantly.
Melanie: What about risk for cancer, Doctor? After a hysterectomy, does that decrease? I mean obviously if you've left the ovaries, that's still there, what does the yearly exam look like if there are different parts that are not there anymore? You know, explain a little bit about now what you want women to think about going forward, as far as their risks.
Dr. Campbell: Yeah, it's a great question. So once your uterus and cervix have been removed at the time of hysterectomy, unless the hysterectomy was done for an abnormal pap smear, you are done having pap smears for the rest of your life. And so that's the last Pap smear that you will need.
Now we're very quick to point out that Pap smear is not the same as an annual exam. We do still encourage women to have annual exams, but you don't receive a pap smear at that exam. Because we're leaving the ovaries behind, a woman is still at risk of ovarian cancer, although at the time of hysterectomy, over the past several years, I and many other gynecologists are removing the fallopian tubes at the time of hysterectomy. Recent evidence shows that it is likely that by removing the fallopian tubes, we are decreasing a woman's risk of ovarian cancer as well.
And so you do still have a very small lifetime risk of ovarian cancer if we leave the ovaries behind, but with the fallopian tubes gone, that risk is probably decreased and you have no possibility in the future of having cervical or uterine cancer. Lots of my patients are thrilled to hear that again, at the time of hysterectomy, you have had the last Pap smear that you will ever have in your life.
Melanie: Wrap it up for us then with your best advice about women making this decision with their physician, what you really want them to know about the success of hysterectomy and how many women it has helped to overcome some of these conditions you've described today.
Dr. Campbell: Yeah the final word that I would say about that, for many women there are a lot of good options that do stop short of hysterectomy, and I would be the first to advocate the simplest approach first, the least invasive approach first. With that said, over the course of the last eleven years that I've been doing hysterectomies, I have not had a patient yet that has returned to me and said that they wished that they had not had a hysterectomy. For the women that reach that point, that have had debilitating symptoms that really brought them down, that have affected their quality of life, the improvement after a hysterectomy, when a woman has come to that decision together with her doctor, and they've both decided it's the most appropriate thing, the improvement is typically dramatic.
These visits that I have with my patients after hysterectomies are usually the very best part of my day. It's the women who we have solved a tremendous problem. There was one recently who I just saw a couple of years after she and I had met after she had been working with a string of physicians. The first words out of her mouth were, "You gave me my life back," and that- again, for many women, the chance to solve so many troubles with a hysterectomy is quite a tremendous thing.
Melanie: Wow, what a fascinating segment. Thank you so much, Dr. Campbell, for explaining this so clearly to us, and for sharing your expertise today. You're listening to The Health Podcast with Pullman Regional Hospital. For more information and to learn more about this subject, providers, and services at Pullman Regional Hospital, please visit www.PullmanRegional.org. That's www.PullmanRegional.org. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): Each year more than half a million American women have a hysterectomy. If you're thinking about having the procedure, having questions is normal, and the best way to be your own best health advocate. My guest is Dr. Nigel Campbell. He's an obstetrician gynecologist at Moscow Pullman OB/GYN, and a member of the Pullman Regional Hospital medical staff.
Dr. Campbell, women have heard this term 'hysterectomy.' They don't know exactly what it entails, or what it means, or why they should even have one. So tell us what a hysterectomy is and what conditions might necessitate this procedure.
Dr. Nigel Campbell, MD (Guest): Yeah, so to answer the first question first, when we say the word 'hysterectomy,' what we are talking about is the removal of the uterus itself, the body of the uterus. The uterus, of course, is the part of the woman's body that carries the baby if she's pregnant, and there are other words that we sometimes attach to 'hysterectomy' that indicate removing more than just the uterus, but when we say 'hysterectomy,' we're referring to just removal of the uterus itself.
In terms of conditions that might cause a woman to choose to have a hysterectomy, there are essentially four main ones that bring most of our patients to choose to have a hysterectomy when they decide to do so. The first one is abnormal bleeding, and so a woman who's had problematic bleeding, either heavy bleeding during her period or heavy bleeding between periods, something that's very problematic to her and disruptive to her life, and something that we've not been able to control in another fashion. Those are women who are candidates for a hysterectomy.
The second reason that we frequently do it, and it kind of goes hand-in-hand with the heavy bleeding, are uterine fibroids. Now uterine fibroids are a benign muscle growth inside the uterus, they're tough balls of muscle cells, and they too can cause some discomfort, some pressure, some symptoms inside the abdomen. They also could cause trouble with heavy bleeding. They also form a large proportion of the hysterectomies that we do.
Another large portion of the hysterectomies that we do, we do for pelvic pain. And so women who develop pain related to their cycle, or pain in the pelvis related to the uterus, again after usually attempting other methods to control the pain, some of those women will choose to have a hysterectomy to relieve their symptoms.
And then last of all, in terms of reasons that we would perform a hysterectomy locally is prolapse. And so when the uterus is falling downward and coming a little ways- coming out of the vagina causing trouble when a woman is trying to do her daily activities, and the sorts of things that she's wanting to do, we frequently do a hysterectomy together with a vaginal repair at the same time to restore her normal functions.
Melanie: Dr. Campbell, are there alternatives to hysterectomy? You mentioned total hysterectomy, what organs that you're dealing with, but in other words are there some conditions which might indicate a hysterectomy, but may not be urgent or even medically necessary? You mentioned if it's affecting a woman's quality of life. How do you determine that? And what might some of those alternatives be?
Dr. Campbell: Yeah, so the biggest thing that I tell all of my patients, is we love doing surgery, that's why we got into this profession, but no one should have surgery unless it really makes a lot of sense for them to do so because there are some risks that go along with it. And so things that are frequently tried and lead up to a hysterectomy are primarily hormones delivered in some fashion. If a woman's primary symptoms are related to pain, sometimes pain medication to go along with hormones.
And so for example, if a woman is having trouble with heavy bleeding, we frequently will start with trying to control that bleeding using estrogen and progesterone in some form to help them out with that. If our hormones fail in cases of heavy bleeding, we also sometimes utilize a procedure called an endometrial ablation, which is where we use microwave energy to destroy the lining of the uterus, again a procedure that makes it so we don't have to proceed all the way forward with a full hysterectomy.
With regard to the pelvic pain, the same way as bleeding, we frequently have some success with administering hormones to control pain and discomfort, and most women with heavy bleeding or with pelvic pain actually do not have a hysterectomy. We're able to control it with other methods.
Melanie: Let's talk about the procedure itself. Are there different kinds of hysterectomy surgery, and how are they performed? Is there an advantage to the different methods; laparoscopic, robotic assisted? Just give us a little overview of the actual procedure.
Dr. Campbell: Yeah, that's the most common question that we get asked. And so for many years, the two options for doing hysterectomy were vaginal or abdominal. And so vaginal hysterectomy is when the only incision that is made, is made inside the vagina, it's made around the cervix, and then we proceed to clamp and tie off the different attachments to the uterus and remove the uterus completely through the vagina. So the only incision is inside the vagina, at the end of the case we sew up that incision.
Abdominal hysterectomy, for hysterectomies that cannot be performed vaginally, either because the uterus is too big, or because of some other reasons that would make it more challenging, abdominal hysterectomy is where we make an incision in the abdomen in a similar spot to where a C-section incision might be. And again, we clamp and tie off the attachments of the uterus and remove the uterus through the abdomen. And again, sew of up the top of the vagina.
In more recent years, the laparoscopic hysterectomies have grown in popularity. It's where make usually three small incisions in the abdomen, one in the belly button and two down to either side, and then again remove the attachments to the uterus, seal off the blood vessels that go to the uterus, and then we using our laparoscopic instruments make an incision at the top of the vagina and then remove the uterus through the vagina. So what you're left with is three little incisions on your abdomen, and then the incision, again, at the top of the vagina that we've sewn up.
An adjunct to the laparoscopic hysterectomy, and what we perform at Pullman Regional Hospital, is the robotic assisted hysterectomy, and that is where we again make three little incisions in the abdomen, we set up the da Vinci robot next to the patient, then we enter a console and complete the remainder of the hysterectomy using laparoscopic instruments with the assist of the da Vinci robot.
It's a little troublesome over a podcast to go through all the details of how that's performed, but essentially it enables us with very large uteri or complex hysterectomies to again perform the surgery in a minimally invasive fashion.
Melanie: What should a woman expect after having a hysterectomy? What is it like? Do they then go through menopause? Do some of the symptoms- they're not quite as severe? I mean what's that like for a woman after the fact?
Dr. Campbell: Yeah, so that's probably the second most common question that I get on a routine basis. The biggest thing that I tell all of my patients, doctors are very good about listing out all of the complications that can happen, and that's important to understand though. But the biggest thing that I want all my patients to understand about a hysterectomy, about 96% of women are very satisfied with the results after the fact. It's a surgery that really has the opportunity to improve the quality of life in many ways for our patients.
And so again, a big question that always gets asked is, "Will this put me into menopause?" And the answer is in almost every case that it will not. So when we remove the uterus, when we perform a hysterectomy, we almost always leave the ovaries behind unless there's compelling reason to remove them, and the ovaries are what supply the hormones to your body. And so we remove the uterus that has caused the problems either with pain or with fibroids or with the heavy bleeding, but we leave behind the ovaries that are providing the hormones that benefit your heart, that benefit your bone health, that help mood, and those sorts of things.
It is important to know that there are studies that show that a hysterectomy will decrease what we call a woman's ovarian reserve, and there are some studies that show women may go through menopause at a slightly younger age after a hysterectomy, even when we left the ovaries behind. But again, even with that, the improvement in their life, and the symptoms that they were looking to get rid of, is significant enough that those women are again, very, very satisfied that they've chosen to undergo a hysterectomy.
All of the other things that women will talk about in terms of pain, discomfort after the procedure, those sorts of things, given enough time to heal, all of these things appear to improve significantly.
Melanie: What about risk for cancer, Doctor? After a hysterectomy, does that decrease? I mean obviously if you've left the ovaries, that's still there, what does the yearly exam look like if there are different parts that are not there anymore? You know, explain a little bit about now what you want women to think about going forward, as far as their risks.
Dr. Campbell: Yeah, it's a great question. So once your uterus and cervix have been removed at the time of hysterectomy, unless the hysterectomy was done for an abnormal pap smear, you are done having pap smears for the rest of your life. And so that's the last Pap smear that you will need.
Now we're very quick to point out that Pap smear is not the same as an annual exam. We do still encourage women to have annual exams, but you don't receive a pap smear at that exam. Because we're leaving the ovaries behind, a woman is still at risk of ovarian cancer, although at the time of hysterectomy, over the past several years, I and many other gynecologists are removing the fallopian tubes at the time of hysterectomy. Recent evidence shows that it is likely that by removing the fallopian tubes, we are decreasing a woman's risk of ovarian cancer as well.
And so you do still have a very small lifetime risk of ovarian cancer if we leave the ovaries behind, but with the fallopian tubes gone, that risk is probably decreased and you have no possibility in the future of having cervical or uterine cancer. Lots of my patients are thrilled to hear that again, at the time of hysterectomy, you have had the last Pap smear that you will ever have in your life.
Melanie: Wrap it up for us then with your best advice about women making this decision with their physician, what you really want them to know about the success of hysterectomy and how many women it has helped to overcome some of these conditions you've described today.
Dr. Campbell: Yeah the final word that I would say about that, for many women there are a lot of good options that do stop short of hysterectomy, and I would be the first to advocate the simplest approach first, the least invasive approach first. With that said, over the course of the last eleven years that I've been doing hysterectomies, I have not had a patient yet that has returned to me and said that they wished that they had not had a hysterectomy. For the women that reach that point, that have had debilitating symptoms that really brought them down, that have affected their quality of life, the improvement after a hysterectomy, when a woman has come to that decision together with her doctor, and they've both decided it's the most appropriate thing, the improvement is typically dramatic.
These visits that I have with my patients after hysterectomies are usually the very best part of my day. It's the women who we have solved a tremendous problem. There was one recently who I just saw a couple of years after she and I had met after she had been working with a string of physicians. The first words out of her mouth were, "You gave me my life back," and that- again, for many women, the chance to solve so many troubles with a hysterectomy is quite a tremendous thing.
Melanie: Wow, what a fascinating segment. Thank you so much, Dr. Campbell, for explaining this so clearly to us, and for sharing your expertise today. You're listening to The Health Podcast with Pullman Regional Hospital. For more information and to learn more about this subject, providers, and services at Pullman Regional Hospital, please visit www.PullmanRegional.org. That's www.PullmanRegional.org. This is Melanie Cole, thanks so much for listening.