What and Why?
At some time between thirty and fifty a large minority of women are offered hysterectomy to bring an end to womb disorders or menstrual problems. It is a great boon and liberation to some women after years of tiredness, heavy bleeding or pain. On the other hand it is also a major step in life that you cannot retrace if you subsequently have regrets. These are the factors you should think of before deciding: not all of them will have occurred to your surgical advisers.
Your womb is a very active organ that makes and then sheds a new skin every month for perhaps 500 cycles. Pregnancy lengthens these intervals, but takes it to much greater extremes of activity instead. It gets no rest except while you take the contraceptive pill which carries hazards of its own.
It is therefore not so surprising that towards the end of your reproductive life your womb begins to go off the rails. Fibroids are the most common result of this — tight balls of fibre and muscle that grow in the womb, enlarging and distorting its shape. These in turn can make menstruation unacceptably heavy and painful. If so, the only treatment that can offer full relief is hysterectomy.
If this situation arises during your forties and you are offered an operation, the balance of benefits weighs heavily in favour of accepting.
If you are much younger than this, or your bleeding problem can be contained, you need to consider it more carefully. Although the gynaecologist does his best to keep your ovaries healthy and working after the operation, a surprising number seem to stop functioning a few years after hysterectomy — exactly as if they knew there was nothing more for them to do. This means you have a very early menopause and may face a long struggle to prevent the onset of middle age — osteoporosis in particular, maybe a weaker bladder or vaginal prolapse. All of these can be tackled positively of course, but it may instead be easier to tackle the bleeding problem in the first place!
The other major reason for hysterectomy comes a little later in life as a rule. Cancer of the womb tends to occur soon after the menopause, and is quite distinct from cancer of the cervix. It usually declares itself as new bleeding after you thought your menopause was all over, though many alarms like this turn out to be yet another period. Even so you would be wise to check unexpected bleeding with your doctor, who may decide you need to see a gynaecologist. The gynaecologist in turn cannot be sure your womb lining is healthy without performing a ‘D and C’ operation, in which the lining of your womb is systematically scraped out for examination under the microscope. Only if that shows abnormal cells may you be offered a hysterectomy.
In this case you would best be guided in the first place by your gynaecologist.
Once you have accepted hysterectomy as your best course, for whatever reason, prepare for it constructively. Familiarise yourself. what is capable of curing bladder weakness can also prevent it.
What can I do?
Advice to maintain and maximise health
1. Prepare a list of all the questions you want to ask your gynaecologist before you see them. They are busy, and you will be a little overawed: even the most articulate people may dry up in these circumstances and regret it later.
2. Do not be rushed into operation against your will. Accept a place on the waiting list, but not a specific admission date until you have had time to sleep on it: be frank about this with the surgeon and make an arrangement to leave a message with his secretary once you have made up your mind. Then think about it in your own time. Talk to your husband and perhaps a few close friends, probably also your family doctor, before deciding. It is very important that you are mentally prepared and convinced, with all your resources behind your decision. Then you can concentrate on preparing, and getting better.
3. Progesterone supplements: You may be one who would benefit from progesterone supplements, which your doctor could prescribe. We have known this causes small fibroids to disappear, and to help the bleeding they can cause. Large fibroids may call for more urgent help.
4. Try to lose some weight if your stomach is fat, this makes the surgeon’s job easier and the stitches more comfortable. It also reduces the risk of thrombosis in your legs after the operation. In any case, a reducing diet will cleanse your bloodstream and leave it free to take on the work of healing.
5. Diet: Even if you are not overweight, a diet based chiefly on vegetables will clear your blood for action far better than regular consumption of meat and flesh foods.
6. Supplements of food-state Vitamin C 250mg, twice daily with food, will reinforce this cleansing effort and top up the stores in your white blood cells which will bear the brunt of the healing process. Vitamin B Complex high potency (one daily,) and food-state Multimineral (two daily, are also powerful reinforcements, if you have time. All these can usefully be taken for the two months prior to surgery and for at least a month afterwards.
7. Homeopathy: For the last week prior to operation and the first week after it, take homoeopathic Arnica 30 tablets, one daily. These are very convenient post-operative medication since you do not have to swallow them: just hold them in your mouth for a little while, then spit out the blank tablet if necessary.
8. Work hard on the exercises designed to get you mobile quickly.