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Doctors' Answers to "Frequently Asked Questions" - Hysterectomy

Related Women's Issues

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Vaginal Dryness Post Total Hysterectomy [posted 12/10/98]
Question: Would a complete hysterectomy help to keep my hormones and severe PMS on an even level? I have tried all the mass doses of vitamins that I have read about and don't seem to find any difference. My mood swings are so bad that I become a different person and not one that I like very much. I really believe that it is all in the fluctuation of my hormones, but I don't know what to do about it and I haven't found a doctor that will answer my question direct. I am very frightened of what I may do next.

Answer: Taking out your uterus would probably have little effect. Taking out your ovaries would, but most physicians wouldn't do this unless you had severe unremitting problems. Have you tried birth control pills?

Vaginal Dryness Post Total Hysterectomy [posted 11/5/98]
Question: I have had a TAH-BSO--37 yrs old. I find that when I take Premarin or Estradiol I seem to have increased vaginal dryness, dry eyes, dry nose with sore patches, and increased irritability. These symptoms seem to be the opposite effect that Estrogen Replacement Therapy should deliver. Are there other options--my sex life now stinks even more!

Answer: The vaginal dryness is probably due to insufficient estrogen, try a higher dosage or combined with vaginal estrogen cream. As to the eyes, nose, etc. No clue here.

Hysterectomy vs. Laparoscopic Myomectomy [posted 8/7/98]
Question: In your opinion, what are the instances one would choose hysterectomy over laparoscopic myomectomy? Why is laparoscopic myomectomy not always the first choice of a doctor?

Answer: In general if there is too much scar tissue or the resection would be too complex through the scope. About the only time that open surgical approach is preferred is if the procedure cannot be accomplished through the laparoscope.

Question: How long will a woman who’s has had a hysterectomy have hot flashes?

Answer: Women with hysterectomies do not get hot flashes - women with oophorectomies do. That is, the uterus has little to do with hormone production - the ovaries do. Removal of the uterus will not produce hot flashes unless the ovaries are also removed at the same time. If a women becomes estrogen deficient, the "hot flashes" usually last about 12-18 months.

Question: I am a 42 year old scheduled for a hysterectomy for an enlarged uterus (14 cm). I have had 2 depro-lupron injections and due for one more. I have lost 5 pounds and had very little side effects. Will she be able to do a vaginal? Am I now in menopause, where my ovaries are not working due to the injections? Should I have my ovaries taken since I am high risk for cancer because it runs on my mother's side, but my father's side is heart disease and they say that you should not take estrogen after a hysterectomy? I feel so much better since I started the injections as if I always had high hormone levels and now I feel normal not having PMS and constant bloating. I have had 3 C-sections, peritonitis and reconstructive laser surgery after the peritonitis. I am concerned about pain I guess because I have been there before. What questions do you suggest I ask my doctor when I go for my pre-op?

Answer: You have hit the best questions. She should be able to perform the surgery vaginally, but previous abdominal surgery may have scarred things down preventing this type of approach. Keep your ovaries unless there is overwhelming evidence of breast cancer. Other cancers don't matter (except endometrial and you're preparing to lose your uterus). Finally, why not stay on the hormone manipulation and avoid the surgery? Your gynecologist can test to see if you are in menopause yet by a simple blood test.

Question: How do you know when you need Hysterectomy? What are the side effects? How long is the recovery?

Answer: This is a long and complicated problem. General indications are excessive bleeding on a regular basis, cancer of the cervix or uterus, excessive pain due to muscular tumor growths, etc. The indications vary widely and in the past were fairly broad. Criticism of excessive surgical procedures has decreased the number of hysterectomies. The recovery depends on whether the surgery is performed through the vagina, is done with a laparoscope or requires an open incision. Usual recovery to work is 2-5 weeks depending on the type of surgery.

High Body Temperature
Question: I am a 40 yr.-old female, who had a hysterectomy 10 years ago, and have been experiencing unusually SEVERE problems with rising body temps in the past couple of years. It seems to be getting steadily worse, but I have no idea what is causing this. My body temperature will suddenly rise drastically when the weather becomes a little warm or I have exerted a little physical effort in some activity. It also occurs when getting out of the shower (although I continually lower the temperature of my shower water to be certain I'm not causing too much steam in the room), and I begin sweating uncontrollably to the point where I feel I may pass out and I am almost unable to breathe. I am also not able to cool myself easily, generally having to sit directly under air conditioning for at least 20 min. (sometimes with cold compresses on my pulse points) just to return to my normal body temperature. I don't know if these are standard post-hysterectomy "hot flashes", or if there may be some other reason for this reaction.

Answer: Did the hysterectomy include your ovaries or not? If not, these sound like typical estrogen withdrawal hot flashes. A diagnosis of menopause(estrogen deficiency) can be made by checking your blood level of LH and FSH. If they are elevated, I'd try a trial of estrogen to see if the problem vanishes. If not, then a further evaluation is necessary to check for other medical problems like carcinoid syndrome, pheochromocytoma etc. which can cause these symptoms.

Weight Gain
Question: I have gained 60lbs since my complete hysterectomy 2yrs ago. I have seen a dietitian and it isn't my diet, do women experience severe weight gain after this procedure? My hormones have also stopped working and my body temperature fluctuates constantly throughout the day, what can I do?

Answer: Hard to know how much is hormonal and how much is hereditary. Check pictures of your mom at each decade if there is a major discrepancy hormone manipulation might help. But, if your build and hers are similar major weight changes will be very difficult.

How Does a Catheter Work
Question: I am a 38 yr. old female. I had a hysterectomy 2 weeks ago to remove a large (12 lb.) fibroid and now have a foley catheter because I was unable to self cath. Can you explain how this catheter works. How was it put in place?

Answer: A foley has a balloon on the end that inserts into the bladder. After insertion, the balloon is blown up(each catheter has the amount on the catheter) with air which then keeps the catheter from being able to be withdrawn. When the catheter is withdrawn, the air is sucked out of the balloon decompressing the balloon and allowing the catheter to be withdrawn.

Premarin vs The Patch
Question: I'm a woman 44 years old, had a complete hyster. in June 1997, I started taking Premarin .625 at the beginning, but decided to I wanted to be on the patch, so my doctor gave me the Climara .1 patch, I have to replace it every 3-5 days because it falls off, or becomes loose, I now have vaginal itching and dryness and get hot real easy. Do you think I'd be better going back to Premarin, I still have refills or sticking out the patch. Which estrogen product do I get more from, am I getting my effect I need from the patches always changing them, plus they are so expensive also my face has been breaking out. Any comments I appreciate, my doctor says my hormone level is OK, but I've taken a few Premarin when I've been on the patch, which I did today. Let me know your opinion so I don't have to bug my Dr. plus how much calcium should I be taking daily, as of now I take none.

Answer: If your vagina is dry and you are having hot spells you are not getting enough estrogen. This might be because of the delivery system(patches) falling off or whatever. But, you will need to get more estrogen. I'd try the pills since you are clearly having trouble with the patches-although it doesn't matter to most women. You will need about 1500 mg a day of calcium carbonate or equivalent for osteoporosis prevention. Judge the correct estrogen dosage by either a repeat LH,FSH(blood tests) or your vaginal dryness.

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