By Joseph NBH, M.D, FACOG, AACS, AACG
Medical Director, Natural Bio Health
The United States Has the Highest Rate of Hysterectomy in the World?
The United States has the highest rate of hysterectomy in the industrialized world. According to the Centers for Disease Control and Prevention (CDC), hysterectomy is the second most frequently performed surgical procedure (after cesarean section) for U.S. women.
Approximately 600,000 hysterectomies are performed annually in the United States, and approximately 20 million American women have had a hysterectomy.
Every day in our Natural Bio Health Clinics in Austin, San Antonio, College Station and Odessa, Texas, we see women who are seeking relief from the consequences of their hysterectomy.
90% of Hysterectomies are Medically Unnecessary.
Studies show that anywhere from 10 to 90 percent of hysterectomies performed in the United States are not medically necessary. Approximately 90 percent of hysterectomies are performed electively. The National Women’s Health Network (NWHN) believes that unnecessary hysterectomies have put women at risk needlessly, and that health care providers should recognize the value of a woman’s reproductive organs beyond their reproductive capacity and search for hysterectomy alternatives before resorting to life-changing operations.
Quoted in the Los Angeles Times, NWHN Executive Director Cindy Pearson says, “I advise any woman who is not in a life-threatening situation to see someone else besides a surgeon to explore nonsurgical options first.”
Many Women Gain 50lbs. and More After a Hysterectomy.
At our Natural Bio Health Clinics, we see many weight loss patients who have gained significant amounts of body fat after their hysterectomy. They also have trouble sleeping, are often constipated and may suffer from depression. Many are prescribed anti-depressants before coming to our clinics.
*The most common reason for these conditions is low levels of the hormone progesterone. Progesterone almost always declines after a hysterectomy. Further, women are advised that now that their uterus has been removed they do not need progesterone. This hormone does protect against uterine cancer but it also has 194 other functions in the female body.
*In our experience, once our clients are placed on progesterone, they tend to lose body fat, sleep better, are able to stop their anti-depressants and their quality of life improves significantly.
Good Reasons for a Hysterectomy?
There are times when a hysterectomy is not only justified medically but can save a life. For example, a hysterectomy may be a medically necessary intervention in the case of several life-threatening conditions including the following: Invasive cancer of the uterus, cervix, vagina, fallopian tubes, and/or ovaries, unmanageable infection, unmanageable bleeding, or serious complications during childbirth, such as a rupture of the uterus. Some cases of uterine fibroids, adenomyosis, endometrial polyps and advanced endometriosis may also require a hysterectomy.
One other unavoidable cause is that of prolapse of the uterus as a result of multiple pregnancies when the uterus loses its support and the patient experiences severe pelvic pressure, feels like “everything is falling out” and back pain. In these cases the uterus could be left in place but the repair is more successful if the uterus is removed because the recurrence of vaginal prolapse is less likely.
*Unfortunately, as mentioned above, the majority of the hysterectomies performed in the United States can be prevented and are not performed for the previously mentioned reasons. This is especially true for women with heavy bleeding and who have none of the above conditions.
Why Are So Many Done Unnecessarily?
*I guess a simple answer is “because it can be done”. It’s a lot easier to “take it out” then fool around for months with various conservative treatments trying to stop abnormal bleeding. There are many parts of the country where it is almost a family tradition where all the women when they reach a certain age they will have a hysterectomy because their mother did. They have no indication to do so except they like the idea of no periods, particularly when their periods are uncomfortable and even painful. They do not know that there are alternatives.
*Some women will make up symptoms in order to have a hysterectomy because they are tired of having periods. Also, a provider can always give a diagnosis of uterine prolapse and pelvic pain and try to justify the hysterectomy. This diagnosis can cover most hysterectomies whether it is true or not.
It IS NOT a Simple Procedure Without Consequences.
Women are often told that it a hysterectomy is just a ‘simple operation” without any negative side effects. *Unfortunately, this is not true as witnessed by the thousands of women who have told us that they wish they had never had a hysterectomy. They may complain of anything from weight gain, depression, stress, pain, cysts in ovaries or breasts, anxiety, lack of energy, loss of joy, and lack of motivation. They are often on anti-depressants and suffer from poor sleep quality.
The procedure itself costs money (unless insurance pays for most or all of the surgery), it involves time off work for many, and is an invasive surgery that can be associated with complications such as bowel or bladder injury, infection, hemorrhage, post hysterectomy hormone issues, or even death, to name a few.
How Can You Make the Correct Diagnosis?
Most fibroid tumors of the uterus (round bundles of abnormal uterine muscle tissue) can be diagnosed during a routine pelvic examination. If the fibroids are in the cavity of the uterus, then an ultrasound must be done. Ultrasounds of the pelvis can also diagnose the condition “adenomyosis” which is the presence of “endometrial tissue that lines the uterine cavity found within the muscle of the uterus. MRIs can also be used for a more refined method of diagnosis but is usually unnecessary.
Cancer of the uterus, which is rare in premenopausal women and is always associated with metrorrhagia, bleeding between periods, can be diagnosed with an ultrasound and endometrial biopsy. Endometriosis is associated typically with symptoms of dysmenorrhea (bad cramps), infertility and painful intercourse on deep penetration and can be found on a routine pelvic examination.
Endometrial polyps, small growths of tissue that line the uterine cavity, can be seen on pelvic ultrasound both with or without using saline as a contrast media. Women with just heavy bleeding without any positive tests or findings are the most common patients seen in a provider’s office.
Progesterone. An Alternative to Hysterectomy.
I am the first to admit that there are certainly indications for hysterectomy as mentioned above. These include dysfunctional uterine bleeding” as seen with uterine fibroids, cancer, adenomyosis and endometriosis.
But, one of the most underutilized treatments, especially for what is called, “functional uterine bleeding” where there is no known physical cause, is the use of natural progesterone. *Women with functional uterine bleeding usually have progesterone deficiency and some degree of premenstrual syndrome symptoms (PMS). They can have irregular periods, lasting shorter or longer than 28 days. The flows can be short or long and heavy. You can see this abnormal bleeding history in mothers and their daughters.
*It is very common for me to diagnosis a patient with heavy flows, PMS symptoms such as premenstrual bloating, tension, mood swings, weight gain and depression, and find out that their daughter has the same symptoms. I think it is incumbent for providers to treat these women and their daughters, who may be even 14 or 15 years old, with progesterone.
The progesterone should be administered cyclically to mirror the luteal phase (ovulation phase of the cycle) which begins 13 to 14 days after the start on the menstrual cycle and continues for 14 days when the next cycle usually begins. This support of the ovulation cycle will invariably prevent heavy bleeding and the cramps that many times are associated with it.
The cramps are usually due to the large volume of blood that causes the uterus to contract as it tries to expel the blood, which is painful, and the large blood clots associated with the heavy flow will pass through a narrow and tight cervix which is also painful.
When Progesterone Does Not Work. Endometrial Ablation.
But what if progesterone doesn’t seem to help. There is another good option called “endometrial ablation”. In this case, the lining of the uterine cavity can either be resected (removed) using hysteroscopy in the operating room under anesthesia or an office procedure using devices that heat up the cavity and destroy the cells which will either stop the heavy flows or caused a marked reduction in the menstrual flow. *These both are very minor procedures and can be very effective and have very limited risks.
*Hysteroscopy can also be used to remove endometrial polyps that can cause heavy bleeding.
*I also believe, since progesterone deficiency can also be considered to be an “estrogen dominant” condition that the use of progesterone in younger women can significantly help to prevent conditions such as endometriosis, fibroid tumors and possibly prevent breast cancer in the future. The use of progesterone would certainly help resolve their PMS symptoms.
Why Isn’t My Doctor Recommending Progesterone?
The article on the naturalbiohealth web site written by Dr. Clark and quoting Dr. Neal Rouzier, has clearly shown the difference between progesterone and “progestin” that was used in the Women’s Health Initiative Study. They also revealed the fact is was the Progestin, Provera, that increased the risk of breast cancer in the study patient and that natural progesterone can actually help prevent breast cancer.
*However, the providers in practice still don’t get the picture and are afraid to use progesterone or they think it doesn’t work. Have they forgotten that progesterone is produced every month in a woman’s menstrual cycle, for over 39 years in most cases, from menarche to menopause. They may have forgotten or not realize that in pregnancy the levels reach up to 15,000 mg equivalents. In our treatment protocols, we are using only 100 mg twice a day from days 14- 28 of the cycle.
*This would not make sense except when we note that the big pharmaceuticals sell progestins and influence the providers and medical societies. Progesterone is one of the safest hormones that can ever be used and has hundreds of other benefits in women. So, by using progesterone cyclically premenopausal and continuously in menopausal women along with natural estrogen, we can actually prevent cancer of the breast by 30% over no treatment and in most cases prevent unnecessary hysterectomies for functional uterine bleeding.