One in three women have this operation - should you? - Health

After years of putting up with painful, ﬂood-like periods every month, there may come a time when your doctor suggests addressing the issue with this potentially life-changing option: a hysterectomy.

The surgery is more common than most of us realise. Almost one in three Aussie women have had a hysterectomy by the age of 60 − usually between the ages of 30 and 50 − according to the Australian Institute of Health and Welfare.

The operation involves the removal of the uterus and sometimes includes the extraction of the ovaries and fallopian tubes, which can cause the onset of menopause. For some women, a hysterectomy is unavoidable due to cancer or life-threatening bleeding. For others who may be suffering from heavy, painful periods, endometriosis or severe pelvic pain, it can be a difficult decision to make.

The upside is, there are now more options. Compared with the peak in the 1980s, the rate of hysterectomies has declined by almost half in some Australian states. One reason? The advent of alternative treatments for heavy bleeding, such as oral hormone pills and intrauterine devices (IUDs), says the Australian Commission on Safety and Quality in Health Care. So, before deciding that removing your uterus is your best way forward, here’s what to consider.

Do I really need a hysterectomy for that?

Other than cancer, virtually every other condition that would previously have led to a hysterectomy can now be tackled with alternative treatments. For example, many ﬁbroids (non-cancerous growths or lumps of muscle tissue that form within the walls of the uterus) can now be shrunk with ﬁbroid embolisation, or even removed while leaving the uterus in place.

Heavy bleeding can often be reduced with medication, endometrial ablation (a surgical procedure that destroys the lining of the uterus) or the placement of a progestin IUD.

Endometriosis can be suppressed using a number of diff erent medications and the associated pain can be reduced with pelvic ﬂ oor physiotherapy (a treatment that can also sometimes be used for pelvic organ prolapse).

When is it the best decision?

Your quality of life should be a major factor in making the right choice for you. Some women are willing to put up with a lot to avoid losing their uterus (fertility being one reason) and are okay with gynaecologist visits, ultrasounds, endometrial biopsies and alternative therapies.

Other women have had enough of the bleeding, the pain (say, from endometriosis) and planning their lives around their periods. If you and your doctor decide a hysterectomy is the best option, that’s just the start of the decision-making process.

Most people imagine an abdominal incision when they think of a hysterectomy, but it’s not the only type offered. Of the Australian women who have had a hysterectomy, 36% had their uterus removed through an abdominal incision, according to a study published in The Australian and New Zealand Journal of Obstetrics and Gynaecology. This means the majority of women had less invasive procedures, such as via the vagina, keyhole surgery or robotic surgery, which allows for tiny, precise incisions.

Many women are able to keep their ovaries, too, and for about 75%, this means menopause won’t come early.

The best thing you can do? Ask your doctor lots of questions so you can make an informed decision based on your desires. That way, if you’re looking for alternatives, you won’t feel like you’re being sold a procedure you’re trying to avoid, and if you do want a hysterectomy, you’ll know what to expect.

"Why I choose to have an endometrial ablation"

After suffering from menstrual migraines and heavy bleeding, Taline Haroyan, 52, decided to look at her options.

“The prospect of having a hysterectomy wasn’t something I took lightly. For me, it was a last resort. I presumed that I’d lose my femininity and need to take hormone replacements for the rest of my life. Or, I’d grow a light beard of some kind!

"My mother suffered from menstrual migraines and I remember doctors giving her injections to knock her out until her periods settled down. She had a full hysterectomy to stop her crippling migraines. She was in her early 40s.

"When I tried to give my body a break from contraception after having my two boys, I realised that during my menstrual days, I was also getting migraines. I was also menstruating heavier and feeling run-down as my iron levels dropped.

"At 52, I finally decided to do something when I had a few embarrassing leak issues. It wasn’t a life.

"Rather than taking out the entire working factory, my gynaecologist suggested an endometrial ablation (removal of the inside tissue layer/lining of the uterus) along with a laparoscopic bilateral salpingectomy (removal of both fallopian tubes) to reduce the bleeding. This would then, hopefully, take the pressure off my body so my migraines would be less severe and frequent.

"The operation was non-invasive, with access via the vagina and three key holes in the tummy. It wasn’t a full hysterectomy but a partial one, as I still have my uterus and ovaries. I can hardly see the scars.

"I saw my doctor recently for my post-op appointment. Turns out, I had a really bad case of endometriosis, which is all fixed now. It hasn’t been a month yet, so I can’t tell you what will happen when my periods are due next. My body will continue to think it’s having a period every month and the only thing that won’t happen is the bleeding. I’m thankful for that at least and crossing my fingers the migraines don’t revisit.”