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Womb with a view

MagazineMay 1996 (Vol. 7 Issue 2)Womb with a view

Regular readers may be surprised to see us publish an article from Caroline Richmond, the once avowed scourge of many aspects of alternative medicine and co-founder of Quackbusters

Regular readers may be surprised to see us publish an article from Caroline Richmond, the once avowed scourge of many aspects of alternative medicine and co-founder of Quackbusters. But lately, she's developed a similar scepticism of certain aspects of orthodox medicine, not least because of her run in with the profession after her womb and ovaries were removed without her consent, she maintains. She is now suing the surgeon.

In Britain, one woman in five will have a hysterectomy under the NHS by the age of 65. An unknown but substantial number will have the operation privately. The extirpated wombs will be sent to the pathology lab, where the vast majority will be found to be normal or to have only benign conditions such as fibroids. Four out of five women have their ovaries removed at the same time.In America, one woman in three has, or will have, a hysterectomy. Yet the French rate is only half that of Britain, and about a quarter that of the USA. French women and their doctors regard the womb as an organ to be preserved. If large fibroids are present and are giving trouble, they will remove them and are willing to do repeat operations if necessary.

Gynecologists defend their high rate of castrating women by saying that cancer of the ovary is the second most common female cancer. This is misleading. Ovarian cancer is the sixth commonest cancer in women, coming after breast, skin, lung, colon, and stomach, in that order. (Cancer Research Campaign factsheet 1.3, 1987).

Ovarian cancer is a terrible disease; two thirds of patients die within three years of diagnosis. But it is also rare about 2000 cases a year in the UK, in a female population of 28.5 million. Professor Klim McPherson of the London School of Hygiene has calculated that castrating a woman will increase her life expectancy by 4.5 days. But her increased risk of heart disease and osteoporosis will reduce her life expectancy by two weeks.

The hysterectomy rate increased rapidly from the 1950s to the 1980s. Interestingly enough, these are the years in which the birth rate fell rapidly. Could it be that gynecologists, faced with fewer deliveries and a drop in demand for their services, busied themselves with inventing the need for more surgery?

The surgical indications for things like fibroids that are uncomfortable but not dangerous are a matter of clinical judgement. They are often small and cause no symptoms: left alone, they can disappear without surgical intervention. Taking them out is a good little earner, and often leads to a long term involvement providing HRT.

Some hysterectomies are done for absurd reasons. These include menopausal symptoms (hysterectomy can only make these worse), endometriosis (which can be zapped with laser treatment), bladder prolapse, unexplained abdominal pain (a common condition in very hard working women, and often caused by stress), a womb that tips in the "wrong" direction (wombs are soft tissues and there is no exact "correct" position, and for "pelvic congestion" (a disease that exists in the gynecologist's imagination).

So, faced with this high pressure salesman, what should you be asking to avoid unnecessary surgery? These questions might help:

Are there any other less drastic operations for my condition?

Early stages of cervical cancer can be cured by removing a cone of tissue from the cervix. Heavy bleeding is often (about 70 per cent of cases) greatly relieved by removing just the endometrium (womb lining) through the cervix. Many ovarian cysts go away by themselves; otherwise the gynecologist can draw off the fluid with a needle, in the outpatient clinic. Endometriosis can be removed by laser, after the abdomen has been opened. Most fibroids can be removed surgically the sort that project into the uterine cavity can be removed during day surgery. Prolapses can be repaired.

Are there any medical treatments for my condition?

Heavy bleeding can be treated with varying degrees of success using medicines, mostly in the aspirin/ ibuprofen family.

Heavy bleeding is associated with being overweight, and it is worth seeing if slimming will help. Fibroids and endometriosis can be treated with hormone based drugs including danazol and goserelin. These have side effects which some people find tolerable and others don't. You deserve to be offered information and choice.

What about a sub total hysterectomy?

A sub total hysterectomy leaves the lower part of the womb and cervix. Though rarely performed in the 1980s, it is coming back in fashion. It is the only hysterectomy operation that leaves a normal vagina with a cervix at the end. Doctors don't like performing it because it is more difficult and because an intact cervix carries a small risk of cancer.

Will you leave my ovaries in?

Many gynecologist like to remove ovaries, saying you don't need them any more and they could develop cancer. But you do need them even after the menopause; they still secrete estrogen (for the vagina, skin and skeleton) and androgen, for energy. The cancer risk is low the normal risk of 1 in 1000 becomes 1 in 7000 after hysterectomy alone.

Will my hysterectomy bring on an early menopause?

Research has shown that hysterectomy brings the menopause four years prematurely, even when the ovaries are left in.


Pulmicort

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