The Wisdom of Menopause

by Christiane Northrup

  Having your fibroids removed can be a very empowering experience. As one of my newsletter subscribers wrote me:

  After having fibroids surgically removed, I also removed most negative issues from my life. It is wonderful! No headaches, no cramps, no backaches. I am still working on more dietary changes, but the ones I have already made have made me more positive, stronger, and carefree. I am also a praying person. So with this, and lifestyle changes, I am well on my way to healing and growing up at the age of forty!

  ~ HYSTERECTOMY. Hysterectomy should be the last resort for fibroid treatment, reserved for those women who, in addition to their fibroids, also have intractable bleeding or pain problems that simply have not responded to other measures. When this is the case, hysterectomy can be a real blessing, dramatically enhancing the quality of a woman’s life.

  Other Fibroid Treatments

  ~ FIBROID EMBOLIZATION. Uterine artery embolization (UAE) involves injecting a substance (usually polyvinyl alcohol particles) into the uterine artery. This causes clotting of the blood supply to the fibroid, which then shrinks over time. The procedure is done by interventional radiologists specifically trained in the technique. To reach the uterine arteries, a catheter is threaded into the femoral vein of the thigh. Most centers report good outcomes, with a worldwide success rate of about 85 percent. All types of fibroid symptoms, including heavy or irregular bleeding, uterine enlargement, and symptoms related to the size of the fibroid, such as urinary frequency, have responded.

  The average patient who undergoes this procedure can expect a 40 to 60 percent decrease in uterine size after about six months, but even those women who have no reduction in uterine size report improvement in symptoms such as heavy bleeding. Although no long-term follow-up data are yet available, UAE has a low risk of complications compared with myomectomy or hysterectomy. However, some serious complications, such as renal failure or an allergic reaction to the clotting agent, have been reported.3 If this procedure appeals to you, seek out the advice of a specialist at a center where UAE is frequently done, call the Society of Interventional Radiology at 800-488-7284, or visit their website, www.scvir.org.

  ~ EXABLATE. ExAblate is a magnetic-resonance-guided focused ultrasound device that combines MRI imaging to map out uterine fibroids with high-intensity focused ultrasound to heat up and destroy fibroid tissue. Because the blood vessels in fibroids help the body to dissipate the excess heat generated during this procedure, it’s particularly well suited for treating fibroids. The noninvasive, outpatient procedure leaves the uterus and ovaries intact. It involves lying on your abdomen in an MRI tube for up to three hours. Side effects may include blisters on the abdominal skin, cramping, nausea, and some pain (which is easily treated with over-the-counter pain medication).

  About 70 percent of patients report that this treatment successfully reduces their fibroid symptoms, although 20 percent require additional surgery within a year. The FDA reports that though the ExAblate treatment successfully reduces symptoms in most women, those symptoms—and the fibroids—may return. (Because of this, I recommend that all women suffering from fibroids also adopt lifestyle changes that alter hormone metabolism and reduce fibroid symptoms naturally.) Even so, I feel that ExAblate is an exciting use of technology and has been a major step forward; in fact, if it had been available when I had my fibroid (which was very large), I would have strongly considered this treatment. Note: Women who want to get pregnant should not use ExAblate because there’s not enough data yet to determine what happens to the uterine wall and lining following the procedure. For more information, call InSightec, the company that developed the technology, at 214-630-2000 or visit the company’s website at www.uterine-fibroids.org; in addition, the website of the nonprofit organization Fibroid Relief (www.fibroidrelief.org) gives information about focused ultrasound.

  CAROL: The Need to Let Go

  Carol was forty-six when she first came to see me for a second surgical opinion. Carol had multiple fibroids in her uterus that were causing her to bleed heavily each month, resulting in chronic anemia and fatigue. For the past four years she had tried desperately to keep her uterus, clinging to the hope that she’d be able to have a child of her own someday. Carol’s condition had deteriorated to the point that keeping her uterus had become her career. In fact, she had even lost her job because of constant absenteeism due to doctors’ appointments and episodes of heavy bleeding that required her to leave work. Though Carol had tried birth control pills, synthetic hormones, and multiple D&Cs to control the bleeding, nothing had helped. Her condition was too dangerous to suggest alternative treatments such as diet or acupuncture. I suggested that her health and overall well-being would best be served by a hysterectomy. (If I was to see her now, I would suggest uterine artery embolization or ExAblate.)

  Carol’s uterine condition was preventing her from actually living her life. She was stuck in a holding pattern consisting of pouring her life’s blood (literally) into unrealized hopes and dreams that had little or no chance of manifesting. Like all of us at midlife, Carol needed to let go of an unrealized dream from her past (having a biological child), allow herself to grieve fully, and then finally move on. Though this is never easy, sometimes it is the most healing choice.

  AN EMPOWERED APPROACH TO SURGERY OR

  INVASIVE PROCEDURES

  When you feel that you have been involved with the choice to have surgery, UAE, or ExAblate and really know your options, then you’ve stepped out of the victim role and into the partnership model. This shift alone improves your chance for a good outcome. You can continue that partnership mode by reading Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques (Angel River Press, 1996) by my colleague Peggy Huddleston. Peggy has written the definitive manual for how to have a healthy and empowering surgical experience. Her healing statements and steps to prepare for surgery have been clinically proven to decrease blood loss, lessen pain (by 23 to 50 percent), and speed recovery. I personally used her approach when I had my own fibroid surgery. (See her website at www.healfaster.com, which also carries her CDs designed to facilitate lasting healing.)

  I also recommend Meditations to Promote Successful Surgery from my colleague Belleruth Naparstek (www.healthjourneys.com) as well as the Surgical Support series developed by the Monroe Institute (www.hemi-sync.com). Both include meditations to prepare for surgery as well as music designed for you to listen to during the procedure itself.

  Hysterectomy for the Wrong Reasons

  Make sure that you get a second opinion if someone gives you one of the following reasons for having a hysterectomy for a fibroid.

  1. “You should have surgery before your fibroid gets any bigger. If you don’t, your fibroid may grow and make the surgery much more difficult in the future.”

  Unless a small tumor is causing intractable bleeding or fertility problems, it does not need to be removed. Not all fibroids are destined to grow, and even if they do, studies have shown that surgery to remove a uterus with large fibroids poses no increased risk to the patient. If necessary, the fibroid can be removed (see the section on myomectomy on page 285) leaving the uterus and the blood supply to the ovaries intact.

  2. “Your fibroid may become cancerous” or “We cannot be sure it is not cancerous unless it is removed.”

  It is extremely rare for a fibroid to be cancerous (the incidence is less than one in a thousand). If a fibroid tumor does become cancerous, it is called a uterine sarcoma, and currently the prognosis for this condition is very poor, which means that diagnosing it via surgery will not greatly increase your chances for survival. In fact, the chances of dying from complications of hysterectomy, though small, are statistically a little greater than the chances of having a uterine sarcoma.

  3. “Your ovaries can’t be seen on ultrasound.”

  If you have had an ultrasound examination (or even an MRI) to confirm the diagnosis of a fibroid, one of your ovaries may not be visible because it’s hidden behind the fibroid. Since
doctors can be held liable for failing to diagnose an ovarian problem if it’s present, they may suggest surgery to be absolutely certain that your ovary is okay.

  However, if you have no reason to believe that your ovaries are diseased, you can ask to be simply followed by your doctor. Remember, inability to see an ovary on ultrasound doesn’t mean that something is wrong with it—it just means that there are limits to technology! In this situation, some women will want to schedule lap-aroscopic surgery so that the pelvis can be examined from the inside with a light. (The uterus and ovaries can also be biopsied during this procedure.) Others will feel comfortable trusting that they are okay. Make whichever choice brings you the most peace of mind.

  Should You Have a Hysterectomy?

  Fibroids and heavy and irregular bleeding are the most common reasons why women have hysterectomies at midlife. Though hysterectomy is sometimes necessary, far too many women have them when they could have resolved their symptoms more easily and naturally using other means, including the newer technologies, such as uterine artery embolization. In addition, there is great value in keeping our pelvic organs intact when possible.

  In an ideal world, every girl and woman would be taught the value of her pelvic organs from an early age; their benefits would be as well studied as those of the male organs, research on safe and effective natural alternatives to bleeding and pain would be common, and hysterectomy with or without removal of the ovaries would be a very rare operation performed only when all other alternatives fail. This mindset is currently in place when it comes to male sexual organs. As a result, orchiectomy, the removal of the testes, is performed only as a last resort, though it is a very effective treatment for prostate cancer. And removal of the penis is just about unheard of, even in cases of penile cancer.

  Unfortunately, the uterus and the ovaries have been the target of bad press for so long that many women have internalized a fear of their pelvic organs. I once overheard a woman I’ll call Jane talking to her friends at a party about her upcoming hysterectomy. Her fibroid was the size of a small orange, she told them, and she wasn’t having symptoms. But, she explained, “I’m fifty, and at my age it’s just a matter of time before something happens in that area. I might as well get it out now.” Many physicians reinforce these fears. A patient who once came to me for a second opinion to avoid hysterectomy for a fibroid had been told by her gynecologist that her uterus (which had produced a healthy baby girl only seven months earlier) was “not her friend.”

  FIGURE 13: PELVIC ORGANS WITH SUPPORTING MUSCLES

  The Greek word hystera (womb) was used in ancient times to describe all manner of women’s suffering, both psychological (hysteria) and physical, believed to be caused by the uterus. In the 1800s after the advent of anesthesia, hysterectomy became an enormously popular cure for women’s ailments and was performed for just about anything that a woman’s husband, father, or doctor thought was wrong with her: overeating, painful menstruation, psychological disorders, and most particularly masturbation, promiscuity, or any erotic tendency.

  Surgical removal of the uterus remains one of the most commonly performed operations in the United States—both doctors and their patients have been taught that these organs are dangerous at worst or expendable at best, though this stance is now changing rapidly. One in three women in this country has had a hysterectomy by the age of sixty. This is a staggeringly high number. Not surprisingly, hysterectomy rates are very high among doctors’ wives. And about 55 percent of women have their ovaries removed at the same time as their uterus, to prevent the possible development of ovarian cancer, despite the fact that the vast majority of us will never get ovarian cancer, but could definitely benefit from the hormones produced by our ovaries throughout our lives.

  Good Reasons to Keep Your Uterus,

  Cervix, and Ovaries

  ~Your uterus, cervix, and ovaries all work together to provide your body with hormonal support throughout your entire life. They also share much of the same blood supply. When the uterus is removed, the function of the ovaries is affected even if the ovaries are left in. Up to 50 percent of women who have had hysterectomies lose the function of their ovaries earlier than they normally would—and they go through menopause earlier, thus increasing their risk for heart disease and osteoporosis.4

  ~Ovaries are the female equivalent of the male testes. As such, they are an important producer of androgens, the hormones that are involved in normal sex drive. Some studies have shown that up to 25 percent of women have decreased sex drive following removal of the ovaries. Removal of the ovaries literally castrates the female—and it is called that in the medical literature.5

  ~The uterus itself undergoes rhythmic contractions during orgasm, which contribute to the depth of sexual pleasure that many women experience during lovemaking. Some women who have had a hysterectomy complain that orgasm is not as satisfying anymore.

  ~Hysterectomy with ovarian removal decreases pheromone secretion, which may decrease a woman’s sexual attractiveness.6 Fortunately, pheromone preparations are available to remedy this. (See chapter 9.)

  ~Natural menopause, with ovaries and uterus intact, is a normal physiological event that takes place over a period of six to thirteen years. As your ovaries gradually shift function, the adrenal glands naturally take over some hormone production, as does the body fat. When a woman has her uterus, or uterus and ovaries, removed, her body goes through an instant menopause, which can be a shock to the hormonal system.

  ~The cervix (the lower portion of the uterus that protrudes into the vagina) is part of the normal pelvic floor and helps to support the bladder. The nerves that go to the bladder are intimately connected to the cervix. When hysterectomy with removal of the cervix is performed, these nerves can be damaged, resulting in an increased risk for urinary incontinence.7

  ~Only 10 percent of hysterectomies are done because of cancer. That means that up to 90 percent of the time, a woman’s pelvic organs are removed for benign disease—disease that can often be treated effectively by nonsurgical approaches.

  WHY KEEPING YOUR OVARIES COULD BE CRITICAL

  Many doctors who do hysterectomies routinely remove the ovaries at the same time in order to prevent ovarian cancer in the future, even if the patient’s ovaries are perfectly healthy. Currently, bilateral oophorectomy (removing both ovaries) is performed in 55 percent of all U.S. women who have hysterectomies. That makes for approximately 300,000 prophylactic oophorectomies performed every year.8 If a woman has a strong genetic risk for ovarian cancer, this may be a sound decision. But the vast majority of women will never get ovarian cancer, and the routine removal of normal ovaries as prevention is a very high price to pay.

  Indeed, recent statistics on bilateral oophorectomy (including a 2009 study following more than 29,000 women who had their ovaries removed before age forty-five, for twenty-four years) are simply too disturbing to ignore.9 This and other studies show that women who have this procedure:

  ~ Double their risk of lung cancer—even if they don’t smoke10

  ~ Increase their chances of coronary heart disease and stroke11

  ~ Increase their risk of dying from any form of cancer (although risk decreases for breast and, of course, ovarian cancer)12

  ~ Increase their risk of mortality for neurological or mental diseases fivefold13

  ~ Increase their risk for getting Parkinson’s disease14

  ~ Increase their chances of cognitive impairment and dementia15

  ~ Increase their risk of hip fracture16

  ~ Report more depression and anxiety later in life17

  Although taking hormone therapy after removing the ovaries can help prevent several of these outcomes, studies also show that long-term compliance is not sufficient to make up for the impact of hormone deficiency following the surgery.18

  The bottom line: when in doubt, don’t take it out.

  Unearthing Your Hysterectomy Legacy

  Over the years I’ve found that all the education and infor
mation in the world won’t change a woman’s life as long as she’s operating from old, unconscious, and unexamined beliefs. Each of us carries a unique personal legacy passed down to us from family members. This is especially true when it comes to women’s pelvic organs, a subject that has been shrouded in secrecy and misinformation for generations. Here are some questions to help you uncover your hysterectomy legacy.

  Which of your family members, if any, have had hysterectomies? Why? Do you know what was going on in their lives at the time? Do you know what their diagnoses were and what symptoms they were having? Would it be possible to find out? Do you feel that you can’t ask because this information is “too personal”? Does a belief in “better living through surgery” run in your family?

  One of my patients believed that she would need a hysterectomy sometime during her forties because “all my sisters had them then.” As a result, she became overly focused on her pelvic organs at midlife, noting every irregular or heavy period and every twinge. Ultimately, her mind-body connection—plus her unhealthy lifestyle—created enough symptoms so that she actually wanted a hysterectomy “for relief.”

  If, after going through these questions honestly, you still believe that hysterectomy is the best solution for you, then it well may be.

  If You’ve Already Had a Hysterectomy

  If you’ve had a hysterectomy and didn’t know that you had any other choice, I know that it’s upsetting to hear that the surgery may not have been in your best interest. One of my newsletter readers wrote: