Dr. Romanzi
                        Dedicated to Your Quality of Life


Home   Vaginal Rejuvenation   Sex & Health    Cosm...
December 2009   pelvic pressure, and fatigue from the anemia caused by
November 2009   heavy bleeding, combined with how y...
Over the ensuing decade, these self-rated attitudes were
compared to symptom impact on each woman’s overall
quality of lif...
Besides these new therapies, it is important to understand 
that not every condition needs treating. Mild endometriosis
ma...
The Aging Ovary


HEADS UP: for most non-medical people, hysterectomy =
remove the uterus and ovaries. The medical definit...
sexual function impact from the condition for which
 hysterectomy was performed, in addition to higher
 scores on the “ben...
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Urogynics the happy hysteretomy

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Urogynics the happy hysteretomy

  1. 1. Dr. Romanzi Dedicated to Your Quality of Life Home Vaginal Rejuvenation Sex & Health Cosmetic Reconstructive Surgery Press About Us/About You Patient Forms PAGES The Happy Hysterectomy by admin About Dr. Romanzi Post a question for Dr. R. (c) Lauri Romanzi, 2010 DR. ROMANZI HOME DELIVERY LATEST POSTS As a relentless advocate for avoiding hysterectomy unless Enter your email address: you will truly benefit from the surgical removal of your  Three (Unhappy) Musketeers uterus, I am here to share information about the benefits – Prolapse, Bladder Outlet Obstruction and Overactive of  hysterectomy when it’s done for all the right reasons. Subscribe Bladder Delivered by FeedBurner Ask Dr R: overactive bladder, My favorite “don’t need a hysterectomy” message is   interstitial cystitis, and about uterine resuspension for treatment of uterine ulcerative colitis prolapse, a condition that accounts for about 16% of An obstructed bladder is a benign hysterectomies in the States, being the third most SEARCH cranky bladder – the story of common indication for hysterectomy after fibroids and  To search, type and hit enter prolapse and the badly behaved bladder dysfunctional bleeding. Since uterine resuspension fixes uterine prolapse just as well as hysterectomy-based Dr R Talks About Prolapse, BLOGROLL Part 1 repairs, there is no need to undergo hysterectomy for prolapse. Heal India e-Newsletter Does Betty need hysterectomy for prolapse? Seek Wellness We think not. Dr R guest But what if you’re suffering with a condition for  Womens Voices for Change blog on Women’s Voices for which hysterectomy truly can make a difference? Change Is there any such thing as a Happy Hysterectomy? LINKS CATEGORIES Health Guru Ask Dr. R. JonasWeb – Webmaster Blog SearchTROOP Breaking News and Seek Wellness Research Reviews Fistula and Childbirth Injury GOOGLE CONNECT Hysterectomy and Alternatives to Hysterectomy The Female Pelvis Pelvic Organ Prolapse Urinary Incontinence Fibroids, adenomyosis, dysfunctional bleeding and LOGIN Uterine Prolapse endometriosis are the biggest players in this “do I or don’t Register Vaginal Laxity I” hysterectomy arena. Let me help you understand  Log in something most of you already intuitively know – one Vaginal Prolapse Entries RSS woman’s hysterectomy blessing is another woman’s Vaginal Rejuvenation hysterectomy nightmare. What turned your neighbor’s life Comments RSS into a happy healthy place might not work so well for you. WordPress.org ARCHIVES According to a  beautifully designed and implemented  July 2010 research project recently published in the bible of June 2010 gynecologic research, ”Obstetrics and Gynecology”, May 2010 whether you’ll celebrate or regret your hysterectomy depends on how much headache your uterine condition is April 2010 causing in terms of pain, painful sex, heavy bleeding,
  2. 2. December 2009 pelvic pressure, and fatigue from the anemia caused by November 2009 heavy bleeding, combined with how you feel about your October 2009 uterus, and how you feel about hysterectomy. August 2009 With the right mix of severe, recalcitrant uterine problems in the setting of unsuccessful non-hysterectomy therapies,  and a laissez-faire attitude toward the role of your uterus in your version of womanhood, a hysterectomy may turn  out to be best thing you ever did. But when the  clinical/personal mix leaves you feeling like less of a woman and wondering why you signed up to remove an organ that plays a crucial role in your feminine identity, you may well regret your hysterectomy. Sometimes the best clinical research just makes a lot of sense. The March 2010 issue debuted the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA).  Taking 10 years to complete, this team of  researchers from California’s Kaiser Permanente HealthCare System painstakingly kept track of over 1400 women with benign (non-cancerous) uterine and other pelvic problems as they decided to undergo hysterectomy, undergo alternatives to hysterectomy, or decide not to decide by foregoing treatment in favor of TIME, the unsung heroine of benign uterine problems. If you can  hang in there until menopause starts, most likely your uterus will calm down and the symptoms will … just…  slowly… stop. At the beginning of the trial, women were asked how they  felt about  the “benefits of not having uterus” lack of menstruation, uselessness of uterus once childbearing complete, no more birth control concerns the “value of the uterus ” sexual function feeling complete as a woman and “hysterectomy concerns” feeling older violated sad about loss of fertility resulting from hysterectomy
  3. 3. Over the ensuing decade, these self-rated attitudes were compared to symptom impact on each woman’s overall quality of life and sexual function as she dealt with her gynecologic disorder. Guess what they found? Among the women who chose hysterectomy, those who felt that the benefits of not  having a uterus outweighed the value of having a uterus and hysterectomy concerns, or for whom the underlying condition had major impact on quality of life and sexual function (pain in daily life, uncontrollable bleeding, painful sex, constipation, irritable  bowel, overactive bladder,  urinary incontinence and the like) and for whom non- hysterectomy therapies did not work who did not want to wait for natural menpause to but the brakes on the condition, reported that hysterectomy improved quality of life in a major and regret-free fashion,  including, when  applicable, their sex lives. Women for whom the underlying condition was not associated with severe impact on quality of life and sexuality, and who rated the value of having a uterus and hysterectomy concerns higher than benefits of not having a uterus were more likely to regret the hysterectomy. Over the past 25 years many a gynecologic staple indication for hysterectomy now comes with non- hysterectomy options. Conditions include fibroids (extremely common benign smooth muscle tumors of the uterus that can make for heavy or irregular periods, pelvic pressure, colorectal and urinary difficulties, infertility and enlarged abdomen), adenomyosis (spongy super- thickening of the lining of the uterus that can cause heavy and irregular periods), and endometriosis (abnormal location of uterine lining tissue outside of the uterus itself where it does not belong, often implanting on the tubes, ovaries, intestines and other pelvic organs causing pelvic pain, scarring and infertility). These options  include hormone suppression with birth control pills or  hormone-containing IUD (intrauterine contraceptive device), endometrial ablation using controlled cautery of  the lining of the uterus so that it doesn’t bleed very much, (http://www.nlm.nih.gov/medlineplus/ency/article/000903.htm), or shrinking fibroids using  uterine artery embolization, a  radiologic procedure that threads a tube into the uterine artery through the groin, injecting embolic material that  blocks bloodflow to the fibroids. (http://www.nlm.nih.gov/medlineplus/ency/article/007384.htm). So now we’ve got choices, and they often work quite well. It used to be wait for menopause, take harsh hormones, (look up Danazol for endometriosis when you have a chance), clean out the uterus with a D&C, and if none of that worked, your options were restricted to toughing it out or hysterectomy.
  4. 4. Besides these new therapies, it is important to understand  that not every condition needs treating. Mild endometriosis may never cause a problem short of a tendency to painful periods, or it can be as brutal as a cancer, socking onto every organ in the pelvis, ruining your fertility and making you feel like your belly’s on fire. Fibroids can be cute little nubbins scattered here and there with nary a clinical impact, or they can be gigantic super-ball-consistency uterine tumors the size of your head.  Dysfunctional  bleedng tack a few extra days on to your period, or it can be a  hemorrhagic pad-soaking, anemia inducing tsunami that knocks the wind out of your life every month. In the SOPHIA trial, of the 1400 women participating fully for the entire 10 years, only 207 (14.6%) chose hysterectomy- ”These women were more likely to report symptomatic fibroids and that they did not want to become pregnant” at the beginning of the study”. ” Women who reported higher levels of pelvic problem impact on sex or who had higher (mental stress) scores were more likely to choose hysterectomy as were women wtih higher scores on the “benefits of not having a uterus” scale and lower scores on teh ‘hsterectomy concerns” scale.  63.9% of  the 207 women who chose hysterectomy were very satisfied with the results. but nearly 22% were only   somewhat satisfied, about 7% were ambivalent, with the remaining, about 8%, frankly dissatisfied.  The majority of  women who used uterine artery embolization and endometrial ablation did not go on to hysterectomy, highlighting the growing role of these effective, uterine- preserving operations for conditions traditionally treated  with hysterectomy. The authors further state “Perhaps the most noteworthy are our findings regarding the significant role of women’s attitudes toward their uterus and hsyterectomy in their decision making regarding and satisfaction with this surgery.”, and “We cannot comment, however, on the extent to which these attitudes were elicited by or shared  with physicians.” Here’s the deal, if the condition is benign but truly ruining your life, and you really like your uterus, find a gynecologist who shares your perspective, and try the all appropriate non-hysterectomy therapies. For those of you who’ve already done everything BUT the hysterectomy, and the fibroids/bleeding/pain is DRIVING YOU NUTS, a hysterectomy just might make your life a lot better.
  5. 5. The Aging Ovary HEADS UP: for most non-medical people, hysterectomy = remove the uterus and ovaries. The medical definition of hysterectomy, however, is removal of uterus only, ovaries LEFT IN PLACE.  Your ovaries make almost all of your  sex hormones. And even if you’re menopausal, there may be some good  reasons to leave your ovaries right where they are until age 75 or so – see http://www.ncbi.nlm.nih.gov/pubmed/20226402, http://www.ncbi.nlm.nih.gov/pubmed/17513923, http://www.ncbi.nlm.nih.gov/pubmed/16055568. Really need a hysterectomy?  Make it a happy one, keep  your ovaries. I have the privelege of contributing my literature reviews to  the Journal of Sexual Medicine (JSM). Below you’ll find my JSM synopsis of the SOPHIA trial: Predictors of Hysterectomy Use and Satisfaction. Kuppermann M, Learman LA, Schembri M, Gregorich SE, Jackson R, Jacoby A, Lewis , Washington AE. Obstet Gynecol 2010 Mar, 115(3):543-551. This prospective observational Study of Pelvic Problems, Hysterectomy, an Intervention Alternatives (SOPHIA) monitored 1420 women over a 10 year period, to describe the natural history of the choice to choose or forego hysterectomy in premenopausal participants with benign clinical conditions for which hysterectomy was one management alternative. Baseline evaluation included pelvic symptom profile, quality of life scoring, sexual function and hysterectomy and uterus-related attitudes, in addition to use of Western and alternative medicine therapies. Hysterectomy and uterus related attitude evaluation included “benefits of not having uterus” (lack of menstruation, uselessness of uterus once childbearing complete, no more birth control concerns), “value of uterus (sexual function and feeling complete as a woman) and “hysterectomy concerns” (feeling older, violated, and sad about loss of fertility resulting from hysterectomy). Participants were English, Spanish or Chinese speaking women ages 31- 54 at enrollment in trial. Over the 10 year period, 207 (14.6%) underwent hysterectomy, some of whom received up to 8 years of follow-up before end of trial. Approximately 64% of these hysterectomy women were very satisfied, with ~22% somewhat satisfied, and the remaining 15-16% neither satisfied or unsatisfied, ~7% of whom were dissatisfied to varying degrees. Women satisfied with hysterectomy had higher QOL and / or
  6. 6. sexual function impact from the condition for which hysterectomy was performed, in addition to higher scores on the “benefits of not having a uterus” and lower scores on the “value of having a uterus” and “hysterectomy concerns” questions. The authors describe a greater likelihood to undergo and be satisfied with the outcome hysterectomy in women reporting greater pelvic problem impact on sexual function and pelvic problems overall, underscoring “the importance of determining the extent to which symptoms interfere with QOL and sexual function when counseling patients about hysterectomy and its outcomes”. The majority of women who underwent alternative therapies such as endometrial ablation and uterine artery embolization, did not go on to hysterectomy. The data clearly demonstrate the conclusion that “women’s attitudes toward their uterus and hysterectomy play a primary role in the decision to undergo and personal satisfaction with the outcome of hysterectomy” for benign conditions. Level of Evidence: IIa Share: 1 comment TAMMY MICHAEL { 06.13.10 at 8:05 am } 1 INTERESTING ARTICLE DR. ROMANZI! I WISH I DIDN’T RUSH INTO MY HYSTERECTOMY, I DID THE D&C FIRST, IT DIDN’T WORK, I ALSO THOUGHT I WAS GOING TO LEAVE THIS EARTH WITH MY UTERUS, IT WAS A WOMEN THING WITH ME. SO HERE I AM 4 YRS. LATER, HAVING PROBLEMS BECAUSE OF HYTERECTOMY THAT COULD HAVE BEEN DONE BETTER. I AM GLAD I KEPT MY OVERIES AND CERVIX, HAIL TO THE CERVIX! HAIL TO THE CERVIX! Leave a Comment Name E-mail Website 5 6 Submit
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