As a physician with over two and a half decades dedicated to women’s health and hormone replacement therapy, I’ve witnessed significant shifts in the landscape of women’s healthcare. One procedure that has consistently captured my attention is the hysterectomy.
While this surgery can be a lifesaving or life-altering intervention for many women, it’s essential to understand the nuances surrounding this procedure.
Regional Disparities: A Puzzling Trend
A striking observation is the higher prevalence of hysterectomies in the Southern United States compared to the Northeast. If you live in Florida, you have a higher chance of being recommended a hysterectomy than if you live in New Jersey.
While the exact reasons for this disparity are complex, several factors likely contribute.
Cultural attitudes toward women’s health, access to alternative treatments, and socioeconomic disparities may all play a role. It’s crucial to explore these differences further to identify potential areas for improvement in women’s healthcare.
Who Undergoes Hysterectomy?
Hysterectomy rates vary across different age groups and ethnicities. Younger women, often in their reproductive years, may undergo this procedure due to conditions like endometriosis, fibroids, or uterine cancer. However, it’s essential to exhaust less invasive treatment options before resorting to surgery.
Interestingly, certain ethnic groups have higher rates of hysterectomy. While more research is needed to fully understand these disparities, factors such as genetic predisposition, cultural beliefs about women’s health, and access to healthcare may contribute to these differences.
Common Hysterectomy Misconceptions
Whether full or partial hysterectomy, the procedure can greatly impact hormone production, leading to early onset menopause or increasing symptoms associated with perimenopause.
Hysterectomy is a complex surgery with two primary procedures, each impacting hormone production.
- Total Abdominal Hysterectomy (TAH): This surgery removes the uterus but leaves the ovaries intact.
- Bilateral Salpingo-Oophorectomy (BSO): This procedure removes both ovaries and fallopian tubes.
Misconception 1: TAH is a better option with less impact on hormones
A common misconception is that the TAH procedure is less impactful to hormone health and balance. But what is not fully understood is that even when the ovaries are left intact, with a TAH procedure, the surgery itself can cause a decline in hormone levels. This is due to the need to clamp arteries during the procedure, which causes a lack of blood flow to the area. This lack of blood flow can impact the ovary, causing a “mini-stroke”.
Additionally, when the uterus is removed, the arteries that feed the uterus and the ovaries are removed, resulting in a lower amount of blood circulating to the ovaries. The net result is reduced blood flow, which leads to a lower functional ovary. This can lead to primary ovarian insufficiency (POI), causing lower estrogen and testosterone levels, which lead to symptoms like mood swings, hot flashes, irregular or missed periods, decreased sex drive, etc.
Misconception 2: Hysterectomy Only Impacts Estrogen Production
While often discussed in relation to estrogen, it’s crucial to remember that the ovaries also play a role in testosterone hormonal balance.
- Total Abdominal Hysterectomy (TAH): While TAH doesn’t directly affect testosterone production, the procedure and subsequent hormonal shifts can indirectly influence hormone levels as mentioned above, which will play a role in optimal testosterone levels.
- Bilateral Salpingo-Oophorectomy (BSO): As the primary source of testosterone in women is the ovaries, a BSO will significantly reduce testosterone levels.
Navigating Hormone Health Post Hysterectomy
For women who undergo a hysterectomy, the net impact of the procedure can lead to a cascade of symptoms, including lowered sex drive, weight gain, hot flashes, night sweats, mood swings, and vaginal dryness.
This abrupt hormonal change highlights the critical need for comprehensive post-operative care. Understanding hormone replacement options is paramount to maintaining optimal health and quality of life post-surgery.
Education empowers women to make informed decisions about their healthcare and to advocate for their needs. By understanding the potential hormonal shifts and available treatment options, women can work collaboratively with their healthcare providers to develop personalized plans that address their unique symptoms and goals.
Bioidentical hormone replacement therapy (BHRT) can be a valuable tool in managing these symptoms. Unlike traditional hormone replacement therapy, BHRT utilizes hormones that are chemically identical to those produced by the human body.
This personalized approach can offer significant relief for many women. It’s essential to work closely with a healthcare provider experienced in hormone replacement to determine the most appropriate treatment plan.
While hysterectomy remains a vital surgical option for many women, it’s important to approach this decision with careful consideration. Educating women about the potential risks, benefits, and alternatives is paramount.
By fostering open dialogue and providing comprehensive post-operative care, including BHRT when appropriate, we can improve the overall well-being of women who undergo this procedure.
Disclaimer: This blog post is intended for informational purposes only and does not constitute medical advice. Please consult with your healthcare provider for any concerns or questions.
As our Associate Medical Director, Dr. Angela De Rosa is integral to the continued education and innovation here at Nava Health. Dr. Angela DeRosa, DO, MBA, CPE, is a dynamic professional on a mission to change the face of women’s health and wellness. As a respected, internationally recognized authority on women’s hormonal health, Dr. DeRosa understands the range of health issues women face leading up to and during menopause, as she was in full-blown menopause by age 35. Dr. DeRosa has more than 25 years of experience in the medical field, both on the pharmaceutical side and in clinical practice.
Dr. DeRosa’s enthusiasm for educating patients on the realities of menopause and the risk factors of hormonal health imbalances has never waned. It was the driving force behind her first bestselling book, A Woman’s Health Survival Guide: How to Prevent Your Doctor From Slowly Killing You. Her book and its controversial title caught the attention of the public, media, and the medical community.
Dr. DeRosa is on the advisory board for the European Menopause and Andropause Society, a member of the International Menopause Society International Society of the Study of Women’s Sexual Health, and a researcher on women’s health issues. Dr. DeRosa is a Midwestern University Clinical Assistant Professor and a Past Arizona Osteopathic Medical Association President.