Adelaide Haas - The Womans Guide to Hysterectomy: Expectations and Options

Copyright 1995, 2002 by Adelaide Haas and Susan L. Puretz

All rights reserved. No part of this book may be reproduced in any form, except brief excerpts for the purpose of review, without written permission of the publisher.

CELESTIAL ARTS
P.O. Box 7123
Berkeley, California 94707
www.tenspeed.com

Distributed in Australia by Simon and Schuster Australia, in Canada by Ten Speed Press Canada, in New Zealand by Southern Publishers Group, in South Africa by Real Books, in Southeast Asia by Berkeley Books, and in the United Kingdom and Europe by Airlift Book Company.

Illustrations 1995 Carole Brugnoni

Library of Congress Cataloging-in-Publication Data
Haas, Adelaide.
The womans guide to hysterectomy: expectations & options / Adelaide Haas and Susan L. Puretz.Rev.
p.;cm.
Includes bibliographical references.
eISBN: 978-0-307-81543-9
1. HysterectomyPopular Works. [DNLM: 1. HysterectomyPopular Works.
WP 468 H112w 2002] I. Puretz, Susan L. II. Title.
RG391 .H33 2002
618.1453dc21

2001007331

v3.1

Every book is written and produced with assistance from many sources; ours is no exception. We acknowledge our debt to the people previously thanked for their help with the first edition.

Our research would not have been possible without the support of the physicians and their staffs, as well as Sieglinde Luskin, and Robert and Virginia Nacamu, who assisted in distribution of our survey; Minna Haas, who helped analyze the returned questionnaires; and Steve Sconfienza who guided us in the statistical analysis of the material. Most importantly, the women who told us their stories provided the personal insights that introduce nearly all chapters.

Our colleagues in the Sojourner Truth Library at the State University of New York at New Paltz helped us gain access to computerized databanks and track down even obscure references.

We received invaluable assistance from several medical professionals. Jed Lawrence Turk, M.D., FACOG, Physician with Fishkill Obstetrics and Gynecology in Fishkill, New York, and Attending Physician in the Department of Obstetrics and Gynecology at Vassar Brothers Hospital in Poughkeepsie, New York, read all medically related chapters of the manuscript of this second edition. His intimate familiarity with the latest procedures and controversies based on his training and his busy professional practice provided an up-to-date medical perspective. We are deeply grateful for his conscientious, thorough analysis, and helpfully detailed recommendations. We appreciate his dedication to this project.

Richard K. McNally, M.D., Director of Pathology for Kingston Benedictine Hospitals Laboratory in Kingston, New York, and Attending Pathologist and Assistant Professor at Albany Medical Center, read and critiqued chapters pertaining to diagnostic procedures and pathology. He made himself freely available to respond to our concerns, and provided prompt answers to our many queries.

Francoise Dunefsky, R.N., Administrative Director for Organizational Development at Kingston Hospital (Kingston, New York), read several chapters and made many worthwhile suggestions. Edmund L. Erde, Ph.D., Professor, Departments of Family Medicine and Psychiatry, UMDNJ/SOM, reviewed the chapter on the medical industry and made many suggestions. Rose Mancuso, Registered Dietician, gave input regarding nutrition and diet. Barbara Kaisik, R.N., F.N.P, and Kelly Davis, Registered Pharmacist at CVS n Saugerties, New York, answered technical questions. All will find their contributions on the pages that follow.

Additional readers for this edition were Marlene Arvan and Fran Moskowitz. Ruth Haas, Aloysius Helminck, and Joseph and Carma Haas served as frequent reminders of the importance of our project.

Carole Brugnoni took our ideas for illustrations and carefully prepared all the line art in this work.

Deepest appreciation goes to the people at Celestial Arts/Ten Speed Press. David Hinds saw the need for a book for women who were candidates for hysterectomy and agreed to publish our efforts. Veronica Randall endorsed this second edition and Marianne Lken and Meghan Keeffe, our editors, guided us through its publication.

Finally, we thank Phillip McDonald and Kurt Haas for sharing our commitment to writing this book. They read many sections and offered valuable comments. They understood the hours we needed to disappear into our studies and recognized that we had important messages for other women and their partners.

In the six years since the first edition of The Womans Guide to Hysterectomy was published, many things have changed. The proportion of American women undergoing hysterectomy has decreased significantly from about one in three by age 65 to one in four. This is largely due to new treatments for some traditional justifications for hysterectomy. For example, in a procedure now being researched, lasers are used to shrink uterine fibroid tumors.

For the roughly 25 percent of women who do have a hysterectomy, improved surgical procedures are available which typically reduce the recovery time both in and out of the hospital. Laparoscopically assisted vaginal hysterectomy is now frequently used instead of hysterectomy through an abdominal incision. Current research on hormone replacement therapy provides new options following hysterectomy. The growth of the Internet has placed a tremendous amount of accurate (and some questionable) information in the hands of those who seek it. These and other changes have prompted substantial revisions to many chapters. Research is ongoing, and the wise woman will keep herself current where her health is concerned.

Perhaps as a child you had your tonsils removed, or as an adult, a fractured leg or arm was placed in a cast. These are ordinarily not perceived as very threatening experiences compared to the mere thought of hysterectomy. Hysterectomy not only evokes the anxiety associated with major surgery, but often also raises disturbing questions regarding youth, femininity, and sexuality.

Our objective remains what it was in the first edition: to provide a positive, nonfrightening, consumer-oriented approach based on well-documented information that is clear, helpful, and encouraging.

How This Book Came to Be Written

ADDIES EXPERIENCE

When hysterectomy surgery was recommended for me because of enlarged fibroids in the 1980s, the gynecologist, Dr. K., at a routine annual checkup, commented, Those fibroids of yours are getting too big; we should plan to remove them.

Eager to avoid surgery, I sought several different medical opinions. I had read that the uterus decreases in size and that fibroids tend to shrink as women approach menopause. I was 43maybe if I just stalled for a few years the problem would go away by itself. I checked with four different physiciansthe gynecologist assigned by my insurance company, the family doctor, a female gynecologist at a large university medical center, and finally a male gynecologist who had performed the surgery on an acquaintance of mine. All agreed: Take the uterus out! Youve had your children, the fibroids have become too large to shrink, and they may impinge on your bladder or kidneys and cause serious problems.

I began to read as much as possible to prepare myself for what lay ahead. Poring over medical tomes and journals as well as popular magazines and books, I was dismayed at the limited amount of information available. Eventually I followed the professional advice, had the surgery, and recovered nicely. I was determined, however, to share what I learned with other women and to provide them with more complete and accurate information than I had.