Vancouver
3 min

Should I get a hysterectomy?

Lesbian, 40, wants no kids and an end to mood swings and cramps

Dear Dr Ren,

What are the effects of getting a hysterectomy? I’m a 40-year-old lesbian, have no kids, want no kids, and I’m considering various methods to stop my periods. I’m mostly looking for relief from the mood swings and cramps I get. I have looked into the Mirena IUD, which supposedly stops menstruation and releases hormones so you aren’t sent into the other effects of menopause, like bone density loss, etc. But a friend had a hysterectomy and says it’s the best thing she ever did. I’m curious to know what health effects and risks are associated with the procedure, and if this is a surgery that is available on an elective basis.

Option Seeker

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Dear Option Seeker,

You are wise to be researching your options, and you do have a number of them. In the past, you would have been hard-pressed to find a doctor who would remove a healthy uterus. Even now that elective hysterectomy has become somewhat available, I urge you to be cautious and to seek medical advice.

Here are some factors to consider:

You will want to keep your cervix and ovaries. This means you must maintain regular Pap tests and internal exams to ensure your ongoing gynecological health. Though you will no longer have periods, you can still get cervical and ovarian cancer. Remain vigilant.

In seeking a doctor to perform this surgery, you want to ask if he or she does cavernous nerve–sparing surgery. This nerve is responsible for clitoral stimulation yet is rarely considered when hysterectomies are done. Astoundingly, this nerve path was mapped only recently. Previously, no one had thought to consider it!

Ask how your surgeon plans to preserve that nerve. If you don’t get an affirmative, knowledgeable answer, continue doctor shopping.

There is a risk of forming scar tissue or developing infection with this (or any) surgery. Hysterectomy is a major surgery that requires anaesthetic, with all its attendant risks.

There are several methods of doing this surgery: intravaginally, laparoscopically or with a bikini cut. Discuss these options with your surgeon.

You don’t tell me if you have any major gynecological issues prompting your decision. This will determine if it can be covered by MSP. You will need to present to your family practitioner with a problem and be referred to a gynecologist. It would be wise to begin questioning the specialist’s cavernous nerve knowledge at this point. If you have no gynecological dysfunction, you may have to pay for the procedure privately.

Given the considerable financial expense of having the procedure performed privately, the risks of undergoing surgery to remove a healthy organ, and the fact that you have only another decade or so of periods left, let’s explore your other, less invasive options.

If you are bothered by premenstrual symptoms, you may be able to mitigate them with the birth control pill, though you may find it delivers too much estrogen, causing other troubling effects.

The NuvaRing produces less estrogen and may well relieve your symptoms, but you should take occasional breaks.

This brings us to the Mirena IUD, which you mentioned you have investigated. This may well offer you the relief from periods you are looking for without the trauma of surgery and the risk of damaging that important cavernous nerve pathway.

The insertion fee for the Mirena IUD is several hundred dollars, but it remains in your uterus for up to five years. It contains no estrogen — it’s progesterone only — and after cramping and possible spotting during the first month or so, you will supposedly forget it’s there. Private gynecologists can insert it for you, but abortion clinics or Planned Parenthood (now called Options for Sexual Health) are expert at this as they do so many of them. Most women report a high degree of satisfaction with Mirena.

So there are the basic facts. You may be able to learn even more from a consultation with a nonjudgmental reproductive counsellor.

I want to address, too, however, the sociological aspects of your decision.

You must be very distressed by your mood swings and cramps to be considering a hysterectomy. I trust you have thoroughly investigated relief for those problems. If not, I urge you to do so.

Beyond this, I applaud your courage and willingness to do whatever is necessary to take care of yourself. Our society judges women in terms of our sexual attractiveness and our mothering qualities. Whether or not we subscribe to those values personally, we do not escape such universal assessment.

Your decision signifies independent thinking based on your particular needs rather than on gender-role expectations. Perhaps it seems a small thing, maybe a solution sought out of desperation or inconvenience, but it would not have been possible for you to consider such an option even a few decades ago. I celebrate your options and thank all the pioneers and rebels who have made possible the choices. Do we have further to go? Oh, yes.

Still, everyone like you who asks, “Why not?” kicks open more doors.