Q: I am confused. I have fibroids, and my gynecologist told me that I should consider a hysterectomy. He said I should have a complete hysterectomy. But I've heard that I can have part of my uterus taken out and leave my ovaries. I am afraid to take estrogen. What is your advice?
-- Fairfield, Conn.
A: The formal definition of hysterectomy is the surgical removal of the uterus. Complete hysterectomy means that the entire uterus is removed. Partial hysterectomy means that only part of it is removed.
However, some health professionals use the term complete hysterectomy to include the removal of the ovaries (oophorectomy) and fallopian tubes, which connect the uterus to the ovaries.
There's yet another term, radical hysterectomy, which is also used in different ways by different physicians. Some use the term to refer to the removal of the uterus and the surrounding connective tissue and lymph nodes only. Others include removal of the ovaries as part of a radical hysterectomy.
Because of this confusing use of the terms, it's important to ask the doctor to explain specifically what parts of your body would be removed during a recommended hysterectomy and what the impact of removing each part would be. This assumes that having a hysterectomy at all is the best choice.
There are six main reasons to recommend a hysterectomy, whatever the type. They include invasive cancer of the uterus; uncontrollable bleeding from any cause; and fibroids that are causing symptoms, if they are in certain locations and are too large to remove alone. Three additional reasons are severe infection, endometriosis, and complete prolapse of the uterus.
A relatively new procedure decreases the need for removal of healthy parts of the uterus when fibroids need to be removed. In this procedure, a catheter is inserted into the large artery in the groin and fed up into the small artery that feeds a single fibroid. Then little beads are released that clog this artery. This causes blockage of blood flow to the fibroid making it shrink.
Because of the potential to drastically reduce the 600,000 hysterectomies done in North America each year, the procedure got quick approval from the FDA, even though only about half the people experience significant benefits and even though the impact over many years has not been evaluated. Because this procedure was only just approved, it may be hard to find a doctor who is now performing it.
Another approach that was even more recently approved by the FDA is called the ExAblate 2000 System. This procedure uses magnetic resonance imaging (MRI) to guide the use of high-frequency, high-energy sound waves to destroy fibroids and other non-cancerous tissue.
According to studies that were done to get approval for the system, about 70 percent of women got relief of symptoms caused by their fibroids, while 20 percent went on to have surgery anyway.
Not knowing any information about the size and location of your fibroids, I can't provide specific advice. As with any recommended medical or surgical procedure, ask the doctor what the risks and benefits are. Also, find out what alternatives are available, including waiting, and how they compare with what is being recommended.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.