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you will truly benefit from the surgical removal of your
Three (Unhappy) Musketeers
uterus, I am here to share information about the benefits
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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. 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. 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. 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. 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. 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
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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!
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