Answers and Questions
by Debbie Braaten
“The great enemy of truth is very often not the lie; deliberate, contrived and dishonest, but the myth; persistent, persuasive and unrealistic. Too often we hold fast to the clichés of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of thought.”
– John F. Kennedy
June 11, 1962
The story of hysterectomy and oophorectomy, surgical removal of the uterus and ovary is a story of enormous loss on every level of life; physical, mental, and spiritual, yet the general public has perceived these surgeries as benign women’s surgeries. This insanity has continued year after year, decade after decade, for over a century without public knowledge of the importance that surgeries like these could have on women’s lives, and that it is happening in the United States. Women and men, for that matter, have not been informed about the multiple functions of these organs beyond their roles of sex and reproduction. It isn’t that the information isn’t available. It’s just that it has been left out, like sleight of hand. As stated throughout these letters, these sex-hormones affect every single cell in our bodies throughout life. There is no time in a woman’s life these organs aren’t needed. The reason, as Dr. Burke stated is that a lot less estrogen is produced is because it isn’t needed for reproduction. However, it continues to be utilized for the maintenance of health. “… many different organs and tissues have … receptors designed to work properly only when activated by estradiol.”1
Women should also be informed that their bodies produce testosterone, and the main source of testosterone in the female body are the ovaries. There is no other source that provides the adequate amounts women still need for building muscle, keeping bones strong, and with the presence of adequate estradiol, for sex drive or any other kind of drive. Presently, the only way women can get testosterone replacement is from compounding pharmacies.
The Intrinsa Patch, a testosterone patch developed for women with low libido after their ovaries had been removed was not approved by the FDA. Testosterone has more than one function in the body and is needed for a lot more than sex. That this patch was created only for sex drive after women’s ovaries were removed is ludicrous. The amount of testosterone created by the ovaries, at menopause, “becomes an increasingly more important portion of the total testosterone women manufacture.” It is needed structural maintenance and repair and is converted into the estrogen women still need.2
The patch, it was claimed by medical professionals, did not improve sex drive enough to be approved. Did anyone ask the participants if this result was okay with them? Not only that, but, all participants received the same amount of hormone, yet individual women may require different amounts to be effective. All men would not be expected to derive the same results using the same amounts of hormone. Neither would they have been expected to have been in a relationship with a woman for one year to participate in trials, yet women were required to have been in a relationship with a man for one year.
It has been two and one-half years since I spoke with Ann B. Burke. It has been 25 years since hysterectomy and bilateral salpingo-oophorectomy, surgical removal of both ovaries and fallopian tubes, were performed on me. Had I known how much these surgeries would take from my life, I would never have gone through with it. Post-surgical changes took place within 36 hours and have continued to compromise my health ever since. Hormone treatment has helped to maintain some semblance of good health, but the fight to ensure access to the bio-identical hormone replacement my body needs and finding a knowledgeable practitioner to prescribe them has been a tremendous effort and has taken its toll. I am bone tired and weary but will continue to do all I can to reveal the post-surgical consequences many have suffered and to clarify why some outcomes are beneficial and others not.
It astounds me, to this day, how these female surgeries are trivialized especially given the extent to which they affect women’s lives. Elizabeth Lee Vliet, MD wrote her first book about women’s health, Screaming to Be Heard in 1995, and we are still screaming. Still, no one listens. Our society reveres its medical doctors as if they are gods and could do no harm. As medical students, they are taught to “… absorb doctrine without argument or question.”3 There is no room for innovation. The state of the science of medicine can be better understood by Dr. Roger J. Williams in his book, Nutrition Against Disease when he wrote, “It then becomes easy to drift into the convention that what is accepted is really and unalterably true. When science becomes orthodoxy, it ceases to be science. It ceases to search for the truth. It also becomes liable to error.”4 Since surgery, I have become tethered to a medical system that destroyed life as I knew it and has left me without solutions. I have had to discover the solutions I need on my own.
I am honored for the initial interest demonstrated by Delegate Heather Bagnall who introduced me to Dr. Ann B. Burke, MD, FACOG, Fellow and Chairman, Maryland Section ACOG, American College of Obstetrics and Gynecology and Vice President of Medical Affairs of a large hospital. I am grateful Dr. Burke took the time from her very busy schedule to answer my questions more than once.
In preparing for this article, I focused on her responses to the following five questions:
- What has changed since 1996 when surgery was performed on me?
- Are women provided post-surgery hormone replacement options, and if so, how are these needs assessed?
- How is the term hysterectomy currently used?
- Can other organs be removed during surgery without the patient’s consent?
- Does Maryland have consent forms? Can I get a copy of the consent form?
WHAT HAS CHANGED SINCE 1996?
When I inquired about the changes in the field since my hysterectomy, Dr. Burke responded that a lot has changed since 1996. One of the things that has changed is surgical technique. Today, 75% of doctors use laparoscopy or robotic techniques which are considered “minimally invasive”. She also claims a lot fewer ovaries are removed. Some time ago ovaries were removed because of ovarian cancer risk in women 40-45 years or older. She said, today, there is better screening.
The great majority of hysterectomies are elective and are not performed for life-threatening reasons. According to HERS Foundation, Hysterectomy, Education and Resource Services more than 98% are unnecessary. Left intact, healthy ovaries would provide health-maintaining functions throughout life. Why are healthy organs continually removed? In his book, Male Practice, Robert S. Mendelsohn, MD, believes preventative medicine is the height of irresponsibility. Of preventative surgery, he says, “It’s like chopping down the prettiest tree in your yard ‘before’ it gets Dutch elm disease, ‘just in case’ it might.”5
There has been virtually no change in the rate of ovarian cancer in the last 20 years which is less than 2%. Removing the ovaries to decrease the risk of cancer is not justified especially considering the life-maintaining functions they perform. During a workshop led by Elizabeth Plourde, Ph.D., “Bio-identical Hormone Replacement, Common Sense Answers!” I learned the overall lifetime risk of ovarian cancer is one of the reasons used to justify ovary removal at the time of hysterectomy.6 The health benefits of preserving the ovaries especially in their functions to protect women from cardiovascular disease, osteoporosis, and Alzheimer’s and to preserve their sense of well-being, clearly outweighs their prophylactic removal. Not only that but Dr. Plourde explains, “…removal of the tubes and ovaries does not provide 100% protection” as some women develop cancer in the peritoneum (membrane covering the abdominal wall) which is indistinguishable from ovarian cancer.7
From the website, “Hormones Matter”, an article by author, WS, titled, “Hysterectomy: The Great Women’s Healthcare Con” by WS, points out the 2015 NIH, National Institute of Health (NIH) cancer statistics show that a woman’s overall lifetime risk of ovarian cancer is 1.3%. Ovaries in women are the equivalent of testicles in men, and men’s risk of developing prostate cancer is 16%, yet men’s testicles are rarely removed. Even though screening may be better, it doesn’t preclude false positives. How would men feel if incorrect screening led to the removal of healthy testicles? Would they be determined to go on with their lives as before without needed hormone replacement? They would not. More stringent screening does not mean no mistakes are made, and healthy organs will still be removed. Maybe mistakes don’t happen as often, but what if it was your organs that were removed?
As I said in the initial letter to Dr. Burke, ovaries left intact at the time of hysterectomy do not always continue functioning. Their function is dependent on blood supply which in most women comes from the uterine artery which is severed during hysterectomy. However, how blood is supplied the ovaries shows great variance among individual women. This probably accounts for differences in satisfaction with hysterectomy as those whose ovaries continue functioning will have more favorable outcomes than those whose ovaries fail. If the ovaries do fail, it doesn’t happen immediately but takes place over a period of two to four years after hysterectomy. The medical term for ovarian failure following hysterectomy is “de-facto castration”.
And last, no matter the technique used, minimally invasive or invasive, organs are still removed, and the effects of their removal remain the same.
ASSESSING THE NEED FOR POST-SURGERY
HORMONE REPLACEMENT OPTIONS
Are women provided post-surgery hormone replacement options, and if so, how are these needs assessed, Dr. Burke answered: hormones decrease dramatically at menopause. There are decreases in estrogen, testosterone, and progesterone. Hormone replacement therapy, HRT is used to manage the symptoms of menopause when indicated. HRT is indicated when the symptoms of menopause are significantly disruptive to the woman. Replacement therapy may contain estrogen, progesterone and testosterone and are dependent on symptoms, physiology, and desired effects.
Less ovarian hormones are needed at menopause because they are no longer needed for reproduction. Throughout life, hormones are necessary for the maintenance of health. There is no other source in the human body which provides a substitute for sex hormones and the myriad of functions they perform. Treating only the symptoms of “menopause” is, in my opinion, the opposite of treatment based purely on testing. Either way, the patient loses. And last, castration is not menopause. Jeannah Haber, creator of the website Hysterectomy Awareness (hysterectomyawareness.org), says, “Loss of ovarian production, is NOT the same thing as MENOPAUSE!”
It puzzles me how women without ovaries can have menopausal symptoms. There seems to be no distinction made between hormone replacement for intact women and those who are not. Also, there is no medical code for women who have had both ovaries removed or for those whose ovaries have failed following a hysterectomy. I doubt, very seriously, that men who had been castrated would be given the same medical code and the same hormone therapy as those intact.
The goal of hormone therapy is to bring about optimal results. The Food and Drug Administration (FDA) claims that efforts to police compounding by restricting interstate distribution would ensure safety. Clearly, this does not make sense, but who is listening? Bio-identical hormone patients were safe prior to the FDA Memorandum of Understanding and would have stayed safe had it not been for the FDA having fallen down on the job and ignoring complaints about the Massachusetts pharmacy that initiated FDA action. Instead pharmaceutical representatives met with leaders in congress smearing compounded drugs, saying compounding pharmacies were making false claims and creating a hazardous picture of compounded drugs such as bio-identical hormones. The FDA claims the new rules for compounded hormones would ensure safety, but this is not true. All the new rules do is reduce competition between hormone manufacturers and compounding pharmacies, and women are not getting the hormone replacement their bodies require.
Pharmaceutical manufacturers have no room to talk about safety, and representatives in congress should know better. FDA-approved drugs have continued being used despite evidence they were not safe, especially those used on women. Below are a few examples:
- The Dalkon Shield, an intrauterine device introduced in 1971, and at the request of the FDA, was taken off the market in 1974 after being installed in 4 million women even though the it had been inadequately tested and began producing dangerous side effects. Over one million have suffered acute pelvic infection, one in five women have become sterile and 17 died. However, it wasn’t until millions had been paid out to victims, with claims still pending, that the makers of the device urged doctors to remove them.8
An IUD, intrauterine device, Paragard was approved by the FDA in 1984. It wasn’t until the last few years, 2019-2020, that a marketing campaign forced the device into the spotlight. Before making a decision about using Paragard, I hope women not only look at the fine print but that they read beyond the lighthearted advertising. Some things cannot be reversed.
- The synthetic female hormone, diethylstilbestrol (DES), prescribed to prevent miscarriage in women for 30 years had not been tested for its long-term effects and in a study by the University of Chicago Medical Center was found to be ineffective against miscarriage. Long-term side effects began appearing in 1972 which included cancer of the breast, vaginal cancer in some of its female children and genital abnormalities in some of the male children to whom they gave birth.9
- Or consider the FDA-approved vaccine, Gardasil whose maker has paid out millions to victims suffering adverse effects.
- And Vioxx, the FDA-approved drug that killed half a million.
Yet the hormones I use in pellet form that I used to be able to get in the exact amounts my body needed have been restricted so that I now must use this hormone regimen in predetermined amounts just like manufactured hormones. One-size-fits-all hormone replacement does not equal optimal results for everyone and sometimes not even most. If these restrictions were imposed on men’s hormones, would they have to put up with one-size-fits-all hormone replacement?
It is ridiculous to expect us to continue with our lives as if nothing happened when the truth is that women like me have been compromised and disconnected. Subcutaneous hormone pellet therapy is utilized in patients in “five continents” and the “safety and efficacy of both estrogen and testosterone pellet therapy has been documented throughout the world’s peer-reviewed journals.”10 Bio-identical hormones are unlike the manufacture hormones used in the WHI, Women’s Health Initiative of 2002 were Premarin and PremPro, a synthetic estrogen and progestin. These manufactured hormones had already been shown to cause breast cancer, heart attack and stroke 50 years prior. Dr. Donovitz said the flaws from the WHI have been published many times, yet continues to be held as the “gold standard” for hormone replacement therapy.11 Premarin is made from pregnant mare urine and is unlike anything produced by the human body. Bio-identical hormones with the exact structure as those made in the human body were not used in the WHI.
I was surprised Dr. Burke mentioned testosterone as it is rare to hear of this as being part of women’s HRT, hormone replacement therapy. How would practitioners know how much testosterone to give a woman if they don’t know what her body produced prior to surgery? There are physiologic standards, but, again, we are not all the same, and without prior testing, hormone replacement becomes a guessing game that results in even more reduced health. The most comprehensive and correct information on testosterone in women can be found in a Maturitas letter from Science Direct. It lays bare all the presumptions we have about bioidentical testosterone replacement for women.
Women’s hormone-producing organs continue to be removed, but effective, bio-identical hormone treatments are discouraged and even outlawed. Doctors should have to tell women that if these organs are removed or fail following hysterectomy, they will most likely need bio-identical hormone treatment that will not be available to them. If women knew they would become debilitated without the hormone therapy their bodies need, would they agree to surgery? Even if it is available, insurance usually does not pay, and the out-of-pocket cost is too much for most.
Continued in Part IV…
ENDNOTES FOR PART III
1 It’s My Ovaries, Stupid!, Elizabeth Lee Vliet, MD, p. 57.
2 Your Guide to Hysterectomy, Ovary Removal, & Hormone Replacement, Elizabeth Plourde, PhD, p. 47.
3 Male Practice, Robert S. Mendelsohn, MD. p. 25.
4 Male Practice, Robert S. Mendelsohn, MD, p. 26.
5 Male Practice, Robert S. Mendelsohn, MD, p. 88.
6 Your Guide to Hysterectomy, Ovary Removal and Hormone Replacement, Elizabeth Plourde, CLS, MA, pp. 48-50.
7 Your Guide to Hysterectomy, Ovary Removal and Hormone Replacement, Elizabeth Plourde, CLS, MA, p. 52.
8 Male Practice, Robert S. Mendelsohn, MD, p. 35.
9 Male Practice, Robert S. Mendelsohn, MD, p. 35-6.
(This is the third part of a series by Debbie Braaten sharing her experience with the challenges navigating the emotional and medical labyrinth which followed her 1996 hysterectomy and the revelations that followed. Parts One and Two can be visited through these links.)