Hysterectomy, Pt I

Hysterectomy

Part I

It has taken me a very long time to complete this project. I am very grateful for Jim Turner’s patience as he has demonstrated more patience than I knew a person could have. Thank you.

– Debbie Braaten

Introduction

by Jim Turner

Women get bad treatment from the medical system. Read “The healthcare system thinks helping women is bad for business” by Gloria Lau & Mary Jacobson, MD, published January 10, 2020 in Quartz, a guide to the new global economy for people in business who are excited by change.

Mastectomy, cesarean birth, hysteroscopy, episiotomy, hysterectomy, all might serve a helpful function in certain very specific life or health threatening situations faced by women. Each is embroiled in hot controversy about misuse, overuse, failure of consent/choice, absence of serious consideration of each patient’s individual physical and emotional costs. Each woman fights the elevation of system efficiency over maximizing personal wellbeing. Pressure for the system affects every encounter between an individual woman and a healthcare professional.

In the following article, presented as a five-part series this week, Debbie Braaten, a longtime member and supporter of Citizens for Health and its ally Voice for HOPE (Healers of Planet Earth), tells her story of hysterectomy from the point of view of one individual woman. She presents a wrenching story. We believe all health care professionals, particularly those who work with women, will benefit from reading Debbie’s story. We also believe that all, and especially male, family members  of women facing health care interventions can benefit from this article.

We thank Debbie Braaten for opening our eyes to the struggle women face in their encounters with the health system in general and specifically with the issue of a hysterectomy that served the system more than the individual. Please read the article and apply its insights in the best way that you can.

– James S. Turner
Washington D.C.
October 4, 2021

Hysterectomy: My Story

by Debbie Braaten

I had always been grateful I had been born in America and not in a country where women were subjected to cruel procedures that rendered them unable to experience sexual pleasure until hysterectomy and oophorectomy were performed on me. These surgeries not only took away my ability to derive pleasure from sex but pleasure of any kind. November 11, 1996, the day my uterus and ovaries were removed from me created grief as I had never known. I grieved for my organs, the hormones they produced and their function.

Some women have benefited from hysterectomy while others have not, but the reasons for the different outcomes are not articulated and instead are blamed on the psychological stability of the patient. However, the outcomes are due to the physical removal of the organs. According to Susan Love, MD, “Hormonal disruption affects substances called beta-endorphins which are associated with feelings of wellbeing.” Furthermore, she says “…endorphin levels are influenced by a change in levels of ovarian hormones oestrogen and progesterone.” Their removal affects all aspects of the whole person; physical, mental, and spiritual. The abundant, whole-body health I had enjoyed prior to surgery was tremendously undermined after these surgeries were performed on me, and I have never been the same. There are no words that can accurately describe the loss. To me these procedures are barbaric.

Prior to surgery I was energetic, ambitious, and driven, but afterward, I could hardly function. The health issues the surgery was “supposed” to resolve, were not and more problems were created. My life was drastically altered, and there was no going back. I wish I knew what I know now, but back then I didn’t even know what questions to ask.

Struggling to understand why important information about hysterectomy’s consequences are not provided to women by their doctors before surgery, I searched for answers. I contacted a member of the Maryland General Assembly’s Health and Government Operations Committee and District 33 Delegate, Sid Saab. I have attached a copy of the response I received from his Office by Ms. Wynee Hawk (see Part 3 of this series). Basically, she said advising a patient of all potential risks was a standard of care issue which is not legislated because it is so variable. The common outcomes of removing the female organs are predictable and well-documented in medical journals. However, women’s access to information remains obscured. Once the patient signs the consent form, whether she has been informed or not, there is no recourse.

I have come to my own conclusions about the disparaging effects of hysterectomy. The outcomes are dependent various aspects, such as:

(1) The organs removed (uterus, ovaries, etc.);

(2) The time in a woman’s life they are removed (before or after menopause);

(3) The continued functioning of organs left intact, i.e. ovaries; and

(4) The individual woman’s hormonal make-up.

Even after having been performed for over 100 years and altering thousands of lives, most women are unaware of the multiple functions of the female sex organs. Before undergoing it myself, I believed the only post-surgical difference would be that I would no longer be able to have children. According to the HERS Foundation Data Bank, 99.7% of women in an ongoing study were given little or no prior information about hysterectomy’s adverse effects.

Neither are we informed of alternatives to surgery such as acupuncture or natural hormones. In a 1970 article written for the New York Times, Jane Brody reported about the hazards of gynecological intervention “even when simpler, less costly, less dangerous and equally effective alternatives are available.” It is incomprehensible to me this information is not common knowledge.

The first oophorectomy was performed in 1817 and the first hysterectomy in 1843. In the beginning hysterectomy was performed for life-saving purposes only. Today most are elective and are not performed to save a patient’s life. The US performs 600,000 hysterectomies each year, more than any other country in the world,1 despite having been included in a congressional hearing about unnecessary surgeries in 1976 and the subject of a congressional hearing regarding unnecessary hysterectomies in 1993. In February of 2000, NBC News Correspondent, Robert Bazell wrote a Reuters Health article addressing the indiscriminate performance of hysterectomy, titled, “Far Too Many Hysterectomies Still Being Performed”. As it stands today the US hysterectomy rate remains unchanged. Concern about its over-performance was raised as far back as 1946 in an article of the American Journal of Obstetrics and Gynecology by a leading researcher, Norman F. Miller:

“But, if what we have observed in this look behind the scenes is confirmed by future studies, then we may be sure that when the curtain rises we shall witness a tragedy, painful and far-reaching in its implications.”

Perhaps the most crucial failure of women’s healthcare is that most medical practitioners are unaware of hormone effects or that these effects ebb and flow with women’s cycles or at different times in her life. In her book, Hysterectomy, Ovary Removal & Hormone Replacement, Elizabeth Plourde, Ph.D. a Menopause Practitioner with  North American Menopause Society (NAMS) says, “The ovaries are not just for reproduction – they are the foundation of life… essential for the healthy continuation of each woman’s life.”2 (p.48) She goes on to say these organs are needed to build strong muscles and bones; for healthy cardiovascular systems; metabolizing vitamins, minerals and food; for the function of the bladder and bowels; stabilization of blood pressure; for sleep, energy levels, sex drive and general well-being.

Despite important connections between hormones and health, levels are rarely checked. Even though excellent blood tests have been available since the burgeoning of fertility clinics in 1962. Most practitioners are unaware which hormones to test for or how to interpret the results. Even if blood assays are taken, most fail to connect the patient’s symptoms with test results. The business of healthcare interferes with healthcare itself when treatments rely exclusively on test results.

In her book, It’s My Ovaries, Stupid!, Elizabeth Lee Vliet, MD tells us science continues to reveal the amazing way “hormonal shifts interact with endocrine, immune, metabolic, cardiovascular, respiratory, musculoskeletal, reproductive, urinary and nervous systems.” (p.72) She also says hormones are chemical messengers and that the ovaries have receptors, or docking sites, for hormones that are made in the immune and nervous systems linking our female hormones to all the other organs of the body including the brain. Additionally, ovarian hormones are responsible for linking one organ’s function with another’s. In my opinion, this information is far too important to continue being left out of the public domain especially for those who might be considering surgery.

How many of us know that “falling estradiol levels can trigger migraine headaches, regardless of your age” or that at your period’s start, falling estradiol can “cause a spasm of the arteries that serve the heart, called coronary vasospasm”, or that low estradiol contributes to sleeplessness, anxiety, and high blood pressure and “falling estradiol levels can cause major mood swings”? As for the latter, who didn’t know that? (Vliet, pp.70 and 248) When hormone connections are missed, an incomplete assessment of a woman’s health is the outcome.

The misinformation that continues to infuse the field of women’s health leads nowhere and serves no one. An example of this is the belief that the ovaries die at menopause. I suppose this could be true if the only purpose of the ovaries was reproduction, but it is not. Aside from the ovaries function of storing and maturing eggs, it has another important role as an endocrine gland and produces hormones before, during and after menopause. Author of “The Amazing Ovaries”, Dr. Sherrill Sellman, ND said that according to Dr. Susan Love, “at menopause, the outer part of the ovary or theca where the eggs grow and develop, shrinks, but the innermost part or stroma actually becomes active for the first time in a woman’s life.”

In a 1984 study on an evaluation of the preservation of the ovary at the time of hysterectomy by Dr. Garcia and Winnifred B. Cutler, Ph.D., Dr. Cutler questioned the removal of healthy ovaries during hysterectomy. Celso Ramon Garcia, MD,3 (1922-2004) said that after menopause “the ovaries continue to function working in conjunction with other body sites such as the adrenal glands, skin, muscle, brain, pineal gland, hair follicles and body fat to produce hormones.” He goes on to say, “the postmenopausal ovaries promote bone health and skin suppleness, support sexual functioning, protect against heart disease and contribute to a woman’s health and well-being.” Christiane Northrup, MD, sums it up simply proclaiming, the ovaries change at menopause from “baby-making mode to maintenance mode.” Why would the belief that the ovaries die at menopause continue to be perpetuated? Not only that, but all organs need a healthy supply of blood to stay alive, so how could they die when blood continues to be supplied?

In addition to the hormones estrogen and progesterone, women’s ovaries produce testosterone, yet most women nor their doctors are aware of this. In his book, Restore Yourself, which he co-authored with Victoria Houston, James Simon, MD claims that women make a lot of testosterone. In fact, he says, “They make buckets of it.” Over a life-time, he continues, women will make more testosterone than they do the estradiol. In fact, he says that over a lifetime, men make more estrogen than women, so men make more of both hormones. (p. xi)

For some women the loss of testosterone is more devastating than for others. According to Dr. James Dabbs, who was a professor and researcher at Georgia State University, “Those with relatively high levels of testosterone and who experience a radical drop… may find the vital loss of energy more disturbing than women whose baseline levels… have been relatively lower.”4 With so much misinformation and control forced on men’s health by the pharmaceutical industry, finding the replacement that is right for each individual is arduous, if not impossible. If our blood levels aren’t taken prior to surgery or at any other time in our lives, how can anyone know what needs to be replaced or how much? They don’t, and there is much unnecessary trial and error trying to find hormone replacement that works. During this time the patient’s health deteriorates. One more thing is that the manufactured hormone, Premarin, the hormone replacement usually given women is unlike anything in the human body. Bio-identical hormones are the exact same structure as what is made by the human body and is needed in appropriate amounts and balances.

Relaying the importance of ovarian hormones, Elizabeth Plourde, Ph.D., says that estrogen and testosterone produced by the menopausal ovaries are essential for the healthy function of the body. She goes on to say that, as the body’s non-ovarian sources of testosterone decrease, the amount supplied by the ovaries becomes increasingly important. Although the adrenal glands produce small amounts of testosterone, it is not enough for most after the loss of their ovarian hormones. (p.47)

No matter the healing modality used, traditional or alternative, there seems to be a consensus that the body can heal itself. When hormone-producing organs have been completely removed, the body cannot heal how it is supposed to. I believe Harry Hoxsey, alternative medical practitioner said it best when he claimed, “If you give the body what it needs, the body can heal itself,” but the first part of the statement, “If you give the body what it needs” is crucial.

The surgery to remove both ovaries is called “surgical menopause”. This term, however, leads us to believe it is just like the menopause entered naturally. The biggest difference between natural and surgical menopause is that one is a natural event in a woman’s life, and the other is not. Surgeons cannot replicate a woman’s natural cycle. When the organs are removed, the hormones produced by them are removed as well as their functions. The removal of the ovaries is a great trauma to a woman’s body at any age.

A medical term and more accurate description for the removal of both ovaries is “female castration”. If ovaries left intact at the time of hysterectomy fail, the medical term is “de-facto castration” and happens more often than previously thought, usually within two to four years. These terms are rarely used in doctors’ offices.

Ovarian failure happens when blood is no longer supplied to the ovaries. Most women’s ovaries are supplied blood via the uterine artery which is cut during hysterectomy. However, not all women’s ovaries are supplied blood the same way. If the ovaries continue receiving a healthy supply of blood, they can continue functioning. There is no way to know this prior to surgery but may account for why some women report beneficial results while others do not. There is no way to know the route of blood supply prior to surgery.

The term hysterectomy itself has been used differently throughout time and has been confusing. Hysterectomy is the surgical removal of the uterus while the removal of the uterus and cervix is called total or complete hysterectomy. Women who have undergone complete or total hysterectomy are often told by their doctors that everything was removed, and this is confusing, because it seems everything would include the ovaries as well. A separate term is used for the removal of the ovaries; oophorectomy. In the US, total hysterectomy has been used to mean the surgical removal of the uterus, ovaries, fallopian tubes, and part of the cervix.

Naturally menopausal women and women whose ovaries have been removed are categorized together and given the same medical code and prescribed the same hormone treatment which is most often not covered by insurance. The needs of surgically castrated women and intact women are very different. Elizabeth Plourde, Ph.D. says that ovaries in women are the equivalent of testicles in men, but we would not lump men whose testicles remain intact with those whose organs have been removed. Neither would they be expected to take the same amount of hormone replacement or the same regimen.

Table taken from page 165 of “Your Guide to Hysterectomy, Ovary Removal & Hormone Replacement” by Elizabeth Plourde, Certified Menopause Practitioner with the North American Menopause Society.

What is important to realize is that insurance companies and the FDA have referred  compounded drugs, including bio-identical hormones, as unapproved new drugs, but that would mean they are illegal (International Academy of Compounding Pharmacists Annual Meeting & Compounders on Capitol Hill, 2008). Because of false claims of safety, compounded hormones have fallen under “Unprecedented Expansion of FDA Oversight”. “The FDA MOU: A Real Threat to Access & Choice!”; “Take Action #1: Comment on the FDA MOU Docket TODAY!”; and “Take Action #2: Support Sen. Vitter’s Amendment to Save Access to Compounded Medications”.

How many millions have died from FDA approved medications?

Women have a right to know what may lay ahead for them. Had my organs been left intact, I would not have to concern myself with this, but now I am tethered to a broken medical system that, after all this time continues to base women’s health on the male model, missing women’s cyclic natures. There are some who have undergone these surgeries who do not want HRT, but I would rather be dead than live without mine as that is exactly what I felt like for nine years until I got the hormone replacement that most resembled my body’s hormones. Hormones or their bio-identical equivalent are necessary to prevent heart problems, osteoporosis, and Alzheimer’s, but finding a practitioner who has the specialized knowledge needed for women like me is not always accessible or affordable. Men, however, get the hormones they need which are most often paid for by insurance, yet they are rarely castrated.

Upon advice, I finally obtained a copy of my operative report and later had the courage to read it. Not only did it tell me the procedure performed, but it said the organs removed from my body were healthy. I gave up healthy organs that supplied my body with the hormones it needed. I did not have to rely on a medical system that is still confused about women and their hormones.

Recently, headlines have drawn attention to the “opioid crisis” which has been a curse for women without their ovarian hormones especially without the hormone, estradiol. An article about the crisis has been written by Red Lawhern and can be found online. When my hormone levels meet my needs, my pain levels are very low, and when my hormones are low, the pain is excruciating and stays that way until hormones are replaced. This may not account for all pain, but hormones, especially the estrogen, estradiol helps raise the pain threshold. This is rarely accounted for by medical doctors.

The pain the surgery was performed for was not relieved and was not due to endometriosis as the doctor suggested. The endometriosis had been completely removed by a previous surgeon. The result is that healthy organs were removed from me based on a history of endometriosis.

One important consideration for women considering surgery is the possibility of adhesions; adhesions which never go away. In 2002, I had yet another surgery for the removal of pelvic adhesions. Upon my first visit, the surgeon told me she might get in and find nothing. I thought I would go out of my mind. Why do we still question the validity of women’s concerns? Did she think it was, “all in my head?”  Not only were there adhesions, but my pelvic cavity was dense with them. The adhesions which had been made worse by the removal of my uterus and both ovaries were attached to my colon.

For a couple of years after the adhesions were lysed, I was fine, but the adhesions slowly reappeared. A doctor I had seen previously told me adhesions don’t cause pain, but I found information to the contrary at Clear Passage Physical Therapy. A study on pain mapping of adhesions found that adhesions that do not allow movement, do not usually cause pain, but those that allow movement between two points such as the bowel and peritoneum cause great pain.

I had been told by a pain specialist I would have to undergo more medical intervention to eradicate the pelvic pain. This intervention consisted of shots injected directly into my spine to numb my pelvic area. I have sacrificed enough. I am unwilling to undergo questionable interventions that have inconclusive outcomes and will not subject my body to them. The price I have paid for my willingness to let a surgeon intervene has been far too high already.

I found a specialized physical therapy for women that was like the therapy I discovered at Clear Passage. I began this treatment at Washington Hospital Center in Washington, DC. From there I was referred to Her Place Physical Therapy in Columbia, Maryland. Prior to treatment at Her Place, I could hardly stand for more than an hour without experiencing excruciating pain. Even with hormone therapy the pain was chronic and was slowly chipping away at what was left of my life. During my therapy at HER place I was under the care of a pain medicine specialist. After eight months of therapy, I could stand for five and six hours at a time with very little pain. The only thing I must do on a continuous basis to keep the pain at bay is stretching exercises, and I am off pain medicine.

It is important that I also share the part of my journey that included pain medicine. After years of being in excruciating pain even with hormone treatment, I sought help. I could not continue life on a functioning level without help. Later I was also put on one of the newer medications that was supposed to take me off the traditional pain medicine (a narcotic). The newer medication was worse to withdraw from than any other I had been prescribed. Some doctors are lying to save their jobs at the expense of the health of their patients. I was so angry when I was prescribed the newer medication before my physical therapy was completed that I didn’t fill my prescription right away (over one week) until I couldn’t stand the pain anymore. I was doing okay and went to work and an hour or so later, found I couldn’t stand. Someone found me and brought me to the doctor. I wish I would have gone to the hospital, so they could see I had taken the prescribed dose. At a later visit with that doctor, she said, “I think I gave you too much.” The doctor had prescribed too high of a dose. I thought I was dying when I laid on that floor.

Women have a right to know that during hysterectomy, the doctor can remove the ovaries without the consent of the patient. This applies to other procedures as well. In Male Practice, Robert S. Mendelsohn, MD writes, “There is only one rational explanation for all of the needless hysterectomies that are being performed. Doctors, being dedicated to the most extreme forms of intervention and wanting the income that comes from intervening, fail their patients miserably by not giving them the information they need to make an informed choice.”

Dr. Mendelsohn also cites a student of medical history, G.J. Barker Benfield, who described the medical treatment women receive at the hands of doctors wrote, “…exploited their power as physicians to retaliate against and control women who were challenging male dominance. They did it by performing aggressive surgery, such as clitoridectomies5 and ovariectomies, as a means of showing women who was boss.” (p.23) When I began my journey to discover how something like what happened to me could continue being done to women for over 100 years without ever hearing of the consequences, I remember Nora Coffey’s words to me, “It (castration) is a very powerful thing to do to a woman.”

Female castration in the 21st Century is unacceptable.

ENDNOTES FOR PART I

1 One of the common reasons cited for lower hysterectomy rates in other major countries is that “these countries have state-paid health plans that removed the economic incentive to perform more surgery”. Robert S. Mendelsohn, Male Practice, p.99.

2 Conventional medicine has also held the theory that estrogen production begins to decline during the perimenopausal years. Dr. Jerilynn Prior, a Canadian endocrinologist, reviewed all pertinent references from 1990 to the present and found no evidence that estrogen levels fall before menopause. All evidence indicates that overall-all estrogen production remains at premenopausal levels.

3 A leading researcher in the field of Obstetrics and Gynecology, Celso-Ramon Garcia (1922-2004) was Director of Surgery at the Hospital of the University of Pennsylvania and faculty member of Penn Medicine’s Division of Human Reproduction and contributed dramatically to the understanding of the management of menopause.

4 Dr. James M. Dabbs was a social psychologist and professor of psychology at Georgia State University and was best known for his behavioral endocrinology work on testosterone. Dabbs’ information referenced from The Hormone of Desire, Susan Rako, MD, p. 79.

5 https://www.mintpressnews.com/MyMPN/female-genital-mutiliation-usa-forgotten-history/

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(This is the first 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.)