Hysterectomy

HYSTERECTOMY: THE SHOCKING TRUTH

by Lee Rothberg

Woman's Newspaper, Princeton, NJ.  c.1986

1. A conversation with Nora Coffey, founder of hysterectomey educational resources and services.

In 1978, Nora Coffey, then in her mid-thirties, had surgery which sent shock waves throughout her body and changed her life forever. The operation removed both her uterus (hysterectomy) and her ovaries (castration). However, contrary to what Coffey had been advised by both her medical and lay resources, their removal produced changes in her body which left her emotionally and physically crippled.
    Prior to the operation, Coffey describes herself as "a strong, healthy, vigorous woman, working as a researcher in biochemistry." Then she says she began to experience annoying, irregular vaginal bleeding which lasted nearly a year. Without exploring any other method of treatment, says Coffey, her doctor advised a hysterectomy.

Before consenting to the surgery, Coffey researched the subject in local libraries and questioned women she knew who had already gone through the operation. According to Coffey, all her resources agreed with her physician — be done with the messy bleeding, be freed from the worry of pregnancy, be a new woman, have the hysterectomy.

Thus, supporting high expectations and a positive attitude, Coffey agreed to have her uterus removed. While Coffey was on the operating table, the surgeon decided to remove the ovaries as well to avoid the possibility of later ovarian cancer.

Coffey says she had been told that she would be back at work after only a few weeks. "If there was indeed a self-fulfilling prophecy (you get what you expect)," says Coffey, "I should've been back at work because I expected to feel terrific."

Yet, as time passed, recovery eluded her and, much to her horror, Coffey began to realize that she had "asked the right questions, but gotten the wrong answers." The books she had read, the women she had spoken to, and the doctor who had advised her had, according to Coffey, "all lied".

She suffered from symptoms of estrogen (a female hormone produced in the ovaries) deprivation. Her skin became like parchment. She was often depressed, extremely fatigued, and had difficulty sleeping. Cellular changes occurred on the surface of her eyes. "It's like accelerated aging," she laments.

Incapacitating bone and joint pain forced her into arm and leg braces within a year after the surgery. "All of the fluid in my joints dried up," says Coffey. "I was immobile."

She experienced short-term memory loss. Things said 20 years ago could be recalled, but Coffey had trouble remembering something said moments ago.

She had trouble connecting objects with their names. "I'll look at a chair and know that you sit in it, but I'll lose the word 'chair'," says Coffey.

She lost the intense maternal feelings she says she once had had for her children. "It was like a curtain going down over my feelings," says Coffey. "The highs and lows of my emotions simply flattened out."

And she lost the sexual desire she had had for her husband. Before the operation, says Coffey, "sex had been, on a scale of one to ten, a ten plus." After the operation, "there was no sexual desire or feeling," she says. "There was a deadening of sensation, from the waist to the mid-thigh."

Coffey speaks frankly of the degeneration of her once wonderful sex life. After her hysterectomy, says Coffey, "We made love only once in a while, but there was no physical sensation for me.

"I tried to imagine the reverse situation — if I was a sexual person and he was not; if he would obviously prefer reading a book." Says Coffey, "I'd probably not want to have sex very often."

Coffey's family also suffered from the after effects of the surgery. She says her children complained that she no longer danced or rode bikes with them and her husband regretted their lost intimacy (they have since separated).

Coffey set out to find a solution to her emotional and physical dilemma. "I had the good fortune, if you will, of being fairly wealthy," she says. "I could go anywhere in the world to find a solution to these problems."

She tried estrogen replacement therapy, but had little success with it. On occasion, when her skin is so dry it cracks, Coffey says she still uses Premarin (a synthetic estrogen) to alleviate that symptom, but it does little else for her.

She tried testosterone implants, even though she knew that this anabolic steroid used by some athletes is associated with liver cancer, permanent masculinizing effects and an unpleasant hypersensitive clitoral feeling which does not abate after discontinuing the drug. The six-month implant relieved her joint pain almost immediately, and; while she did experience a classic steroid reaction — puffiness from water retention — she chose to live with the knowledge that any long-term effects would happen far in the future.

The implant also improved her sexual desire. But it did not produce a corresponding increase in her sexual fulfilment. "Sexual desire can be stimulated by taking androgens," she admits. "But then all you have is a stimulated libido in a dead body."

Finally, after using the implants for over seven years, disturbing side effects led Coffey to seek substitute therapy. A friend suggested acupuncture. Desperate to discontinue the implants and fearful of a return of immobility, Coffey tried it. "It really helped," she says. "I go every week. It has boosted my energy level and general feeling of well-being."

The technique works, says Coffey, because it stimulates the adrenal glands to produce estrogen and the male hormone androgen.

It has been eight years since Nora Coffey had her uterus and ovaries removed. Today, she says that her energy level is borderline at best. "I push myself every day, every minute, every second," she says. She still has no desire for sexual intimacy and maternal feelings toward her children are depressed. She still faces the possibility of immobilizing joint pain.

A Long Island couple received a $500,000 award from a jury because the woman's gynecologist unnecessarily performed a hysterectomy in 1979, causing medical complications and requiring additional surgeries and continuing pain.
    When asked why she had ever consented to the surgery, the woman explained that she had been the doctor's patient for 17 years. "When he said I needed a hysterectomy, I believed him," she said.  — Newsday (April 27, 1985)

But over these past eight years Coffey has also done something to stop other women from going through what she has had to endure. In 1982, Nora Coffey founded an organization called HERS (Hysterectomy Educational Resources and Services) which gathers both medical and lay information on "the alternatives to hysterectomy and the known risks and complications of the surgery". "I wanted to stop this from happening to my mother, my sister, my daughter," says Coffey. "From the instant that I knew what had happened to me and why, and that I could prevent this from happening to even one other woman, it became my goal," says Coffey.

2. ARE THE HYSTERECTOMIES PERFORMED IN THIS COUNTRY NECESSARY?

According to numerous sources, hysterectomy (the surgical amputation of the uterus) is today the most frequently performed major surgery in the United States. Figures, according to Naomi Stokes' The Castrated Woman, approached the one million mark in 1985.

In addition, says Nora Coffey, President and founder of the HERS Foundation, 512,000 women undergoing a hysterectomy last year had their ovaries removed (oophorectomy, or female castration) during the surgery whether the ovaries were healthy or not.

However, there is evidence that much of this surgery is unnecessary. While the figures are subjective, a number of authorities in the field estimate that the percentage of unnecessary hysterectomies ranges from thirty to ninety.

Over 5,000 women whose doctors have recommended hysterectomy have received the names of second opinion physicians from the HERS Foundation, says Coffey. Only 2% of the 5,000 have gone on to have the surgery.

Dr. Niels Lauersen, New York gynecologist and author of It's Your Body: A Woman's Guide to Gynaecology, estimates that about one-third of the surgeries are unnecessary. While the surgery can save a life in cases of confirmed invasive cancer or uncontrollable infection or bleeding, Dr. Lauersen says that most hysterectomies are elective. "No woman should ever agree to a hysterectomy before she has tried all other avenues of treatment," he cautions.

Dr. Penny Budoff, author of No More Hot Flashes and Other Good News, says that 70% of the patients that come to see her for a second opinion don't need the surgery.

Dr. Mitchell Levine, a Boston gynecologist, says "There's no question that a very, very high percentage of the hysterectomies done in this country can be avoided. My own personal guess is something in the 90% range."

There are many hypotheses as to why so many physicians perform so many unnecessary hysterectomies. The theories range from simplicity and cost (removing a uterus is easier and cheaper than spending hours in microsurgery removing fibroids) to the need to make money.

"The uterus is a favored target for a small number of unscrupulous doctors who deliberately use scare tactics to persuade patients to have high-priced, unneeded surgery," says Dr. Herbert Keyser, author of Women Under the Knife: A Gynecologist's Report on Hazardous Medicine.

"Some of us aren't making a living, so out comes a uterus or two each month to pay for the rent," admitted a Baltimore specialist in a 1975 New York Times interview.

However, there seems to be another reason that so many doctors — and patients — agree to the removal of the uterus. Much medical and lay literature supports the widely accepted attitude that hysterectomies have no serious long-term side effects, that a woman's uterus serves no purpose once she has born her children, and that a woman does not value her reproductive and sexual organs as does a man.

Because the female sexual organs are hidden deep in the body out of sight, says Coffey, the uterus and ovaries do not present as looming a figure as the prominent external male genitalia.   "Women haven't been taught to value their reproductive and sexual organs as a man values his," says Coffey.

The Physician's Manual for Patients, Genell J. Subak-Sharpe, Editor (1984), states: "While it is to be expected that you will experience a short period of depression and fatigue after surgery, there is no reason to be concerned about the long-term effects of the operation. . . . Although the operation does signal the end of childbearing, women who undergo hysterectomies can usually look forward to many years of health, vitality, and sexual enjoyment."

The Woman Doctor's Medical Guide for Women by Barbara Edelstein, MD (1982) states: "Your uterus is nothing but a big, unresponsive blob. There are those who argue that it can increase orgasmic response by increasing pelvic congestion, but the vaginal wall, which is richly supplied with blood, can do all the congesting you need for good orgasm."

Understanding Hysterectomy: A Woman's Guide by F.G. Giusini, MD and FJ. Keefer, MD (1979) states: "Organic and emotional reasons are the only valid ones for a lack of sexual response. Sexual response is an emotional experience that finds its source in a mind and heart which is prepared for it. Whether a woman has or does not have a uterus has nothing to do with her sexual response."

There is an abundance of misinformation oh the subject of hysterectomy and its effects on a woman's body, says Coffey. "We know that at least 9,000 women (who've called HERS) have been affected with adverse after-effects of hysterectomy."

The long-term consequences of hysterectomy/oophorectomy can include an increased risk of coronary heart disease, bone and joint pain with resulting immobility, chronic fatigue, urinary incontinence and frequency, depression, loss of short-term memory, osteoporosis (brittle bones), loss of maternal instinct, blunting of emotional feeling, vaginal dryness and thinning, and excessively dry skin, say numerous sources.

"The two most common illnesses that women think they have years after the hysterectomy are arthritis and Alzheimer's," says Coffey, referring to bone and joint pain and memory loss.

Women don't often connect these symptoms with the surgery as these symptoms may appear months or years afterward, she adds.

But the most tragic misinformation, says Coffey, deals with the effect of hysterectomy on sexual response. Anaphrodisia (the loss of sexual desire, arousal and sensation) affects many women after hysterectomy, she says.

Coffey's claim that many women lose their libido (sexual desire) after hysterectomy is substantiated by both the calls her Foundation has received and recent medical findings.

"A Post Hysterectomy Syndrome," by D.H. Richards, published in the October, 1974 issue of Lancet, reports a loss of libido in some patients as well as a post-hysterectomy syndrome characterized by depression, fatigue, headaches, hot flushes, dizziness, urinary symptoms, and insomnia. The paper attributes many of these symptoms to hormonal imbalances. It cautions physicians not to consider their patients "neurotic" when presented with these complaints.

"Your uterus is nothing but a big, unresponsive blob." — The Woman Doctor's Medical Guide for Women by Barbara Edelstein, MD (1982)

"Sexual Response After Hysterectomy/Oophorectomy: Recent Studies and Reconsideration of Psychogenesis," by Dr. Leon Zussman, et al, published in 1981 in the American Journal of Obstetrics and Gynecology, criticizes the psychogenic theory, which relies solely on psychological factors to explain the loss of sexual feelings after the surgery, the authors contend that hormonal and anatomical factors contribute to the loss of sexual functioning. The researchers found that "from 33% to 46% of women have difficulty becoming aroused and reaching orgasm after this surgery."

Theresa Larsen Crenshaw, a physician specializing in sexual medicine, explains in her book Bedside Manners (1983) that whiule most doctors tell their patients that hysterectomy should have no negative effect on their sexual responsiveness, she has seen patients who prove otherwise.

Women with whom Coffey has spoken say that their doctors believe sex should be the same after hysterectomy. "Since the outer genital organs and the vagina are not affected, a woman's sexual activity is not impaired and her sexual desires should not change" is the "current information and opinion" in a pamphlet called "Understanding Hysterectomy" (1983) developed by the American College of Obstetricians and Gynecologists. It seems, says Coffey, that many physicians believe that as long as the vagina can accommodate a penis, sex should be great. And the women believe it.

However, she adds, much of the confusion over maintenance or loss of sexual desire probably resides in the value the woman placed on sex before the hysterectomy. "If, on a scale of one to ten, sex was a one," says Coffey, "a woman won't lose much. If, on the other hand, it was a ten, she loses it all."

Not only does the American public appear to minimize the effect of hysterectomy on the female body, it also appears to ignore the possibility that this major surgery in and of itself can result in serious postoperative complications and even death.

In The New Our Bodies, Ourselves, written by the Boston Women's Health Book Collective, it is reported that between 40% and 50% of the women who undergo a hysterectomy suffer complications in the postoperative period. Hemorrhaging, injury to the urinary tract, perforation of the bowel, and infection are just some of the immediate postoperative complications of this surgery.

The mortality rate for hysterectomy (deah as a direct result of the surgery) is one to two per thousand, writes the Collective. Anesthesia complications, bleeding and infection are the cited causes. At the current rate of hysterectomy, the number of deaths from the surgery can approach over one thousand per year.

An article written by Dr. Charles East-erday et al called "Hysterectomy in the United States" and published in the August, 1983 issue of the Obstetrics and Gynecology Journal states: "Substantial disagreement persists over the appropriate indications for hysterectomy compared with those for conservative surgery or alternative therapy. . . . Despite advances in operative gynecology, hysterectomy today carries a substantial risk of morbidity."

3. THE HERS FOUNDATION — FREE INFORMATION, GUIDANCE AND REFERRALS ON HYSTERECTOMY

According to Nora Coffey, founder and President of the non-profit HERS Foundation in Philadelphia, PA, too many doctors perform unnecessary hysterectomies, too many fail to tell women that there can be devastating after-effects from removal of the uterus or ovaries, and too many don't offer alternative treatment for the problems that are, seemingly, so quickly solved with the knife.

Likewise, says Coffey, too many women fail to ask for more information before surgery, too many subsequently suffer from the aftereffects, and too many remain silent, fearing the label of hypochondria and pretending that any malaise is "all in their heads". What woman wants to admit that she's asexual? Coffey asks.

Coffey and her staff of three at the HERS Foundation believe that women should pay more attention to what is being done to their bodies. Founded in 1982, HERS provides free information--over the phone---on the known risks and complications of the surgery as well as methods of alternative therapy. For women who are suffering from the aftereffects of the surgery, HERS offers coping techniques and validation of the symptoms.

The HERS library has over 1,000 articles from scientific journals, says Coffey, and they are available to any caller for a fee of $2. The articles cover topics such as the common reasons why women are advised to have hysterectomies, alternative and less invasive methods to treat these ills, and immediate and long-term side effects of the surgery. Coffey says that she has read everything that's been written on hysterectomy since 1913.

Coffey and her staff, all of whom say they have experienced unnecessary hys-erectomy, claim to have counseled over 5,000 women whose doctors recommended hysterectomy. The calls, they add, come from throughout the United States as well as from Europe, Central America and the Middle East.

Only 2% of these 5,000 continued with the surgery, says Coffey. The 98% who didn't found help through alternative methods and in some cases needed no treatment.

Coffey says that HERS has also counseled over 9,000 hysterectomized women who are experiencing symptoms such as loss of maternal feeling, bone and joint pain, chronic fatigue, hot flashes, insomnia, loss of short-term memory, diminished emotional responses, loss of sexual desire and a host of other hysterectomy-related symptoms.

"Women call me and they're confused and bewildered," says Coffey. "They've had a hysterectomy (with or without the removal of the ovaries) and they have no sexual feeling. They can't understand it.

. "I just explain that the uterus plays an important role in sexual response," she continues," and that when you have the uterus amputated it's like trying to walk without a leg. All of a sudden they understand."

Coffey says that many of the women who call tell her that they've talked to their gynecologist about their loss of sexual desire only to be rebuffed with a comment like "I've never heard anything like that before."

Almost one million American women were hysterectomized this year, writes Naomi Stokes in her book The Castrated Woman. Over 500,000 were castrated as well. That's almost two hysterectomies arid one castration a minute.

"When I get thirty calls from women who've been hysterectomized by the same doctor and he tells each and every one that same thing, I know that he knows darn well what he'd doing to those women," she says irately.

Coffey and her staff say they talk to from 30 to 50 women a day, two or three of whom are suicidal. However, they also say that they don't give medical advice:. Instead, says Coffey, they offer a referral list of specialists for second opinions as well as extensive information on the topic.

Coffey explains that when women call, the HERS staff does not say, "Don't have a hysterectomy". In fact, the staff places no judgement on the surgery. They say, "These are the things that you can do about this condition. These are the doctors on our referral list who can give you a second opinion." Then it's up to each women to make up her own mind.

Some women, says Coffey, call HERS to share their own remedies for symptoms such as dry skin, vaginal dryness and hot flashes. (Many women report that oil of evening primrose in a capsule taken orally is helpful, says Coffey. Others find that vitamin supplements, especially vitamin Bl, help with failure to concentrate, depression, and memory loss.) However, Coffey says that HERS does not prescribe — it simply relates other's experiences.

The Foundation's quarterly newsletter publishes information on hysterectomy and its possible side effects (such as increased risk of heart disease, osteoporosis or brittle bones, and post hysterectomy syndrome).  Recent issues have included review of new literature on nthe sunbect, discussions of prior HERS conferences and pages from the diary of a woman who had undergone a hysterectomy.

HERS shedules periodic conferences on subjects pertaining to hysterectomy/oophorectomy.  The next will be at the Sheraton University City in Philadelphia on September 11,  1986. The keynote speaker is Dr. Robert Mendelsohn, a Chicago physician and outspoken critic of unnecessary hysterectomies.

In his book, Malepractice: How Doctors Manipulate Women, Dr. Mendelsohn states, "If modern medicine continues on its present course, one of every two women in this country will part with her uterus before she reaches the age of sixty-five."

For further information, contact the HERS Foundation at 422 Bryn Mawr Avenue, Bala Gynwyd, PA 19004; (215) 667-7757.

4. WHAT FUNCTIONS DO THE UTERUS AND OVARIES PERFORM?

For most of us, the ovaries exist to house the eggs and the uterus to provide "bed and board" for the fetus. However, both play more extensive roles in the female body.

It has recently been discovered that the uterus produces a hormone called prostacyclin which offers women protection against cardiovascular (heart) disease. When the uterus is amputated, this protection vanishes and the chances of coronary disease increase. According to the Easterday study, cited above, "premenopausal hysterectomy is associated with a threefold increase in the risk of coronary heart disease during the remaining premenopausal years."

The uterus also functions as an integral part of the female sexual response. In fact, it is involved in every phase of

According to "Hysterectomy In The United States", a study done by Dr. Charles Easterday et al, the mortality rate for hysterectomy (death as a direct result of the procedure) averages one or two per thousand surgeries. That's three to five women a day.

female sexual arousal — excitement, plateau, orgasm and resolution — as defined by sex researchers William Masters and Virginia Johnson.

During the excitement phase, the uterus fills with blood, much the same way as the penis, and elevates in the pelvic cavity. During the plateau phase, the uterus expands to twice its normal size, thus increasing sexual tension. During the orgasmic phase, the uterus contracts rhythmically. And, during the resolution phase, the uterus gradually loses its sexual tension as the blood recedes.

The ovaries are "the essence of a woman's femininity," says Dr. Niels Lauersen, New York gynecologist and author of Listen to Your Body: A Gynecologist Answers Women's Most Intimate Questions. The ovaries produce the female hormones estrogen and progesterone as well as a small amount of androgen, a male hormone, all of which produce sexual desire and an overall feeling of well-being. They continue to produce these hormones, albeit in reduced quantities, even after menopause.

If the ovaries are removed (castration) in a premenopausal woman, an abrupt process termed "surgical menopause" occurs. The process is more severe than normal menopause as the body has no time to gradually adjust to the loss of these hormones.

Loss of libido (sexual desire), hot flushes, depression, weight gain, headaches, fatigue, vaginal dryness and thinning, and backaches are some of the symptoms that result from physical hormonal disruptions. Dr. Lauersen states, "Many castrated women feel a reduced

A study of over 8,000 women (ages 45-55) conducted by Massachusetts epidemiologist Sonja M. McKinlay reported that "Women who had a hysterectomy reported much more chromic illness than did women who underwent a natural menopause." According to the Psychology Today review of the study, the use of sleeping pills and hormones doubled in the hysterectomized group, who also felt generally less healthy than their naturally menopausal sisters.

Some physicians prescribe estrogen replacement therapy (ERT) for women who complain of ill side effects after removal of their ovaries. Others, however, disagree with this theory.

"It's safe to say that the ovary is a complex, highly evolved organ with many biochemicaland hormonal functions," says Dr. Mitchell Levine, a Boston gynecologist. "Topretend that somebody taking an estrogen pill every day would substitute for this highly complex organ whose positive and negative feedback process cycles to the brain, is ridiculous.

"I talk to a small number of poverty-level women who call and say things like 'I had female surgery and I lost my nature. How do l get it back?' It took me a while to be sure I understood exactly what she was saying," says Coffey. "But her expression 'lost my nature' is what many women describe to me as 'I died on the operating table. I'm not the same woman anymore.'"

You may partially replace it but you can never duplicate a normal ovary," he concludes.

In this country, half of the women who undergo a hysterectomy also have their ovaries removed. The reasoning given is to "save" the woman from the remote possibility of ovarian cancer.

However, Dr. Lauersen issues this warning to women concerning prophylactic excision of the ovaries: "Usually it is not necessary to remove the ovaries of a menstruating woman during hysterectomy. A doctor may say that he wants to remove the ovaries to prevent ovarian cancer, an insidious disease that does not have obvious symptoms. However, studies have indicated that it would take 7,500 oophorectomies (excision of the ovaries) in order to prevent one death from ovarian cancer. Ovarian cancer, which only accounts for 4% of all cancers in women, is more frequently discovered after menopause in women between 55 and 64 years old."

Coffey has observed that the degree to which a wotaan loses her libido depends upon the extent to which she enjoyed sex before her hysterectomy. "The loss is proportionate to what was there before," says Coffey. "If, on a scale of one to ten, sex was a one, a woman won't lose much. If, on the other hand,.it was a ten, she loses it all."

Unfortunately, even if the ovaries are not removed during hysterectomy, the operation can result in a reduced blood supply to the ovaries, thus decreasing or even eliminating their function. Many women who have retained their ovaries exhibit the same symptoms as those who have had their ovaries removed.

5. ALTERNATIVE THERAPIES

- Dr. Niels Lauersen, a New York gynecologist, says that hysterectomy can save a life in cases of confirmed invasive cancer, uncontrollable infection or bleeding.  However, he adds that "No woman should agree to a hysterectomy before she has tried all other avenues of. treatment."

Dr. Robert Mendelsohn, author of Malepractice: How Doctors Manipulate Women, says that doctors' "selling" of hysterectomy is smooth and convincing. He urges women to familiarize themselves with other gynecological treatments which are far less invasive.

The following list of alternative therapies is not intended to serve as medical advice. It is meant simply to illustrate some of the therapies, other than hysterectomy, available to women who have certain identified medical conditions other than the life-threatening ones cited by Dr. Lauersen. The list is compiled from Dr. Budoffs No More Hot Flashes and Other Good News, Dr. Lauersen's Listen to Your Body, and conversations with Nora Coffey, founder and President of the HERS Foundation.

Fibroid — a solid growth of muscle tissue and fibrous connective tissue found in or on the uterine wall which, according to Nora Coffey, normally grows slowly or in periodic growth spurts.

Because fibroid growths are often called "tumors", the lay patient may immediately fear that she has cancer. However, according to Dr. Lauersen, fewer than one half of one percent ever proceed to that stage.

Fibroids can cause symptoms such as bleeding, pain, pressure and frequent urination. However, many women have fibroids and aren't even aware of them.

Fibroid growth is usually stimulated by estrogen. Fibriods usually shrink during menopause.

Alternative therapy for fibroids includes limiting one's intake of estrogen (avoid birth control pills and estrogen-rich meat) and/or myomectomy, a delicate operation which removes only the fibroid and leaves the uterus intact. "Women need to see a specialist. Not all surgeons are experienced with myomectomy." adds Dr. Lauersen.

Abnormal Uterine Bleeding (menorrhagia) — irregular bleeding from the uterus that is not associated with a tumor, inflammation, or pregnancy. Usually caused by a hormonal problem, dysfunctional uterine bleeding should end with menopause.

Alternative therapy for menorrhagia includes hormone treatment and/or a D and C (scraping the lining of the uterus) and/or (after thorough investigation) adjusting to the inconvenience.

There is also a new technique called YAG laser surgery. This innovative procedure, as yet in its infancy, combines a solid YAG crystal and neodymium to produce an intense infrared light which coagulates and sterilizes instantly. The procedure, which removes the lining of the uterus (endometrium) while leaving the uterus in place, is not without risks, in addition, it requires that the performing surgeon be expert with the YAG laser as well as with hysteroscope, a telescope-like instrument that is inserted into the uterus for the procedure. According to an article in the March, 1986 issue of Ms. Magazine, fewer than a dozen surgeons are, at this time, qualified to perform the technique.

Endometriosis — a condition in which the lining of the uterus (endometrium) migrates to other pelvic structures (e.g. fallopian tubes, ovaries, on the outside of the uterus), causing severe pain and bleeding in the abdominal cavity before and during menstruation. Endometriosis ceases after menopause.

Alternative therapy for endometriosis includes hormone treatment or limited surgery to remove the misplaced endo-metrial tissue or trying to live with the discomfort.

Pelvic Inflammatory Disease — an infection of the pelvic cavity often caused by an IUD or a sexually transmitted disease.

Alternative therapy for pelvic inflammatory disease includes triple antibiotic therapy administered intravenously or surgery limited to scraping away the infection in conjunction with intravenous antibiotics.

During hysterectomy in a premenopausal woman, ovaries may be routinely removed to "save" the woman from the remote possibility of ovarian cancer.  However, Dr. Lauersen notes that ovarian cancer only accounts for 4% of all cancers in women and is more frequently discovered after menopause in women between 55 and 64 years old.

Prolapsed Uterus — a weakening of the muscles which hold the uterus in place.

Alternative therapy for prolapsed uterus includes Kegel Exercises to restore muscle strength or use of a pessary (a device which holds the uterus in place) or limited reconstructive surgery to repair muscles and suspend the uterus, requiring a specialist.

Hyperplasia — a condition caused by crowded cells and glands that build up in the uterus because they have not sloughed off during menstruation.

Alternative therapy for hyperplasia includes hormonal treatment and/or a D and C.

Dysmenorrhea — severe menstrual cramps.

Alternative therapy for dysmenorrhea includes exercises to relieve cramps, and/or Antiprostaglandins (medication specifically for the relief of cramping).

Urinary stress incontinence — the loss or leakage of urine when there is sudden pressure to the bladder (e.g. when sneezing or coughing).

Alternative therapy for urinary stress incontinence includes Kegel exercises to improve bladder control and the tone of the muscles controlling urination, or limited reconstructive surgery.

In-situ cancer of the cervix — non-invasive cancer of the surface of the cervix.

Alternative therapy for in-situ cancer of the cervix includes removal of the diseased tissue with cryosurgery (al freezing technique) or cone biopsy (removal of a cone-shaped portion of the cervix).

Lee Rothberg is a Registered Nurse and member of the Editorial Board of the Woman's Newspaper.