Dr. Herbert Goldfarb Answers Your Questions

Aug. 25, 2003 -- -- Dr. Herbert Goldfarb, director of gynecological endoscopic surgery at NYU Downtown Hospital in New York, provided information about alternative solutions to hysterectomy in a segment on 20/20. Goldfarb answers some viewers' questions here.

QUESTION: For reasons of breast cancer I was given a hysterectomy five years ago at age 35. Since then, unable to take hormone replacement, I am suffering from hot flashes multiple times each day. I don't sleep longer than three hours without waking up. And intercourse is painful to the point of not being worth the pain. Any suggestion?

DR. GOLDFARB: The treatment of hot flashes related to surgical menopause is a real problem. Many oncologists accept that in spite of breast cancer vaginal estrogenic cremes can help reverse some of the sexual difficulties.

QUESTION: I had a hysterectomy four years ago, I'm 57 now. Being single for some time, I didn't have sex until recently and I discovered my uterus was MUCH SHORTER and could not accommodate my partner, and [sexual intercourse] was very painful. Although my partner was very careful and caring, it was just not the same. My doctor NEVER explained that my uterus would be shorter. If he had I would not have had a hysterectomy! (My uterus had dropped and I was going through the change so, a hysterectomy was highly recommended). When I asked my doctor if this could be fixed, he gave me a prescription for Librex, a pill that is for lubrication, which wasn't the problem. However, he (doctor) said it would help loosen up the uterus tissue and with more "practice" my uterus would probably become stretched enough to enjoy and accommodate my partner. I never got an answer if an operation could correct this or not? Can an operation be done to lengthen my uterus? Or do I have to go through life like this?

DR. GOLDFARB: Hysterectomy can sometimes result in a shortened vagina which results in pain during intercourse (dysparunia) The vagina can actually be lengthened by frequent intercourse. As an alternative plastic vaginal dilators can be used to dilate the vagina in conjunction with vaginal estrogenic creme.

QUESTION: Is there any connection with having a tubal ligation and starting perimenopause at an early age? I had the surgery when I was 32 years old and started perimenopause at the age of 35. I too have lost a lot of my sex drive. I also have friends in the same situation and we are all wondering the same thing.

DR. GOLDFARB: It is unusual to have such sequela after tubal sterilization. If extensive coagulation has been performed, then it's conceivable that blood supply to the ovary can be interrupted. It's also possible that the menopause was coincidental, but it's highly unusual.

QUESTION: I have been diagnosed with vaginal prolapse. I also have some bladder leakage. I have been advised to have a partial hysterectomy. My vagina can be seen upon exam, but it is not protruding out. I am 42 years old and have already had an endometrial ablation with balloon, a few years ago, for excessive bleeding. My periods are now "normal." Do you recommend this procedure for me at this time, or should I wait? If I wait … how long do you suggest? Thank you in advance for you advice.

DR. GOLDFARB: Vaginal prolapse can be treated by laparoscopic support surgery. Hysterectomy is not necessary. In addition, after hysterectomy a significant number of women suffer recurrence and have subsequent prolapse of the vaginal vault.

QUESTION: I was told that I have fibroids and, if necessary, the solution would be a hysterectomy. I asked about other procedures that would be less invasive, and he recommended the hysterectomy since I don't plan on more kids anyhow. Are there any studies done of any other alternative methods of removing fibroids? Success rate, and complications, if any? Thank you very much for your time.

DR. GOLDFARB: Hysterectomy for fibroids is usually unnecessary. For more information see my Web site at www.nohysterectomy.com

QUESTION: My daughter has chronic endometriosis and has already had one perfectly healthy ovary removed. She still has significant pain. Does she have any options other than hysterectomy?

DR. GOLDFARB: Endometriosis should NOT be treated by hysterectomy. First we should determine how much endometriosis is present. Then we develop a strategy to excise the endometriosis laparoscopically. Hysterectomy should not be discussed as a viable option.

QUESTION: I had a hysterectomy and my right ovary removed in December 1999 at the age of 43 due to an ovarian tumor (benign) and fibroids. My left ovary was removed in 1990 due to a benign tumor. Question: Why do doctors tell women that the depression and weight gain that many experience (I gained 40 pounds in five months following surgery) are not supported in the literature as side effects of this surgery?

DR. GOLDFARB: Weight gain after hysterectomy — once ovaries are removed your metabolic function slows precipitously. I personally feel that unless cancer is present, ovaries should hardly ever be removed. I would recommend you consider hormone replacement. Surgical menopause is a pernicious event. If you decide not to take hormone replacement, then you need to work hard with a program of dietary control and physical activity to save your body and your psyche.

QUESTION: What can I do now to deal with mood swings and depression without taking HRT or antidepression drugs?

DR. GOLDFARB: A program of physical exercise coupled with neutralceuticals can help restore vigor and a feeling of well-being. People who stay home, overeat and pity themselves for bad fortune are destined to live out their worst fears.

QUESTION: Is hysterectomy the only solution when cancer is detected? Can the cancer be treated without removing the uterus/ovaries?

DR. GOLDFARB: It depends on the type and severity of the cancer. It is not proper to generalize. Invasive cancer of the uterus, cervix or ovaries usually requires hysterectomy.

QUESTION: Dear Dr: My sexual life after an elected hysterectomy is great, however, I have numerous other problems. My cholesterol suddenly went high, my energy level went low and my body is still not back in shape after two years! Is there a verifiable medical reason for these changes just because of removal of female organs?

DR. GOLDFARB: The answer is yes. This is not an unusual occurrence. A program of physical exercise and certain vitamins can help to restore energy.