When faced with a difficult decision, I sometimes make the old Pro & Con lists. Not original, but hey, it works. But to do so, I really needed to know a whole lot more about hysterectomies in general and TAHBSO in particular. Nothing like some good, old-fashioned research.

The internet is a sometime confusing jumble of “old-school” medical resources mixed in with alternative medicine sources mixed in with “snake-oil cures.” It took some time to weed out the reputable from not-so-reputable from the earnest but possibly clueless. I mean let’s face it, the possibility of cancer is nothing to fool around with, right?

Right.

Here is one of the most reputable sources I was able to find:

In 2002, the Ontario Women’s Health Council issued a report on Achieving Best Practices in the Use of Hysterectomy. In it, the panel of experts says,

Hysterectomy is one of the most common surgical procedures performed on women. The 1998/99 National Population Health Survey noted that 22% of women in Canada aged 35 or older (1.8 million women) have had a hysterectomy. The majority of procedures are carried out for discretionary reasons, meaning those indications other than cancer or pre-cancerous states, and as such are often performed to enhance the quality of a woman’s life rather than to save her life.

Canada has experienced a significant decrease in the rate of hysterectomy since 1981. Although the numbers are notably less than in the United States, Canada still performs hysterectomies at double the rates of Britain, Sweden, the Netherlands and Norway. There is concern among the medical and health policy community as well as among women that hysterectomy is used too frequently as a first line of treatment.

Further,

Hysterectomy is one of the most common surgical procedures performed in the western world. The majority of these procedures are carried out for discretionary reasons, meaning those indications other than cancer or pre-cancerous conditions, and as such are often performed to enhance the quality of a woman’s life rather than to save her life. However, even among discretionary (non-cancerous) reasons, hysterectomy may have a role in preventing health problems such as anemia secondary to blood loss.

There is concern among the medical and health policy community that hysterectomy is used too frequently as a first line of treatment. Information from well designed studies on the effectiveness of hysterectomy for improving quality of life is limited. As well, the impact on quality of life when hysterectomy is not available has not been addressed. Both of these issues require further attention.

As with most of the sources I have located, this document does devote a great deal of space to the use of hysterectomy in treating uterine fibroids, endometriosis, and uterine prolaspe, but does have this to say about my particular diagnosis (From Appendix H SOGC Clinical Practice Guidelines on Hysterectomy):

Endometrial hyperplasia is usually diagnosed because of a complaint of abnormal uterine bleeding which leads to either office endometrial sampling or a D & C. The most significant histological finding is the presence or absence of cytologic atypia. The majority of patients without atypia will respond to hormonal manipulation in the form of progestin. Endometrial hyperplasia with cytologic atypia on an endometrial biopsy warrants a hysteroscopy and D&C to rule out concomitant endometrial adenocarcinoma, which is present in 17 to 25 percent of cases. Up to 25 percent of atypical endometrial hyperplasia may progress to endometrial cancer despite progestin therapy, with an average time of progression of four years.

For endometrial hyperplasia with atypia, either progestin therapy or simple hysterectomy are initial treatment options. When progestin therapy is chosen, patients should undergo a repeat endometrial sampling within six months. For patients with persistent endometrial hyperplasia or in patients who continue to experience irregular bleeding, a hysterectomy is recommended. Patients without atypia but with persistent hyperplasia on follow-up endometrial sampling despite a trial of both low and high dose progestin therapy may be treated by hysterectomy.

The boldface type is my addition. To date, I have not been presented with any real options other than total, radical hysterectomy in spite of these clinical guidelines. Shouldn’t it be MY choice, rather than someone else’s?