#178: Do I Need a Hysterectomy?

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I can't wait to see you in there. Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. Okay, ladies, this week we're going to talk about hysterectomies. So I got a question from Amy in Michigan, and she wants to know, should she go through with the hysterectomy that her doctor is recommending? Okay, this is a really important question, and some of you guys have probably gone through this surgery and you've had a hysterectomy yourself. You know, they say there are more than 400,000 hysterectomies a year in the United States. And at least 68% of them are for benign reasons, meaning not cancer. So the majority of hysterectomies are done for symptoms, symptoms of heavy bleeding or pain, scarring from previous surgeries, from endometriosis, fibroids, or prolapse. Things are falling down. I did a really awesome episode on prolapse back in the day, and if that is something you're struggling with, you should listen to that. Episode. Let's see, I just paused to find out what episode number that was. That was 34, way back in the day when this was actually called the Gutsy Gyn— I'm sorry, the Functional Gynecologist Show. So fix your pelvic floor. Listen to that episode if you feel like things are falling down, you're feeling a bulge inside of the vagina, you're feeling a lot of pressure. That is an eye-opening episode. But if you are considering a hysterectomy, or if you have had a hysterectomy for benign reasons, you still should listen to this episode because there's some really important key points that most gynecologists don't talk about and they leave out of the conversation when they talk about risks, benefits, and alternatives. You know, that's my biggest pet peeve is we tell you that we're giving you informed consent, but it's not true complete informed consent because there's a lot of stuff not being said in these conversations. And so first and foremost, there is a reason you are having heavy periods or painful periods or the growth of endometriosis or recurrent ovarian cysts. You know, whatever the reason is for the surgery that they are recommending or that you have had, what is the root cause? I really want to pound this into your head that you should always ask why, why, why, why, why are these things growing? Why am I suffering with these symptoms? Where is it all coming from? And that's where a lot of gynecologists fall short is they don't think about the root cause. You know, if you've been following me for a while, you know that gynecologists are surgeons. We spend 4 years in a surgical residency. So if you come to us with a problem, I say us meaning conventional gynecologists, we are going to recommend very possibly a surgical procedure because that is the— those are the tools in our toolbox. That is what we know how to do, you guys. And so endometrial ablation, IUDs, hysterectomies, surgeries for prolapse. Laparoscopies, all of these things. Those are the tools that we were taught. And so sometimes this stuff is needed without a doubt. But sometimes if you don't take care of the root cause of that issue, then it's going to create issues in other areas. So I think about playing whack-a-mole. If you've ever played whack-a-mole, these little moles, they pop up at random times through these holes. You whack one down. With your mullet, and then another one pops up. The same exact thing happens when you don't address the root cause of a problem. It's you have this symptom that pops up, you whack that symptom with medication or surgery, and it seemingly goes away. But then another symptom pops up, and then another symptom pops up. And so you're constantly whacking these different systems. Symptoms like whack-a-mole, um, and I call that Band-Aid medicine. And so it's really important to figure out how to get rid of the moles, period. And that is by getting to the root cause of your problems. And the majority of reasons women need hysterectomies stem from hormone imbalances. And even further back than that, those hormone balances are being driven by your other systems. They're being driven by gut issues, gut dysbiosis. They're being driven by adrenal dysfunction, adrenal fatigue, adrenal overload, thyroid that is mismanaged or not diagnosed, food sensitivities, all of these root cause issues, mold. I could go on and on. Heavy metal exposure. If you aren't evaluating and treating all of those things, The hormone imbalance will show up in a different way. So right now it might be showing up as crazy heavy periods or fibroids. And if you remove the uterus, it's going to continue to wreak havoc in the other parts of your body, and it's going to show up as mood disorders or weight gain. That's a major symptom. Or fibrocystic breasts or increase your risk of breast cancer. It's really important to think about why this is happening and not just remove the uterus. Okay. So to get back to Amy's question, should she have the hysterectomy? That's a great question. If the uterus physically cannot be controlled in the current situation, if your doctor does not know how to get your hormones back into balance and to evaluate for root cause issues, and you're really struggling, say you're bleeding so much you've required blood transfusions or iron infusions, or you're close to that, you're ending up in the ER, yeah, you might want to do a hysterectomy because you do need to stop the bleeding in the situation. If it's not so severe, a lot of the times You have the opportunity to seek out a functional medicine physician and actually tackle these root causes and get those hormones back into balance so that that bleeding slows down. And sometimes it's literally as simple as supporting your liver to detox its estrogen more effectively. Sometimes it. Means cutting back on the alcohol and taking some supplements like Liver Lift 1 that helps you metabolize your estrogen, or Estrotame, which redirects your estrogen metabolism down a safer pathway. So taking Estrotame and Liver Lift 1, I would say that helps over 50% of my women who are struggling with heavy periods and excess estrogen. We call estrogen dominance. And something as simple as liver support can really make a huge difference. So the other question is, do I let them take my ovaries when I have a hysterectomy? I was just talking with a gal who's having a hysterectomy because she has abnormal cells on her cervix. Okay. That's not even a uterus problem. That's a cervix problem. And that can almost always be removed by doing a LEEP procedure or removing the section of abnormal cells off of the cervix. If it's to the point where the gynecologist is recommending a hysterectomy, I would highly recommend you keep your ovaries because, ladies, your ovaries are where your hormones are made. That's where they're produced. You know, we have hormones that are made in our brain and our brain talks to our ovaries and tells our ovaries to make more or less progesterone. Progesterone and testosterone and estrogen. And so if you remove the ovaries, you are literally removing the source of the majority of your sex hormones instantly. So when you wake up in the recovery room, you are in surgical menopause. You are in menopause at that point going forward in your life. It's not a gradual thing. It's an immediate thing and it doesn't feel good. So you want to have a lengthy discussion with your surgeon if you are planning to have your ovaries removed, or if there's even a possibility of it, because you want to know that when you wake up, there is a plan to replace those hormones unless you're already in the menopausal state. Say you are 40 or 45 years old and you're going to wake up in surgical menopause, you're going to be miserable. You will be crying and depressed and very irritable, and you may well not be attracted to your partner anymore. And you may really struggle. You may start to gain weight and have hot flashes and night sweats and vaginal dryness and all of these issues. So You need to have a plan going into this surgery if those ovaries are going to be affected at all. Like, what kind of estrogen and progesterone am I going to get? Am I going to get testosterone? And have all— have this conversation with your surgeon. And if they're not comfortable talking about hormones or do using hormone replacement therapy, you can always look for Someone who specializes in that, because unfortunately, the majority of the time, the surgeon and the hormone expert are not going to be the same person. That's a really rare situation, and count yourself blessed if you have that kind of physician that's a good surgeon and good with hormone replacement. So I really want you to think about that. It's also recommended to have your fallopian tubes removed now anytime you have a hysterectomy. So the thought is there was a study out that showed that ovarian cancer may potentially start in the fallopian tubes, and this one study really shifted the way gynecologists practiced, and it's now recommended that we remove fallopian tubes whenever we go in to remove the uterus. As long as you're finished having children. I want you to be aware that some of the blood supply that feeds the ovaries and keeps them healthy does come from the fallopian tubes. And so if you clamp and remove the blood flow from the uterus and from the fallopian tubes, it could affect the health of the ovaries. And the studies suggest that you do go into menopause maybe a few years earlier. There's no absolute— this hasn't been studied very well, unfortunately, but just know that. So say you're 48, 49 years old and you're going in for a hysterectomy and having your tubes removed. Even if you keep your ovaries, you might end up going into menopause from that surgical procedure. And so again, you want to have a game plan in place with your surgeon of what are we going to do if this happens and how are we going to evaluate it? How are we going to know? I really just want you to have informed consent. I want you to know and be comfortable with what you're signing up for, because once you're asleep on the table, you don't really get to say anything and have a choice. It's up to the discretion of the surgeon and they're making those decisions in real time. Without your input, so the more that you can relay your wishes and your desires before you go into that OR, the better off you're going to be. So I hope that makes sense. And I will tell you, there's also a trend to encourage women to have their ovaries removed because of the fear of ovarian cancer. And this is really blown out of proportion, unfortunately. And the benefits of keeping your ovaries are not discussed time and time again as much as the very small risk of ovarian cancer. So if you've heard me on other episodes, you may realize that cancer does not happen from one thing. Cancer is multifactorial. It means many things are causing a problem over a long period of time, consistently disrupting the health of those cells and causing them to go rogue, causing your body not to destroy and remove those cells. I call it cleaning house. All of our cells die. That's how they work. Like, a red blood cell lasts 21 days. The cell inside your gut lasts 24 to 48 hours. They all get turned over and renewed. But if you don't have a good cleaning house system, if you don't have major antioxidants going in there and a proper immune system reaction, then you may have these cells that hang around too long and they stop functioning properly and they start Growing abnormally, and that is what leads to cancer. So it's multifactorial. It's you not metabolizing your hormones properly, not having your hormones balanced, having too much oxidative species, oxidative stress from inflammation and highly processed foods, nitrites in your foods, all the plastic chemicals in our food and water supply, and in our cleaning products and our personal care. Products, all these toxins, they get into our cells, our cells try to function as best they can, but they cannot keep up. And so unfortunately, cancer is when you have this perfect storm of too much chaos and debris and not enough cleanup and repair. And so it really does stem so much from our lifestyles. Like if we're not getting good restorative sleep, when those processes all happen if we're sleep deprived, if we are drinking too much alcohol and not letting our liver metabolize our hormones, if we're eating the standard American diet, which is very nutrient deplete and just high in chemicals. All of these things contribute to your cells not behaving properly and developing abnormal cells. So I believe the best thing you can do to prevent ovarian cancer, And uterine cancer and all these problems is to live well, make healthy choices consistently every day that decrease your risk. Even if you have genetic mutations that predispose you to these problems, say you have the BRCA gene mutation, those genes don't get expressed; they don't get turned on unless something irritates them and aggravates them and causes them to get expressed. Otherwise, the healthy genes get expressed. So your genes are not your destiny. You know, one of my favorite functional doctors founders is Mark Hyman, and he said, "Your genes are the gun, but your lifestyle pulls the trigger." So it doesn't matter necessarily what your genes are doing; it matters what you're doing every day consistently. Are you consistently making Poor food choices. Are you consistently leading a sedentary life and not moving your body? Are you consistently drinking alcohol and straining your liver? Like all of these things matter. So I know it seems like it's a little far off when we're talking about a hysterectomy, but I promise you all of this stuff affects your uterus, your tubes, your ovaries, all. Your lady parts, and so I just invite you to start asking why. Don't jump into decisions based on fear. I would ask for more facts and really think what could I do to improve my health going into this situation or coming out from a hysterectomy from these surgeries. What can I do going forward to change the trajectory of my health, of my future? So I hope that answered your question, Amy, and I hope it helped a lot of other people as well. And if you've already had a hysterectomy and you listened, I hope you listened to this. It's not too late to look into hormone replacement therapy and doing gut reparative work and evaluating for mineral imbalances and vitamin deficiencies and cleaning up your diet because all of that really, really, really does matter. So please listen to my other episodes. There's so much information. It's like a wealth of knowledge that your doctor's not telling you, and I'm just telling you for free. So soak it all in because I really believe we're supposed to be lifelong learners. We are here on this journey for this short time on the earth and we're supposed to be figuring things out and growing. We should never be stagnant. We should never be trying to skate through life. That's not what life's about. So I hope you found this helpful. If you did, please share it with every woman you know, because we all have uteruses and we all potentially face these questions and these challenges. So lift up another sister in this world. Find a woman that you can lift up and share this knowledge with. And I would love it if you would leave me a 5-star review and let me know what else you want to hear about, because that helps me get the word out. Like, I'm trying to reach the millions of women that this is affecting, and I need your help to do that. So thank you so much. I'm so honored that you take your time to hang out with me and to listen to me, um, and that you trust me. And that means the world to me. So go have an amazing kick-ass week.

Bye!