The startling facts about women and hysterectomies: l) Approximately fifty percent of the women in the United States will undergo a hysterectomy by age 70. 2) The average age for a hysterectomy in this country is 35.6 years. 3) Hysterectomy is second only to caesarean section as the most commonly performed major surgery in the United States - nearly one million each year. 4) About 650,000 hysterectomies are performed each year. 5) The medical term for removing the ovaries is "female castration". Approximately half a million women experience this surgery each year in the United States. 6) Ninety-eight percent of the women referred by HERS (Hysterectomy Educational Resources and Services Foundation) to gynecologists for second opinions were told they did not in fact need a hysterectomy. 7) The hospital cost alone for hysterectomies alone in this country is approximately three billion dollars annually.

When are hysterectomies recommended? Women who are diagnosed with endometrial (uterine) cancer, ovarian cancer, or advanced stages of cervical cancer generally need a hys-terectomy as a life-saving measure. Other benign tumors, such as uterine fibroids or ovarian tumors, are occasionally so large that the tumor alone cannot be removed.

In my experience, I have seen uterine fibroids to be the most common reason for hysterectomies. Women often tell me, long after their surgeries, that their mothers and grandmothers also had their uteruses removed for the same reason. Some of these women have experienced fibroid-caused symptoms such as excessive bleeding, urinary problems, pelvic pain, or painful intercourse. Yet many women whose fibroids are diagnosed on a routine pelvic exam and who are asymptomatic still end up with hysterectomies. There are natural alterna- tives to surgery for uterine fibroids (see "Healing Uterine Fibroids" by my husband and myself, The New Times , August, l990). And, in most cases, even when surgery is necessary to take out the fibroid, it is usually possible to leave the uterus and ovaries.

Hysterectomies are also recommended to some women who have excessive bleeding during their perimenopausal period. Again, there are natural therapies which usually control the bleeding (see my article "Womenopause", The New Times, October, l990). These women are often told that they're not going to need their uteruses anymore anyway, so "Why not take them out?". They may also be urged to have their ovaries removed for the same reason. There are other women who have endured excruciating menses since menarche and feel relieved by the idea of ending their suffering early. A smaller number of women receive hysterectomies for more unusual conditions such as recurrent ectopic pregnancies or severe endometriosis.

Why not get a hysterectomy? Why do I need my uterus and ovaries after my child-bearing years? I believe that Mother Nature created our bodies quite perfectly and that it's best to keep all of our organs as long as we can. The long-term consequences of a hysterectomy can include osteoporosis, bone and joint problems, increased incidence of heart disease, urinary problems, loss or decrease of sexual desire, and depression.

Some of these problems can be averted by taking estrogen replacement therapy following the hysterectomy, however ERT carries with it other possible side effects such as liver cancer, gall bladder disease, fatigue, vaginal dryness, and, possibly, breast cancer and circulatory prob- lems. Most of these symptoms result from the withdrawal of estrogen. It is important to remember that it is ovaries, not the uterus, which produce estrogen. Therefore, I suggest that, even if a hysterectomy is necessary, a woman try to keep one or both ovaries. Sometimes, due to the trauma of surgery, these remaining ovaries will not function optimally. However generally the estrogen production will continue, even in the absence of a uterus, until the natural time of menopause. If retaining one or both ovaries is not possible, the woman, regardless of age, will experience premature, surgically-induced menopause and will need to make some decisions immediately about whether or not to take hormones.

If I do need a hysterectomy, is it dangerous? No. The surgery is usually quite straightforward and extremely safe. The mortality rate from hysterectomies dropped from close to 90% in l830 to 10% in 1890. By l985, with the use of antibiotics and transfusions, the mortality rate is only one in a thousand. It is very important that you choose a surgeon who you really trust. I have found that, by preparing women through nutrition, homeopathy, and hypnosis, they recover much more quickly from a hysterectomy.

If I've been told I need a hysterectomy, how can I find out if it's really necessary? First, consult at least two physicians specializing in women's health care to get their opinions. If you feel inclined to naturopathic or other forms of alternative medicine, seek out such a physician, again one specializing in women, to hear the natural side of your story.

Don't panic. No matter what the diagnosis and prognosis, it is essential that you take the time to gather all of the information you need, outer and inner, to make the right decisions. Anyone, professional or lay, can order a Medline search on a particular health topic. This will provide

you with the data on the effectiveness of a given therapy for your condition. You may be able to interpret the medical research for yourself or may need one of your doctors to help you sort it out. There is also quite a bit of popular literature on hysterectomy. I recommend Women on Menopause: A Practical Guide to a Positive Transition by Dickson and Henriques (the only book on menopause to mention homeopathy and other natural alternatives besides diet), The Menopause Self-Help Book by Lark, The No-Hysterectomy Option by Goldfarb (includes no natural therapies but discusses clearly diagnosis and orthodox treatment options), and No More Hysterectomies by Hufnagel.

Make sure that you are really comfortable with and trust any doctor that you're working with. Deciding to go ahead with a hysterectomy is a big step with life-long repercussions. Talk to other women who have been in a similar situation and find out how they feel, in retrospect, about the choices they made. If you wish to contact HERS, the support organization mentioned above, call (215) 667-7757. Use meditation, creative visualization, or hypnosis to journey within and find out what you inner self has to say about your particular situation. Imagine yourself at a crossroads. One path leads to a hysterectomy; the other path does not. See or feel yourself traversing one path, then the other. How do you feel? What is the outcome? What are the lessons for you?

If you do decide on a hysterectomy: Make your preferences very clear to your surgeon. Under what conditions would you be willing for him or her to remove your ovaries along with the uterus? Do you want your favorite inspirational or healing to be played during the surgery? Make arrangements for any special food you wish a friend or family member to bring you (hospital food is neither the tastiest or the healthiest, to put it mildly), garner all of the love and support you need, surround yourself with flowers, tapes, books- whatever makes you comfortable and happy. A combination of homeopathic remedies and specific nutritional sup-plements before and after surgery can speed your healing process tremendously. I have found it extremely helpful to do a pre-surgery hypnosis session to clear any fears and to implant very positive suggestions for healing. Invite any inner teachers, guides, or masters to be present at your surgery and to participate fully in your healing. Know that they will truly be there for you.

After your surgery, you may wish, again, to get several opinions about whether or not to take estrogen replacement therapy. Depending on your age, eating habits, lifestyle, and risk of osteoporosis, there may very well be natural alternatives for you instead of hormones. And if you do opt for hormones, there are a number of choices available, even though your gynecologist may not offer them to you unless you ask.

What will my life be like after a hysterectomy? Although it is obvious that I recommend hysterectomy only as a last resort, in all fairness, I want to say also that some women feel wonderful after a hysterectomy. I have patients and friends who have are very relieved to have the surgery over and to move on to the next stage of their lives. How a woman feels after having her uterus and/or ovaries removed depends a great deal on how she feels about herself and her life love and support from her sexual partner, friends and family, and her connection with spirit. Give yourself plenty of time for healing and be honest with your feelings.

I have a patient who was glowing and peaceful for weeks after a sudden hysterectomy, only to find herself on an emotional roller coaster when she really got in touch with a hysterectomy meant to her, her relationship, and her unfulfilled dreams of motherhood. I have another patient, who tried for several years unsuccessfully to reduce her large uterine fibroid with natural therapies. She came in for hypnosis, homeopathy, and supplements to prepare her for surgery, had a terrific recovery, and says she's never felt better. The aftermath of hysterec-

tomy is highly variable. You may be stronger than ever or you may be on shaky ground for weeks or months after. We each have our own individual process to experience and lessons to learn.

You are clearly a whole, complete woman with or without your uterus or ovaries. Your inner wisdom and connection with the Divine feminine nature within can never be taken away from you by anyone. Open your heart to whatever your experience may be. Embrace those who are your helpers in your healing process. Surround yourself and them with love and healing. Ask that you may be healed at the deepest level possible and that is exactly what will happen.

Dr. Judyth Reichenberg-Ullman is a naturopathic and homeopathic physician and cofounder of the Northwest Center for Homeopathic Medicine in Edmonds, WA. She is coauthor of The Patient's Guide to Homeopathic Medicine and Beyond Ritalin: Homeopathic Treatment of ADD and Other Behavioral and Learning Problems. She can be reached at (206) 774-5599.