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My doctor is suggeting a hysterectomy for dysplasia

By Anonymous November 4, 2011 - 6:38am
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I am 50 years old. Had a cone biopsey for mild cervical dysplasia in March 09. I was clear unitl February 2011 another abnormal pap, dyplasia is back. Had a Leep done in September (cowboy hat) biopsey came back moderate with no clear margin, margin is mild. He recommends a hystertomy but could do an apple core biopsey. He said he has already taken out alot of the cervix. I got a second opinion, she said she would probably recommend the hyterectomy, why take chances. Either way I have to go under general anesthesia and I'm nervous about it coming back again or advancing to severe. It would be a vaginal hysterectomy and would leave the ovaries. I have recently started menopause. Can you give me your opinion

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EmpowHER Guest

I am 37 years old. Just diagnose with sever e cervical dysplasia. my treatment options is lazer surgery or hysterectomy (vagina) leaving the ovaries of course. and i do not plan to get pregnant anymore in the future. if i will do the lazer surgery, there is still a chance that precancer cells will come back... not with hysterectomy.doctor says 99.9% they wont come back. im thinking more on doing the hysterectomy..do you think its wise chose?

September 19, 2014 - 9:21pm
EmpowHER Guest

I am an OB/GYN and Fellow of the American College of Obstetrics and Gynecology (FACOG). Yes, it could be argued that hysterectomy is indicated. However, your condition is only mildly dysplastic at this point. To go from mild dysplasia (CIN 1) to invasive cancer is a 20-30 year process. In fact studies show that on average, it takes 12 years to go from carcinoma in situ (CIN 3 where the full thickness of the mucosa (skin) of the cervix is involved with abnormal cells) to invasive cancer. Furthermore, different types of the HPV virus are more aggressive than others. The fact that you are 50 years old and only have mild dysplasia indicate that your particular virus may cause abnormalities but is somewhat wimpy in doing so. I doubt you have HPV types 16 or 18. IT WOULD BE COMPLETELY SAFE FOR YOU TO WAIT 6 MONTHS AND HAVE A REPEAT COLPOSCOPY AND FURTHER BIOPSIES IF INDICATED.

As far as surgical menopause, ACOG has moved away from recommending removing the ovaries at time of hysterectomy prophylactically (preventively). The thought used to be that this practice lowered the risk of getting ovarian cancer. It had been noted that 15% of individuals with ovarian cancer had previous pelvic surgery where the ovaries could be removed. Given that the risk of getting ovarian cancer is anywhere from 1:40 to 1:60 means that a whole lot of ovaries were removed unnecessarily. Recent studies this past decade have shown an improved lifespan, better bone density, lower cardiovascular risk and an overall improved sense of well being in women who had ovaries after menopause versus women who did not. We have found that even though the ovaries stop producing estrogen at the time of menopause, they continue production of testosterone. In fact, one of the modules we as OB/GYNs can go through in annual recertification has us look at our practice of prophylactic oophorectomy (remove ovaries) and change to more recent practice standards.

This information may be too little, too late but this is my personal take on current recommendations on practice standards of care per ACOG.

Gary N. Gregerson, M.D., F.A.C.O.G.

January 12, 2012 - 5:13am

Susan, I believe the writer said the hysterectomy would leave her ovaries. She would, therefore, NOT go into surgical menopause after the surgery, right?

I too have had repeat cervical procedures done to get rid of HPV but there has been enough time between them for my cervix to 'grow back'. I will see later this month if the HPV is gone, once again.

If I were in the writer's shoes, I would have the hysterectomy. I don't say that lightly because I try hard to avoid surgeries. But having this turn in to cancer would be so much worse. (I am a breast cancer survivor because it was caught early and I had a lumpectomy.) Good luck to the writer.

November 4, 2011 - 11:02am
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