Sterility - for protecting maternal life?

[CountryMom27]

My husband and I have two children and are now middle-aged. With both pregnancies I had serious complications that put me at high risk, and that was 8 & 10 years ago. I recently went to my doctor because I’ve been having increasingly painful and heavy periods, and pain with nausea during times of my cycle. It’s been difficult on all of us, particularly since I’m working my way through depression and an eating disorder that has flared up significantly due to immense stress, and in addition to caring for our two young children, I am the primary caretaker for my father who has advanced Alzheimer’s and I work full-time. To say I am exhausted before even adding in the medical issues is putting it mildly.

My doctor has diagnosed me with endometrial hyperplasia - a thickening in the wall of my uterus. The two treatment options are hormone birth control (which is not an option for me - medically or spiritually) or ablation (removal of the uterine lining). She’s recommended the surgical option of ablation as well as a tubal ligation - the reason being that if I were to conceive after the ablation, I would be at significant risk for uterine rupture given past surgeries. I’m still waiting on the biopsy results - but if those come back positive, then I will have to have a hysterectomy. Either way I will be sterile.

I’m not sure what to do. Each month gets continually worse. I’ve received a second opinion that supports her conclusion, and I’ve prayed for guidance. I feel tremendous sadness over the idea that I may either lose my womb or essentially destroy it, either way permanently eliminating future children. My husband does not want any more children, and doesn’t understand my feelings on this. I’m terrified that this could be pre-cancerous but am trying not to get ahead of myself and am focused on the odds that this is not cancer.

I know it is a sin for me to be sterilized just because I had complicated high risk pregnancies before. I don’t have to have the ablation, but the pain, discomfort, and blood loss is increasing each month and it impacts my health as well as my family and my ability to support them. In choosing to have this procedure, am I closing myself off to children? Am I turning away from Christ? When I pray to Him, I only see that he is a compassionate and loving God, but if I choose this, I don’t think I would feel regret for my sin, only sadness at the finality of things.

Please help - but only if you can do so in a kind and gentle way. I know that posters here have the best of intents, but I’m in a fragile state, so please choose your words carefully. I told my husband I want to talk with our priest, and while he doesn’t see the need, he’s not going to disrupt that. However, I can’t see our priest until next week and I’m really having a hard time in the interim. Any advice and guidance you could offer would be appreciated.

Thanks -

 

[Xantippe]

1. If the birth control is in order to control a medical condition (rather than to prevent pregnancy), it’s not immoral.
2. The ablation is not a moral problem if it is intended to treat a medical condition.
3. The tubal ligation is a problem, because it would be intended to prevent pregnancy rather than to treat an illness.
4. A hysterectomy is not immoral if you do it intending to treat medical problems (rather than to prevent pregnancy).

You can consult the National Catholic Bioethics Center people, but I think that’s fairly clear.

You might benefit from talking to a counselor (perhaps an older female counselor) about your feelings of sadness about ending your reproductive years. It might also be a good time to ask for more help from your husband and kids. The kids are getting to be pretty big.

 

[pollylodges]

Saint Michael, the archangel, defend us in battle, be our defense against the wickedness and snares of the devil, may God rebuke him, we humbly pray. And do you, O’ Prince of the Heavenly host, by the power of God thrust into Hell Satan and all the other evil spirits who prowl about the world for the ruin of souls.

Amen.

†

Our Father who art in Heaven, hallowed be thy name.

Thy kingdom come, thy will be done on Earth as it is in Heaven.

Give us this day our daily bread.

And forgive us our trespasses, as we forgive those who trespass against us.

And lead us not into temptation, but deliver us from evil.

Amen.

†

Hail Mary, full of grace, the Lord is with thee.

Blessed are you among women, and blessed is the fruit of your womb Jesus.

Holy Mary, Mother of God, pray for us sinners, now and at the hour of our death.

Amen.

†

 

[Nan_S]

1. If the birth control is in order to control a medical condition (rather than to prevent pregnancy), it’s not immoral.
2. The ablation is not a moral problem if it is intended to treat a medical condition.
3. The tubal ligation is a problem, because it would be intended to prevent pregnancy rather than to treat an illness.
4. A hysterectomy is not immoral if you do it intending to treat medical problems (rather than to prevent pregnancy).

You can consult the National Catholic Bioethics Center people, but I think that’s fairly clear.

You might benefit from talking to a counselor (perhaps an older female counselor) about your feelings of sadness about ending your reproductive years. It might also be a good time to ask for more help from your husband and kids. The kids are getting to be pretty big.

This is all true.

You said you would not consider the hormone pills for spiritual reasons. When they are the best method for treating a serious medical condition, which is what you have, they are licit, i.e., permitted. In your case the pills are to cure a disease, and not to merely regulate fertility.

I noted that you said the pills were not an option for medical reasons as well. Still, they are a significantly less drastic measure than either surgical option. Perhaps, knowing that there is no spiritual restriction on using them in your case, you and your doctor might reconsider giving them a trial before taking the more drastic surgical options. The recovery from a hysterectomy can be difficult.

I pray that God brings balance back into your life. You are not alone. I also know what it feels like to be working full time, and simultaneously be the primary caretaker for small children. There were many nights when sleep was just something I imagined as I fought my way through until dawn. Recently my mother has also been diagnosed with Alzheimer’s and I am learning to work with that dreadful disease as well.

May God bless you and help you find rest.

 

[DOJ96]

Whatever choice you make, I pray that you can restore your health. It would not be a sin, but you must make the choices that seem right to you. Take care of yourself so that you can be the best you: the best woman, wife, mom, etc. Let your family help you, too. Sending you prayers for comfort, healing, and peace :hug1:

 

[UnCatholicBride]

Because of the risk of cancer, I would not trust ablation to treat hyperplasia. I know all too well the pain and the bleeding you are suffering from, and as soon as we are doing building our family I will be having a hysterectomy.

 

[CountryMom27]

Thank you all for your advice. To clarify a little, the reason I won’t take hormones is because I’m not comfortable taking birth control (to me, it feels different from the ablation even though it would be necessary) and equally importantly, my body does not react well to hormones. My eating disorder and depression would likely be worsened by hormones, and my doctor took that into account in making her recommendation.

Thanks too for the counsel. I am seeing a therapist weekly to help with other issues, and we’ve talked about this and I expect will talk more now that my surgery is scheduled (the doctor’s office decided to schedule it even though my biopsy results are not in yet). It is weird to think that this is my last month of being fertile, and yes, I am very sad about that.

In terms of the tubal - I found Xantippe & Nan S’s responses surprising. After the ablation, any chance of pregnancy carries a very high risk of fetal and/or maternal death especially given my medical history, so having a tubal at the same time as the ablation is necessary, unless I ask my husband to have a vasectomy. But that seems wrong, since I’ll already be facing surgery and recovery as it is. Nan S - I’m sorry to hear about your mother. It is a terrible road we’re on, but there have been moments with my dad that I hold on to when the days get difficult.

UnCatholicBride - at this point, if the biopsy comes back negative, the hysterectomy seems to be too radical of a choice to me. Also putting my body into immediate menopause and facing a 6-8 week recovery would be difficult. The procedures I had done (TVU, endometrial biopsy, sonohysterogram) have a 95% sensitivity for diagnosis.

The whole experience has been very frightening. I’m glad I have my faith and my family (and a good medical team) to support me. I know at this point - waiting for my biopsy results - I am not yet really letting myself feel what’s going on - but I feel like I have to KNOW before I react. I’m talking to our priest on Tuesday and will ask his counsel as well. I am pushing through day by day but it feels as though just when I start to gain some traction with my depression, this comes along. I just pray that my results come back healthy this week.

Thank you for your support and the information -

 

[Julianna]

At age 31, I was there. Same symptoms. I had a hysterectomy. I don’t do well with hormones, and I don’t trust the chemicals in the “pill”. I kept my ovaries. I am now 56 and am going through menopause. I completely understand where you are coming from with the pain…add depression and the serious illness of a family member, you need to do something.

Can you keep your ovaries? Is that an option? You will NOT turn into an old lady, nor will you lose your libido. You can’t take care of what you have until you take care of YOU. Without you, who will care for your family member, who will care for your children?

 

[Magdalen2013]

I know of a lady in a similar situation and her priest said to have the hysterectomy. He said it was more important for her to be alive to take care of the children she already had than to run the risk of another pregnancy killing her.

If you have the uterus removed and not the ovaries you will not go into instant menopause, as the hormones come from the ovaries not the uterus.

 

[maryjk]

UnCatholicBride - at this point, if the biopsy comes back negative, the hysterectomy seems to be too radical of a choice to me. Also putting my body into immediate menopause and facing a 6-8 week recovery would be difficult. The procedures I had done (TVU, endometrial biopsy, sonohysterogram) have a 95% sensitivity for diagnosis.

A Uterine ablation covers symptoms of uterine cancer. My Catholic GYN will not do them because of that.

A hysterectomy does not put you into “immediate menopause.” A hysterectomy does not remove your ovaries.

 

[Nan_S]

In terms of the tubal - I found Xantippe & Nan S’s responses surprising. After the ablation, any chance of pregnancy carries a very high risk of fetal and/or maternal death especially given my medical history, so having a tubal at the same time as the ablation is necessary, unless I ask my husband to have a vasectomy. But that seems wrong, since I’ll already be facing surgery and recovery as it is. Nan S - I’m sorry to hear about your mother. It is a terrible road we’re on, but there have been moments with my dad that I hold on to when the days get difficult.

Thank you for your kind words about my mother. She doesn’t have good days anymore. She has good portions within the day. It’s slowly getting worse.

About the tubal ligation, the church teaching is what it is. The church does not keep on top of the nuances of modern medicine and continually fine-tune their guidance. I personally feel there is medical justification for doing the tubal ligation with the ablation, especially in the US where people are quick to run to lawyers screaming “malpractice.” But no one said being a Catholic and following the rules of the church would be popular or easy.

 

[Listener]

It does seem to me that tying off the tubes should be part of the uterine ablation medical procedure. If a woman had a hysterectomy and kept her tubes, wouldn’t the doctor have to sew her tubes shut? Actually, I’m just guessing. Maybe a doctor reading this could explain how this works. If you have an ablation, isn’t the lining of the uterus permanently removed? Doesn’t the uterus just become a shell of an organ that is totally incapable of carrying a baby? If so, wouldn’t it be surgically incorrect to have an open doorway to this useless shell of an organ? I don’t know - I am not a doctor, and I am really not familiar with the procedure.

As the previous poster said, the Church can’t make a formal declaration on every new medical procedure. Sometimes we have to use prudence to make these decisions, after consulting a priest.

 

[CountryMom27]

To clarify a few things - yes, a partial hysterectomy (saving the ovaries and cervix) can sometimes stave off menopause, but there is sometimes compromised blood flow to the ovaries, and the estrogen drop can cause premature menopause. One study I read stated that pre-menopausal women start menopause an average of 4 years earlier if they had a partial hysterectomy. Still, if my biopsy shows anything funky, I would do it in a heartbeat. I won’t take any risks with cancer. It’s also important to note that any hysterectomy has a 6-8 week recovery time, plus hospitalization. I just don’t know how we’d handle that right now, but I’m trying not to get ahead of myself.

It is important to realize that a hysterectomy is a significant and risky operation with downstream impact. For many women, it is a God-send, and certainly if there is cancer or precancerous tissue.

As far as ablation hiding cancer, I thought that my biopsy was sufficient to rule out cancer (as much as they can rule it out - nothing is 100%). It all depends on the biopsy - if it’s two of the four types of hyperplasia, then it’s very unlikely to continue on to cancer. If it’s the other two, then I’ll have to have the hysterectomy.

Julianna - thank you for the understanding. It’s odd for me to feel so fragile - I’ve always been the strong one that everyone depends on, and it’s hard for me to be in this position. Just admitting that I have depression and an eating disorder has been incredibly painful. I don’t believe that God gives us situations to test us, but I do find it ironic that I’m being forced by biological reasons to ask for help and admit my fallibility.

I prayed in Mass today - not just for myself and my family, but for others as well. The hymn during the Eucharist - I can’t remember which one it was - really spoke to me. Essentially it was that the Lord is always with us, always ahead of us, forging a path for us. I felt in that brief instance that He was telling me that no matter what, I will never be alone and that whatever I decide for my health is the right decision for my family.

I’m meeting with our priest on Tuesday and I’m going to bring this all to him. It’s hard - I’ve told him in passing that I was struggling, but I’ve never shared with him my eating disorder. The shame I feel about what I’ve done to the body that God has given me is overwhelming.

Thank you all for being gentle with me -

 

[Magdalen2013]

It does seem to me that tying off the tubes should be part of the uterine ablation medical procedure. If a woman had a hysterectomy and kept her tubes, wouldn’t the doctor have to sew her tubes shut? Actually, I’m just guessing. Maybe a doctor reading this could explain how this works. If you have an ablation, isn’t the lining of the uterus permanently removed? Doesn’t the uterus just become a shell of an organ that is totally incapable of carrying a baby? If so, wouldn’t it be surgically incorrect to have an open doorway to this useless shell of an organ? I don’t know - I am not a doctor, and I am really not familiar with the procedure.

As the previous poster said, the Church can’t make a formal declaration on every new medical procedure. Sometimes we have to use prudence to make these decisions, after consulting a priest.

A hysterectomy removes the tubes – they’re part of the uterus. Given a choice between ablation and a hysterectomy, I’d take the hysterectomy…

 

[Listener]

A hysterectomy removes the tubes – they’re part of the uterus. Given a choice between ablation and a hysterectomy, I’d take the hysterectomy…

No, a hysterectomy does not necessarily remove the tubes. I had a hysterectomy many years ago. I kept my tubes and ovaries. I could feel myself ovulating every month like clockwork until I was 55 years old. I also had a week of PMS every month.

Did my doctor tie my tubes in the process? I have no idea.

 

[lifeisbeautiful]

It does seem to me that tying off the tubes should be part of the uterine ablation medical procedure. If a woman had a hysterectomy and kept her tubes, wouldn’t the doctor have to sew her tubes shut? Actually, I’m just guessing. Maybe a doctor reading this could explain how this works. If you have an ablation, isn’t the lining of the uterus permanently removed? Doesn’t the uterus just become a shell of an organ that is totally incapable of carrying a baby? If so, wouldn’t it be surgically incorrect to have an open doorway to this useless shell of an organ? I don’t know - I am not a doctor, and I am really not familiar with the procedure.

As the previous poster said, the Church can’t make a formal declaration on every new medical procedure. Sometimes we have to use prudence to make these decisions, after consulting a priest.

That’s a thought! I don’t know the medical side of why they tie the tubes, but the teaching on this matter is pretty straightforward and can be easily applied to any medical procedure.
Having one’s tubes tied (or any procedure/medication) in order to be able to have sex without getting pregnant is not moral. Having one’s tubes tied because, regardless if one has sex or not, it is medically necessary (not as a form of birth control, but to heal some part of the body), can be ok. I just don’t know if the latter ever happens.

 

[Hopey]

That’s a thought! I don’t know the medical side of why they tie the tubes, but the teaching on this matter is pretty straightforward and can be easily applied to any medical procedure.
Having one’s tubes tied (or any procedure/medication) in order to be able to have sex without getting pregnant is not moral. Having one’s tubes tied because, regardless if one has sex or not, it is medically necessary (not as a form of birth control, but to heal some part of the body), can be ok. I just don’t know if the latter ever happens.

I am not aware of any medical reason to tie tubes other than sterilization. They removed tubes because of ectopic pregnancy.
If you go to have your tubes tied in which there is not a medical reason to, ectopic pregnancy, it would be immoral.
Because I don’t know all diseases that could happen, I wait to see if there is a time in order to treat the disease (and disease not being a baby) they have to tie them.

 

[Vico]

My husband and I have two children and are now middle-aged. With both pregnancies I had serious complications that put me at high risk, and that was 8 & 10 years ago. I recently went to my doctor because I’ve been having increasingly painful and heavy periods, and pain with nausea during times of my cycle. It’s been difficult on all of us, particularly since I’m working my way through depression and an eating disorder that has flared up significantly due to immense stress, and in addition to caring for our two young children, I am the primary caretaker for my father who has advanced Alzheimer’s and I work full-time. To say I am exhausted before even adding in the medical issues is putting it mildly.

My doctor has diagnosed me with endometrial hyperplasia - a thickening in the wall of my uterus. The two treatment options are hormone birth control (which is not an option for me - medically or spiritually) or ablation (removal of the uterine lining). She’s recommended the surgical option of ablation as well as a tubal ligation - the reason being that if I were to conceive after the ablation, I would be at significant risk for uterine rupture given past surgeries. I’m still waiting on the biopsy results - but if those come back positive, then I will have to have a hysterectomy. Either way I will be sterile.

I’m not sure what to do. Each month gets continually worse. I’ve received a second opinion that supports her conclusion, and I’ve prayed for guidance. I feel tremendous sadness over the idea that I may either lose my womb or essentially destroy it, either way permanently eliminating future children. My husband does not want any more children, and doesn’t understand my feelings on this. I’m terrified that this could be pre-cancerous but am trying not to get ahead of myself and am focused on the odds that this is not cancer.

I know it is a sin for me to be sterilized just because I had complicated high risk pregnancies before. I don’t have to have the ablation, but the pain, discomfort, and blood loss is increasing each month and it impacts my health as well as my family and my ability to support them. In choosing to have this procedure, am I closing myself off to children? Am I turning away from Christ? When I pray to Him, I only see that he is a compassionate and loving God, but if I choose this, I don’t think I would feel regret for my sin, only sadness at the finality of things.

Please help - but only if you can do so in a kind and gentle way. I know that posters here have the best of intents, but I’m in a fragile state, so please choose your words carefully. I told my husband I want to talk with our priest, and while he doesn’t see the need, he’s not going to disrupt that. However, I can’t see our priest until next week and I’m really having a hard time in the interim. Any advice and guidance you could offer would be appreciated.

Thanks -

It is not moral, if the purpose of the operation is to prevent dangerous pregnancy, but you said it is for “the pain, discomfort, and blood loss is increasing each month and it impacts my health as well as my family and my ability to support them”. So is a simpler treatment available?
53. Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.
Ethical And Religious Directives For Catholic Health Care Services