A pregnant mother asks NFPI about the morality of having a hysterectomy to alleviate menorrhagia and to avoid another pregnancy because she or the baby may not survive. She also has a disease that affects the thyroid which causes her hormones to be off balance and worries about using NFP. She wants to follow Church teaching. She seeks our advice.
You asked about the morality of having a hysterectomy to alleviate menorrhagia. Here is the relevant quotation from Humanae Vitae, section 15:
“Lawful Therapeutic Means
15. On the other hand, the Church does not consider at all illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result therefrom–—provided such impediment is not directly intended for any motive whatsoever. (19)”
You can read the entire document at our website. Click on Spiritual Resources, and then on the encyclical.
What is meant first of all in this case is a disease that is life-threatening, such as cancer of the uterus or the ovaries. That doesn’t rule out lesser maladies, but it seems to me that they would need to be untreatable by other means and truly disabling, not just inconvenient. My brief review of what turned up in a Google search for menorrhagia made it appear that this is a situation that is both common and inconvenient but not serious. The different sites offered ideas about both causes and treatments. Marilyn Shannon starts her chapter on heavy bleeding with a hopeful sentence: “In counseling women with various cycle irregularities, I have found that heavy and prolonged bleeding almost always can be improved with better nutrition.” Fertility, Cycles and Nutrition, p.79. She also treats of this in her Chapter 7 on causes of cycle irregularities. Since this disorder is treatable by other less drastic means, I have to say that it would not be good medicine or morally justified to remove your uterus unless the malady became disabling.
You also asked about a hysterectomy to avoid pregnancy. That would be a case of permanent contraception similar to having your tubes tied, so that cannot be morally justified.
Here are my recommendations.
First, get a copy of Shannon’s book and use it well. You can obtain it through our website.
2. Observe and chart well. You can download free charts near the bottom of the home page of our website, www.NFPandmore.org.
3. You didn’t say what manual you were using; you might find our manual helpful. — Natural Family Planning: The Complete Approach. I hope that you will do ecological breastfeeding for the many benefits for yourself as well as for your baby. The most difficult part of getting back into regular cycles is when fertility is finally returning because sometimes this can be ambiguous even with the help of Chapter 5 in our manual. Here it is sometimes very helpful to use the cervix observations as well. If you get into a time of confusion, it is sometimes better simply to abstain for a good hunk of time rather than be worried all the time. And remember, the temperature sign is valuable because continued low temps are an indication of non-ovulation and non-pregnancy.
4. Once you get back to more or less regular cycles, if you find that on and off mucus patches in Phase 1 are too confusing or risky, you might be better off simply to limit your marriage acts to Phase 3. To give yourself more confidence, add one day or even two days to the normal Phase 3 rules. I can’t prove it, but I suspect that adding one day lowers the risk-of-pregnancy rate from 1 in 100 woman-years to 1 in 1000 woman years. Note also that Shannon writes that she has seen women go from short luteal phases to full length luteal phases with improved nutrition.
5. Do not feel sorry for yourselves. That’s always dangerous. We know a couple in which the wife had a chronic emotional-worry problem, so when they were entering premenopause they abstained for two years until she was clearly into menopausal infertility. We know another couple who abstained for 18 months after the birth of a child.
I congratulate you for your desire to live by the Faith and for inquiring as you did. May God bless you richly for your fidelity.
Sheila writes a weekly blog that is posted every Sunday. You may find it interesting to pay a weekly visit to our website blogs.
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I obviously don’t have a panacea, but I hope this is helpful.
John F. Kippley
Sex and the Marriage Covenant