TROUBLE AT `HOME'; SHOW'S JILL FACES FEAR OVER HYSTERECTOMY.

Byline: Betty Kwong Daily News Staff Writer

He grunts, he's accident prone, and he's always got a witty - and inappropriate - remark stashed in his tool belt.

She obsesses, she complains, and she's sometimes the only voice of sanity in a family whose antics all too often mimic real life.

ABC's ``Home Improvement'' has kept viewers laughing for eight seasons, but Tuesday night they also want to make viewers think.

In a two-part episode (8 p.m. Tuesday and March 2), Jill and Tim Taylor are headed to the hospital again, only this time it's not to patch up another one of Tim's boo-boos.

Jill's the one on the examination table, hearing the same words more than a quarter of all American women already have faced by their 60th birthday.

Jill has to have a hysterectomy.

It can be a devastating discovery. And the woman who plays Jill knows from personal experience.

``I had to have a partial hysterectomy about two to three years into doing the show,'' said Patricia Richardson.

``I didn't have to do any research, I knew all about it,'' Richardson said. ``My mother had to have a total hysterectomy when I was growing up, and I remember very clearly - I was in high school - being alarmed about that.''

Despite ongoing development of alternative methods to treat the problems that lead to a hysterectomy, surgical removal of the uterus remains one of the most frequently performed major surgeries in the United States.

The most common reason to perform a hysterectomy (about 30 percent) is to remove uterine fibroids, the same reason Jill Taylor's doctor prescribes a hysterectomy on the show. While scientists are still mystified by the cause of fibroids, most often the abnormal growths composed of muscular and fibrous tissues are benign. In fact, researchers have suggested that between 40 percent and 75 percent of women may develop fibroids sometime over a lifetime - and the majority of them may never know or be affected by it.

But in some women, untreated fibroids may continue to grow, or cause excessive menstrual bleeding and pelvic discomfort or pain.

Those very symptoms were Jill Taylor's first warning signs that something was wrong. By the time the two-part episode ends, doctors will have discovered additional growths - dermoid cysts - on her ovaries. And a total hysterectomy (removal of the uterus) as well as an oophorectomy (removal of the ovaries) is performed, sending 42-year-old Jill into early menopause.

``He cleaned me out. He gutted me like a fish,'' Jill moans when she finds out after surgery.

Women who have been through Jill's experience say the show's writers were on target: The emotional toll of a hysterectomy can be as drastic as the physical.

``Some women feel a hysterectomy is taking a vital part of their body away from them and subtracting their femininity or their womanhood,'' said Joan Kenley, a psychologist who co-authored ``Whose Body Is It Anyway?'' after having a partial hysterectomy when she was in her 50s.

``Some women get depressed afterward, even if they choose hormone replacement therapy. Some women can't have orgasms ... and some people have a mystical connection to their womb and feel a huge sense of loss,'' Kenley said. ``On the other hand, there are women who still feel the energy, still feel feminine, functional and are even more orgasmic after a hysterectomy.''

Say doctors, the best bet often is to keep organs intact if at all possible. Medical research has come up with a multitude of options for most women with fibroids, and, if detected early enough, they can be treated without the major surgery.

``There weren't these options 10 years ago. It was a hysterectomy or nothing,'' said Dr. Alan DeCherney, chairman of obstetrics and gynecology at the UCLA School of Medicine.

``Today, patients are less and less inclined to have hysterectomies,'' DeCherney said. ``So alternatives are found. And if it means less surgery, if you can have something that's less invasive, why not?''

Endometrial ablation, or removing the lining inside the uterus, is one of the more common methods to stop excessive bleeding, said Dr. Donna Shoupe, professor of obstetrics and gynecology at the USC School of Medicine.

The lining may be destroyed by cauterization. Or, in Shoupe's clinical trial on a new outpatient procedure, the lining is destroyed by freezing.

In cases with significant fibroids, a myomectomy - the removal of the fibroid, but not the surrounding organs - is often the first stop before leaping to a hysterectomy.

And in some instances, medications can help temporarily shrink larger fibroids to increase the options for treatment, said DeCherney.

Both doctors, however, caution that the show's portrayal of Jill's case is somewhat unrealistic. While a two-year lapse in gynecological visits could be enough time to allow a fibroid to grow large enough to require surgery, it is highly unusual for doctors to discover dermoid cysts on a woman's ovaries amid surgery - and then have them so entangled that the ovary must be removed, they said.

``Usually they're diagnosed when they're a teen-ager,'' DeCherney said.

``To have fibroids and dermoid cysts? That's a lot of disease to have,'' Shoupe said. ``But I'm glad they did it (oophorectomy) with some explanation.''

That's television. And we are in the middle of a sweeps period, when every network's pulling out all the stops to boost ratings.

Overall, though, both doctors say ``Home Improvement's'' exploration of this common female experience should be a loud reminder to get checkups at least annually.

Jill Taylor laments on the show that she'd been too busy raising a family and earning a master's degree to see her doctor in almost two years.

``A lot of women know they have fibroids. It's very reasonable to follow them, to keep track of their growth from year to year,'' Shoupe said. ``Sometimes they're even placed on medication, like birth control pills, that prevent them from growing.

``There are many different solutions and many different options now,'' she said.

Jenifer Hanrahan contributed to this story

CAPTION(S):

2 Photos, Box

Photo: (1--Cover--Color) REAL TV

By age 60, more than a quarter of American women will know the fear `Home Improvement's' Jill faces

(2) Jill and Tim Taylor (Patricia Richardson and Tim Allen) learn that she has developed uterine fibroids and needs a hysterectomy on a two-part episode of ``Home Improvement'' that begins Tuesday on KABC (Channel 7).

Box: ALTERNATIVE TO HYSTERECTOMY

Knight Ridder Tribune