It’s the second most common surgery women undergo in the U.S., yet new research suggests that nearly 20 percent of hysterectomies performed to treat noncancerous conditions are actually unnecessary, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Though the number of hysterectomies performed in this country has fallen from a peak of more than 680,000 in 2002 to some 434,000 in 2010, it’s projected that 1 in 3 American women will have one by age 60. What’s more, the new study suggests that alternative treatments to hysterectomy are underused.
“A hysterectomy is the surgical removal of the uterus and typically the cervix, and sometimes the fallopian tubes and ovaries,” explains Melissa Goist, assistant professor and OB-GYN at The Ohio State University Wexner Medical Center in Columbus. “This is [serious] surgery. Major organs, blood vessels and other pelvic organs are encountered during the procedure and can be at risk of injury.”
Complications can include damage to organs such as the bowel and bladder, bleeding and blood clots in the deep veins of the body, infections and complications associated with anesthesia. After undergoing a hysterectomy, a woman will no longer have menstrual periods nor can she get pregnant.
Hysterectomies not only treat cancers of the uterus, ovaries, cervix and fallopian tubes, but also various noncancerous conditions. These include chronic pelvic pain; uterine prolapse, where the uterus slips into the vagina due to a lack of pelvic support; abnormal uterine bleeding; uterine fibroids — benign tumors in the uterine wall; and endometriosis, when tissue that lines the uterus grows outside the uterus. The last three afflictions on this list were responsible for the majority of hysterectomies performed for benign conditions, according to the study.
These new findings are “no big surprise, really,” says Sheryl Ross, OB-GYN and women’s health specialist at Providence Saint John’s Health Center in Santa Monica, California. “Women need to be offered alternative therapies prior to undergoing a hysterectomy. Doctors underutilize these nonsurgical options and it is a disservice to women.”
The goal in using alternative treatments, Ross says, is to alleviate the most common symptoms of medical conditions that hysterectomies are used to remedy: heavy, irregular uterine bleeding; anemia; and pelvic pressure and pain. Hormonal medications such as the birth control pill and progesterone intrauterine devices can control many of these symptoms.
If a woman suffers from fibroids — which are a leading cause of hysterectomies — one alternative procedure is uterine artery embolization, a minimally invasive treatment performed by a radiologist to shrink or eliminate the masses, which can range in size from a pea to a softball. Small particles are injected into uterine arteries to block the blood flow feeding the fibroids. Another option, myomectomy, surgically removes only the fibroids and leaves the uterus in place, thus preserving a woman’s fertility.
For women with chronic and severe bleeding, a procedure called endometrial ablation destroys the lining of the uterus using various agents such as an electric current, extreme cold or heated fluid to reduce or stop menstrual flow.
To treat uterine prolapse — a condition post-menopausal women and moms who’ve had vaginal births are especially prone to — a rubber device called a pessary can be inserted into the vagina to support the uterus. And kegal exercises, which involve squeezing the pelvic floor muscles, are highly recommended for strengthening the muscle under the uterus.
So who does need a hysterectomy? “Women who have tried and failed several nonsurgical options,” Ross says. “Depression and anxiety are common emotional consequences that women experience as they journey down the road of treatment options. Medical treatments can be painfully slow in resolving the symptoms and may have challenging side effects that are often worse than the problems associated with the primary diagnosis,” such as those caused by hormones.
Women who have had chronically heavy and irregular bleeding that required blood transfusions may best benefit from a hysterectomy, as could some women suffering from their uterus and/or bladder falling out of the vagina, Ross says.
A hysterectomy can also help doctors arrive at a definitive diagnosis if certain cancers are suspected, explains Jaime Arruda, assistant professor of obstetrics and gynecology and practicing surgeon at the University of Colorado Hospital in Aurora. And, Arruda adds, most cancer diagnoses should be treated with hysterectomy though there are less invasive options too.
While hysterectomies shouldn’t be completely discounted, Goist recommends that women always ask their doctors about whether they may be candidates for alternative procedures. “Most gynecological surgeons will discuss all possible options and the pros and cons of each depending on the patient’s situation.”
Says Ross: “Alternative treatments should be the first-line recommendation in treating medical conditions that might ultimately require a more definitive solution. Women appreciate a comprehensive conversation of all the alternative choices in treating disruptive symptoms.”
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Having a Hysterectomy? Why You Might Not Need One originally appeared on usnews.com
