The hysterectomy is one of the most common medical procedures amongst women. More than 400,000 hysterectomies are performed in the U.S. each year. In fact, one in three women will have undergone one by the age of 60. By removing the women’s uterus or womb, hysterectomies successfully treat fibroids, endometriosis, uterine prolapse, vaginal bleeding, chronic pelvic pain, and cancer of the uterine, cervix, or ovaries.
Unfortunately, it also ruins the patient’s chances of having children. To make matters worse, a new study shows that one in five women who underwent the procedure, thereby destroying their fertility, might not have needed it.
Appearing in the American Journal of Obstetrics and Gynecology, the University of Michigan-led study of almost 3,400 women in Michigan indicated that the medical alternatives to hysterectomies are being underused, and that treatment guidelines aren’t often followed.
“The workup and evaluation of patients with leiomyomas is very important in determining the appropriate therapies for patients. Each patient’s complaints, symptoms, size and location and number of fibroids has to be taken into account,” explained Jay M. Berman M.D., F.A.C.O.G., Associate Professor at Wayne State University School of Medicine. “The patients concerns about QOL, potential loss of fertility, loss of uterus and length of recuperation are important in choosing therapy.”
According to the researchers’ findings, almost 18% of hysterectomies performed for benign indications were unnecessary, and a pathology analysis for 38% of women under 40 — nearly two out of five — didn’t support the decision to undergo a hysterectomy.
“Over the past decade, there has been a substantial decline in the number of hysterectomies performed annually in the United States,” said U-M Medical School Department of Obstetrics and Gynecology associate professor Daniel M. Morgan, M.D., the senior author of the study. “An earlier study found a 36.4% decrease in number of hysterectomies performed in the U.S. in 2010 compared to 2002. However, despite the decrease in numbers of hysterectomies in the U.S., appropriateness of hysterectomy is still an area of concern and it continues to be a target for quality improvement.”
The study also found that nearly half of all women (40%) didn’t receive any documentation of alternative treatments before their hysterectomy. It also revealed that less than 30% had received medical therapy, while 24% underwent other minor surgical procedures prior to the hysterectomy, meaning these women had received multiple, unnecessary surgeries.
“Increasingly patients are looking for minimally invasive options for treatment. Radiofrequency ablation is an excellent alternative to hysterectomy that can be applied to a broad range of patients with fibroids. It is minimally invasive effect for bulk and bleeding symptoms and has a short recovery period. Uterine artery ablation, high frequency focused ultrasound, endometrial ablation, and hysteroscopic myoma resection are other alternatives but are not applicable to as wide a range of patients,” said Berman.
Radiofrequency ablation, when used to destroy fibroids, applies energy through a small needle array that destroys the fibroid cyst, witout affecting any of the surrounding tissue, which can then be completely reabsorbed.
Dr. Morgan also noted that “this study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain.”