Why A Hysterectomy May Be Unnecessary

  • 11
    Shares

A hysterectomy is a surgery that permanently removes a woman’s uterus. Once the uterus is removed, she can no longer become pregnant. Hysterectomy is the second most common surgery performed on women in the United States, just after C-section (1). One of every three women has a hysterectomy before the age of 60, and there are more than a half-million of these procedures performed every year (1, 2). Women who get hysterectomies face serious risks, including surgical complications, such as blood loss, infection, or bladder damage (3). Women are also at increased long-term risk of developing heart problems after a hysterectomy. About 10% of hysterectomies are needed to remove life-threatening uterine cancer (4). However, many are performed for non-cancerous conditions that could potentially be treated by other, less invasive methods.

Depending on why a hysterectomy is being done, a surgeon may remove the entire uterus or part of the uterus, and possibly even the ovaries from some women. The uterus can be removed through an incision along the bikini line or vertically down the abdomen, through smaller abdominal incisions for laparoscopic procedures, or through the vagina (2). More than two-thirds of hysterectomies are performed to treat uterine fibroids, endometriosis, or other causes of heavy uterine bleeding and pain (1). Even though these medical problems are often treated by hysterectomy, there are alternative options available that do not require major surgery. The American College of Obstetricians and Gynecologists recommends that women with non-cancerous conditions be aware of these alternative treatments before a hysterectomy is attempted (5). In many cases, the alternatives may be effective, avoiding the need for removal of the uterus and reducing a woman’s risk of complications.

More than one-third of hysterectomies, or 200,000 operations, are done each year to remove fibroids (6). Fibroids are the most common non-cancerous gynecological tumor in premenopausal women, affecting 70-80% of women (6, 7). Fibroids grow from the wall of the uterus. A woman may have one or multiple fibroids, and these can develop any time during her childbearing years. Some fibroids stay small and cause no problems. Others grow large and cause heavy bleeding, pelvic pressure, pain, and fertility problems. Although hysterectomies are a common treatment for fibroids, there are a number of non-surgical or less invasive options that a woman can consider. These treatments are discussed here and include the following:

  • Watchful waiting, which means monitoring the tumor size and symptoms over time, because fibroids tend to shrink after menopause
  • Medications that reduce the hormones believed to cause fibroid growth
  • Uterine artery embolization, which is a minimally invasive approach to reduce blood flow to the tumors in the uterus, causing them to shrink
  • Myomectomy, which is a surgery to remove the tumor only, allowing a woman to keep her uterus

Another common reason that hysterectomies are performed is to treat endometriosis. This is a condition where the tissue that normally lines the uterus, called endometrial tissue, also grows abnormally in other places, usually the ovaries, bowel, or bladder (5). This problem affects more than five million women in the United States and can cause severe pain, heavy bleeding, and infertility (8). Alternatives to hysterectomy that may reduce bleeding and pain include hormonal medications, such as birth control pills. Some women choose to get a hysterectomy to treat their endometriosis. However, if a hysterectomy does not remove all of the abnormal tissue from a woman’s body, it will not cure all of the symptoms.

About one of every five hysterectomies is done to treat uterine prolapse, which is when the uterus shifts away from its normal position, because the muscles of the pelvic floor have become too weak (5). Uterine prolapse can be treated without surgery by Kegel exercises or by inserting something called a pessary device into the vagina to increase support.

Some women with poor quality of life and serious symptoms from these non-cancerous conditions may benefit from hysterectomy. However, many women get a hysterectomy because they are unaware of the alternatives, which are less risky and would allow a woman to keep her uterus, potentially allowing for future pregnancies. More than one-third of women do not have an alternative treatment before surgery (9). For example, one study showed that only one out of four women who received a hysterectomy for prolapse were offered a pessary device before surgery (10). Fortunately, physician groups have established guidelines for offering alternative treatments, and patients are becoming more aware of these options. As a result, the frequency of hysterectomy has started to go down, particularly in women younger than 55 and patients with fibroids, endometriosis, or abnormal bleeding from the uterus (11). Still, many women have this major surgery without understanding all of their options.

A woman should seek medical advice to determine if she needs a hysterectomy. She can always seek multiple medical opinions if she has concerns about symptoms or treatments. Women should ask for information about alternatives to surgery, types of hysterectomies, and the risks of any treatment given her specific situation.

References:

  1. Medical News Today. Whiteman. Almost 1 in 5 hysterectomies are ‘unnecessary’, study finds.
  2. National Women’s Health Network. Hysterectomy.
  3. Bohlin et al. Factors influencing the incidence and remission of urinary incontinence after hysterectomy. Am J Obstet Gynecol 2017;216:53.
  4. Johns Hopkins Medicine. Hysterectomy.
  5. American College of Obstetricians and Gynecologists. Choosing the Route of Hysterectomy for Benign Disease.
  6. National Institutes of Health. Uterine Fibroids.
  7. Centers for Disease Control and Prevention. Common Reproductive Health Concerns for Women.
  8. National Institutes of Health. Endometriosis.
  9. Corona et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol 2015;212:304.
  10. Sammarco et al. Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse. Int Urogynecol J. 2018 Jun 22.
  11. Morgan et al. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women. Am J Obstet Gynecol 2018;218:425.

Rita Nahta
Dr. Rita Nahta has a Ph.D. in pathology from Duke University. She lives in Atlanta, GA, where she serves as a medical school professor, teaching a variety of classes, including about the effects of drugs on pregnancy. She writes about women’s health, oncology, and medical education.

Add Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.