WOMEN'S HEALTH
January 20, 2015

Unnecessary Hysterectomies

Too often surgery is the only option offered to women with certain gynecological issues. It shouldn't be.

There a number of uterine conditions that, though painful and serious, pose almost no risk to women's overall health. Yet too often, according to a recent study, doctors recommend a hysterectomy — the surgical removal of their entire uterus — to women with benign conditions such as abnormal uterine bleeding, endometriosis, fibroids, or pelvic pain.

About 18 percent of the hysterectomies done for reasons other than cancer are unnecessary, according to the new study from the University of Michigan. Roughly 38 percent of hysterectomies in women under 40 for benign indications were unnecessary; of the hysterectomies performed on women between the ages of 40 and 50, 12 percent were unnecessary. It was 7.5 percent among women over 50 years old.

Almost 40 percent of the medical records examined offered no evidence that alternatives to surgery had been tried prior to hysterectomy.

The good news is that the annual number of hysterectomies in the U.S. has declined significantly in recent years. Despite this decrease, however, “The appropriateness of hysterectomy is still an area of concern and it continues to be a target for quality improvement,” said Daniel Morgan, senior investigator of the research, in a press release.

Too often, the researchers found, women with benign gynecological issues were not offered alternatives to hysterectomy. In many cases, they were given hysterectomies when there were no pathologic findings (such as cancer or advancing disease) that supported the need for surgery.

The investigators reviewed the medical records of almost 3,400 women who had hysterectomies during a 10-month period in 2013. Almost 40 percent of the medical records examined offered no evidence that alternatives to surgery had been tried prior to hysterectomy. Fewer than 30 percent of women received medical therapy and 24 percent had a minor procedure before undergoing hysterectomy.

Because it brings an end to women's ability to bear children, doctors were more likely to consider an alternative to hysterectomy for women under 40 years old.

The post-operative outcome — such as a quick recovery with no infection — is the standard yardstick for determining the success of gynecological surgery, said Jason Wright, chief of the division of gynecologic oncology at Columbia University and New York Presbyterian Hospital in New York City, in the news release.

As reimbursement policies change, the need for surgery may become an even more important issue for patients and insurance companies, Wright added.

“Reducing the number of procedures performed in women who may not necessarily require the procedure in the first place has the potential to have an even more meaningful impact in reducing adverse outcomes and cost than optimization of postoperative care.”

Women of all ages should not immediately assume that a hysterectomy is their only option. It may be needed, but they should be sure to explore options to surgery with their doctors. And if they remain unconvinced that surgery is necessary, women should get a second opinion from another specialist.

The study is published online in the American Journal of Obstetrics and Gynecology.

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