As many as one in five women who have hysterectomies in the United States may not need the surgery, according to a new study published in the American Journal of Obstetrics & Gynecology.
That’s a very troubling finding, particularly given that hysterectomy (surgical removal of the uterus) is the most commonly performed major gynecologic surgery in the country. Each year, more than 400,000 American women have a hysterectomy. This study suggests that at least 80,000 of those procedures may be unnecessary.
It also suggests that despite a significant decrease in the number of hysterectomies performed in the U.S. over the past decade (a decline of 36 percent between 2002 and 2010), many physicians continue to be reluctant to treat benign (non-cancerous) uterine conditions, such as abnormal uterine bleeding, uterine fibroids, endometriosis and pelvic pain, with less drastic treatments than removing the uterus.
“There are a lot of alternative options out there that can be used instead of doing a hysterectomy,” Lauren Corona, the study’s lead author and a third-year medical student at Wayne State University, told MinnPost. “So, for me, these findings were really surprising.”
The American College of Obstetricians & Gynecologists (ACOG) currently recommends several alternative treatments for benign uterine conditions, including hormonal management, endometrial ablation, operative hysteroscopy and the use of a progestin-releasing intrauterine device (IUD).
For their study, Corona and her colleagues examined the medical records of 3,397 women who underwent hysterectomies for benign (non-cancerous) conditions at 52 hospitals in Michigan over a 10-month period in 2013. Most of the women had endometriosis, pelvic pain, abnormal uterine bleeding, fibroids or a combination of those conditions. Women with cancer, endometrial hyperplasia, cervical dysplasia, a pelvic mass, an organ prolapse or a family history of cancer were not included in the study. The researchers looked for how often non-surgical options were recommended to and/or tried by the women and how often the pathological findings from the hysterectomy supported the choice of surgery.
They found that 38 percent of the women had no documentation that they had been offered or tried an alternative treatment for their benign condition before their hysterectomy. They also found that the older the women were, the less likely their records indicated they had considered or undergone an alternative treatment. Of the women in the study under the age of 40, 68 percent received alternative treatments. That compared to 62 percent of the women aged 40 to 50 and 56 percent of those aged 51 and older.
The researchers also found that almost one in five women (18 percent) had postsurgical pathologic findings that did not support the decision to have a hysterectomy.
This finding also revealed an age discrepancy. “The younger women were more likely to be having negative pathologies,” said Corona. Indeed, 38 percent of women under the age of 40 who underwent a hysterectomy had unsupportive pathology, compared to 7.5 percent of those over the age of 50.
The pathology reports were also most likely to be unsupportive of the hysterectomy when the woman had been diagnosed before the surgery with endometriosis or chronic pain.
Like all studies, this one has several limitations. Most notably, the data comes from one state, and it’s possible that information regarding alternative treatments did not make it into some of the patients’ records, thus underestimating how often such treatments were used.
Patient’s or doctor’s choice?
Still, the study offers strong evidence that alternative treatments are being underused.
Why do so many women continue to undergo unnecessary hysterectomies?
“That’s a very interesting question. I can’t tell you the answer to that,” said Corona. “It may partially have to do with the woman’s choice. They might think it’s just easier to have [their uterus] taken out. Maybe there’s something in the media that makes them think that, and they’re therefore not willing to try other options.”
“Or it may be that the physicians are pushing [hysterectomies] without necessarily following the ACOG guidelines,” she added.
Corona urges women with benign uterine conditions to ask their physicians about alternative treatments before undergoing surgery.
“And physicians need to try and calm their patients’ fears and let them know that hysterectomy isn’t necessarily the best option,” she added.
You’ll find an abstract of the study on the American Journal of Obstetrics & Gynecology website. The full study is behind a paywall.