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Health Care, Healthcare, Public Health, Women's Health

Nearly 1 In 5 Hysterectomies Are Unnecessary, New Study Finds

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An estimated one in three women in the United States will have had a hysterectomy by the age of 60, making the procedure the second most common surgery among women (after cesarean section). But according to a new study published in the American Journal of Obstetrics & Gynecology, one in five hysterectomies may be unnecessary.

Hysterectomy involves the surgical removal of the uterus, ending menstruation and the ability to become pregnant. Depending on the reason for the surgery, a hysterectomy may also involve the removal of other organs and tissues such as the ovaries and/or fallopian tubes. Doctors may recommend hysterectomy to treat a variety of medial conditions, including painful uterine fibroids, uterine prolapse, uterine cancer, endometriosis and chronic pelvic pain.

Although the number of hysterectomies performed annually in the U.S. has fallen by more than a third since 2002, more than 400,000 women still undergo the procedure each year, and there remain persistent concerns about the appropriateness of these surgeries.

About 68 percent of hysterectomies for benign conditions are done to treat abnormal uterine bleeding, uterine fibroids, and endometriosis. However, the American Congress of Obstetricians and Gynecologists (ACOG) recommends alternatives to hysterectomy, such as hormonal and other forms of medical management, endometrial ablation, and use of the levonorgestrel intrauterine device as primary management of these conditions in many cases. According to the ACOG guidelines, hysterectomy should only be used as a last resort for these benign conditions, and only after  other treatments have failed.

In this latest study, researchers from the University of Michigan set out to assess how often these alternative treatments are being recommended to women with benign gynecologic disease before performing hysterectomy, and whether the pathologic findings from the hysterectomy supported the need for surgery.

Nearly 40% of women not offered alternative treatment prior to hysterectomy

The researchers collected data for the study over a ten-month period in 2013, examining the medical records of 3,397 women who underwent hysterectomies for benign conditions, including uterine fibroids, abnormal uterine bleeding, endometriosis, and pelvic pain.

The analysis revealed that nearly 40 percent of women did not have documentation of alternative treatment before their hysterectomy. Fewer than 30 percent received medical therapy, while just 24 percent underwent other minor surgical procedures before the hysterectomy, the researchers found. Those most likely to receive alternative treatment included women under 40 years old and women with larger uteri.

More importantly, the results also showed that nearly one in five women (18.3 percent) had post-surgical pathological findings that did not support the need for hysterectomy. Although women under 40 years old were most likely to receive alternative treatment prior to hysterectomy, they also had the highest rate of unsupportive pathology. Nearly two in five women under 40 (37.8 percent ) had pathological findings that did not support the need for hysterectomy compared to 12 percent for those aged 40-50 and 7.5 percent for women over 50 years.  Women diagnosed with endometriosis or chronic pain were also more likely to have unsupportive pathology.

“This study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain,” says senior investigator Daniel M. Morgan, MD, Associate Professor of Obstetrics and Gynecology at the University of Michigan. Based on their findings, Dr. Morgan and colleagues propose that the appropriateness of surgery should serve as a new quality indicator in gynecology.



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