Hysterectomy Not Always the Only Option

Hysterectomies without alternative treatment first common for endometriosis and abnormal uterine bleeding

(RxWiki News) Why have major surgery when a less intensive treatment option might do the trick? This complex question might be one women and their doctors need to discuss.

A new study found that a common procedure among women, hysterectomy, might be a little too common.

"Over 400,000 hysterectomies are performed annually in the United States and it is estimated that 1 in 3 women will have had a hysterectomy by age 60 years," explained the authors of this new study, led by Daniel M. Morgan, MD, of the University of Michigan Health System in Ann Arbor.

"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," he continued.

Dr. Morgan and colleagues noted that many hysterectomies are also performed for issues like abnormal uterine bleeding and endometriosis. In endometriosis, the uterine lining begins to grow outside of the uterus. However, the American Congress of Obstetricians and Gynecologists suggests other treatments as the first line of defense for these issues.

“This study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain,” Dr. Morgan said in a press release.

Alternative treatments can include medications, other surgery options or the use of an intrauterine device (IUD). An IUD is inserted into the uterus and releases hormones.

Dr. Morgan and colleagues wanted to see if alternative treatments like these were being used before hysterectomy.

In hysterectomy, the uterus is surgically removed. This may be due to a number of conditions, including cancer or when weakened muscles allow the uterus to fall into the vaginal canal.

Dr. Morgan and team studied nearly 3,400 hysterectomies performed in 2013. In 37.7 percent of these cases, there was no documentation that these patients received any alternative treatment before having a hysterectomy.

In addition, 18.3 percent of the patients had cervices, uterine linings, ovaries and other related tissue that their doctors described as normal. This could be a red flag that hysterectomy might not have been the only choice, Dr. Morgan and team noted.

Dr. Morgan and team noted a chance that some data on alternative treatments was left out of the records they studied.

This study was published online Dec. 23 by the American Journal of Obstetrics and Gynecology.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
January 8, 2015