More Hysterectomies, More Inappropriate Reasons

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Jan. 31, 2000 (New York) -- Hysterectomy is the second most common surgical procedure performed on women in the U.S., but a new study suggests that it may be overused. The study finds that many doctors may be going against set recommendations and performing hysterectomies even when the woman does not meet all the criteria and other sources of pain and bleeding have not been ruled out.

Of nearly 500 hysterectomies studied, 70% did not meet a physician expert panel's criteria for hysterectomy and 76% did not meet criteria established by the American College of Obstetricians and Gynecologists (ACOG). The study appears in the February issue of the journal Obstetrics and Gynecology.

Hysterectomy involves the removal of the uterus (partial hysterectomy), the removal of the uterus and the cervix (complete hysterectomy) or the removal of the uterus and all attached structures (radical hysterectomy). A hysterectomy may be recommended to treat and relieve severe bleeding and pain resulting from infection, cancer, fibroids, endometriosis, or prolapse, in which the floor of the uterus sags, causing bladder- and bowel-control problems.

In the new study, author Michael S. Broder, MD, and colleagues from UCLA looked at the women who had endometriosis, chronic pelvic pain, or premenopausal abnormal bleeding. Of those cases, hysterectomy was judged to be inappropriate 53% of the time by a panel of physicians and in 76% of cases where strict ACOG criteria were applied.

Broder and colleagues found that procedures such as exploratory surgeries and biopsies of the uterus, which should be done prior to hysterectomy to rule out other sources of pain and bleeding, were not done in 77% of cases where women had pain and in 45% of cases where they had abnormal bleeding. An additional 21% of eligible women were not offered alternative treatments or procedures such as hormone therapy to eliminate pain or bleeding prior to hysterectomy.

Suzanne Trupin, MD, who reviewed the report for WebMD, says the findings are not too surprising. Trupin, a clinical professor in the department of obstetrics and gynecology at the University of Illinois College of Medicine in Urbana, says there is a general feeling among researchers, patients, and health care insurers that some hysterectomies can be avoided and that more efforts should be focused on reducing hysterectomy rates, especially in areas of the country where they are unacceptably high.

Continued

"We've known for some time that there are some percentage of hysterectomies that probably are unnecessary and therefore probably wouldn't meet rigid criteria for hysterectomy. The message from this article is that 76% did not meet ACOG criteria preoperatively [before surgery] for hysterectomy, but that doesn't mean that all of those patients shouldn't have had hysterectomy or that hysterectomy wasn't appropriate," Trupin says.

Broder and colleagues say a lack of research showing the risks and benefits of hysterectomies may be making some doctors unsure about when a hysterectomy is or is not appropriate. They also suggest that since a hysterectomy is viewed as relatively safe, many doctors and patients may feel that the benefits outweigh the risks even when all the standard criteria are not met.

Trupin says the relationship between doctor and patient plays a big role in deciding how quickly to proceed to hysterectomy, but says the high percentage of patients in this study who did not receive a biopsy of the uterus beforehand is troubling. In addition to ruling out cancer, the biopsy gives other important information that helps guide the surgery so that more surgery won't be needed in the future to correct something that is missed or shows up unexpectedly during the hysterectomy.

The message for women with pain and bleeding is to ask questions about their options and to make sure they are satisfied with the reasons their doctors are recommending a hysterectomy, says Trupin. "You want to be sure that, in your individual case, you are being checked thoroughly enough to be sure you are getting the right operation and, in the process of being checked more thoroughly, you may uncover things that can be treated medically rather than surgically," she says.

Vital Information:

  • A hysterectomy, or surgical removal of the uterus, can be recommended to treat severe bleeding and pain caused by infection, cancer, fibroids, endometriosis, or prolapse.
  • In a recent study, 70% of hysterectomies performed did not meet an expert panel's criteria for having the procedure.
  • Patients should ensure that they are being checked thoroughly to rule out other causes of pain that may be treated nonsurgically.
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