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    More Hysterectomies, More Inappropriate Reasons


    "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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