Too Many Hysterectomies?

Experts: As Many As 2/3 In U.S. May Be Needless, Especially Due To Emerging Alternatives

(CBS)  Some 600,000 hysterectomies are performed in the United States each year, according to the Department of Health and Human Services, and fully a-third of women will have had one by the time they turn 60.

But experts are raising the yellow flag, saying many of the procedures -- perhaps as many as two-thirds -- may be unnecessary, particularly when new alternatives are considered.

On The Early Show Wednesday, Dr. Rebecca Brightman, an obstetrician/gynecologist at New York's Mt. Sinai Medical Center, stressed that, in many cases, a hysterectomy can be life saving.

But, she added, with the newer technologies, many women may not need the invasive surgery, which involves the removal of the uterus, and often, the ovaries as well. Hysterectomies leave women unable to give birth, and there's a risk of bladder and bowel injury.

"I think a lot of women are encouraged (to have a hysterectomy) by their physicians," Brightman told co-anchor Maggie Rodriguez, "and I think the most important thing for women to realize now is that there are alternatives. Not every woman is a candidate for these alternatives, and there are certain times when a woman absolutely needs a hysterectomy."

The 600,000 figure represents a slight decline, but is still too high, Brightman says, adding that the statistics amaze her, since less invasive procedures are constantly evolving. Women, she says, need to know the newer technology exists and take advantage of it.

Women who NEED hysterectomies include those with cancer of the uterus, ovaries, or cervix, those with intolerable pain, and those who've tried other things without success, Brightman points out.

In general, she says, other conditions that might call for hysterectomies include:

Fibroids: They're very common, even more so in black women than white women. Their seriousness depends on their location. Fibroids are typically benign and slow-growing, thought their frequency tends to increase when women hit their 40's, due to increased levels of estrogen in their systems.

Excessive bleeding: It has to be evaluated. It can be caused by many things, but can be treated in ways other than having a hysterectomy. Women would need an ultrasound and, as they approach menopause, would need a biopsy of their uterine lining to determine whether cancer is present.

Endometriosis: This is the growth of tissue outside of uterus. Women used to routinely have a hysterectomy for it. Not anymore. It can be controlled with hormones, such as those in low-dose birth control pills.

Once cancer, fibroids or polyps (which can be removed without a hysterectomy) have been ruled out, hysterectomy alternatives include:

Hormone therapy: Not everyone is a candidate for it. "There are certain contra-indications to using hormones," Brightman told Rodriguez. One could be patients with breast cancer. Women who are candidates for hormone treatment would be those "without an underlying structural abnormality" -- a woman without fibroids, without a uterine polyp, a woman who just has frequent heavy menstrual bleeding.

Thermal Ablation: A new procedure that destroys the lining of the uterus to decrease bleeding. It leaves women unable to have a baby. In it, a warm, hot balloon is inserted into the uterine cavity. Some women with fibroids, many times women without them, have it.

Uterine Artery Embolization can be tried for fibroids. The "great, new procedure," Brightman says, diminishes the blood supply to the uterus, shrinking fibroids and the amount of bleeding, if the fibroids were causing it. This procedure doesn't always work, though, and some women will still need a hysterectomy.

Every situation is different, Brightman emphasized, and it all comes down to a woman being thoroughly evaluated and properly informed of non-surgical or less invasive approaches. Women should have a full understanding of options other than hysterectomies, and should discuss the fertility question as well -- most women who have hysterectomies are between the ages of 40-44.

And -- go for a second opinion.

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Add a Comment

by michellem99-2009 March 7, 2008 1:18 AM EST

I read the article, I still have every thing. I will not have them remove my ladie''s parts. While I hated the periods and thet stopped at 37. What I was not perpard for was I strong then a waeking due to the harmornes shutting down. I COULD LIFT A 20LB SACK OF DOG FOOD. NOW CAN''T CARRY 5 LBS. This is what the change of life did to me. I am on harmores as my body don''t make them. Even with harmores replacement the dr have me don''y make me strong. Yer dry as well. Sexx is painful after the change. A lot to think about. Barbara I am 53 and can pass as a 20 year old. Dear Lady, if ye feel mot right about that bloody Dr removing yer parts then if it were me I tell him to take a hike as yer not going to DO an osparation that I am having 2rd thots on and yer not forcing it on me. I am a layperson. i had my tubes fixed so no babies.

Reply to this comment

by chgo4 March 6, 2008 7:01 AM EST

im 37yrs old and i dont know what to do for the first time in my life!my doctor told me i need a hysterectomy,and in my heart i feel that he is wrong.yes im in pain and i dont want to be so i said to him ok lets do this,but i ask myself every day should i or should''nt i. ps my life will change on march 28th at 7am that is the day of my surgery

Reply to this comment

by mythoughtsr March 5, 2008 8:22 PM EST

The endometrial ablation ONLY works if you have a "compatible uterus". I know because I had it done and it didn''t work. THEN they said, oh let''s do the older roller ball ablation, that''ll work! NOPE! That didn''t work. Finally, I just had the hysterectomy. Wonderful results, new life, still have my ovaries, no more suffering. Thank goodness my doctors had the common sense to sedate me and keep me for several nights after the hysterectomy.

Deesean40, "normal" for me as a teenage girl was 12 days of agony and pain, two of them curled in bed in the fetal position.

I do not feel butchered. I am a new woman. With grown children, no more periods and a new lease on life, I HIGHLY recommend the hysterectomy to any woman suffering from unbearable periods.

Reply to this comment

by godofredo29 March 5, 2008 5:48 PM EST

The same complaint could be voiced about hernia repairs in men. It''s like the medical profession sees these surgical procedures as if they were like having a tooth pulled or something rather than the serious invasive procedures that they are--requiring careful monitoring afterwards and sometimes even rehab.

Reply to this comment

by deesean40 March 5, 2008 5:30 PM EST

For women between 35-50 years of age I recommend the embolization if your fibroids are not too bad. I had this procedure 3 years ago and it worked perfectly for me. My uterus shrunk down to a normal size and my period is as normal as a teenage girl. A hysterectomy changes your life forever. I''ve heard this from many woman. The *** drives disappears, urinary tract infections become common, the hot flashes kick in, the hair thins and some woman become very dry. Unwarranted Hysterectomies just keep the Dr''s with fat pockets and the love to recommend this surgery on women of color. Don''t let them butcher you....pray and seek an alternative early in the process.

Reply to this comment

by diamonddoll9 March 5, 2008 1:03 PM EST

First of all after listening to this Dr I can safely say I would NEVER go to her. Her description of "warm, hot" (which is it?) on the ablation was very misleading. She made it seem like no big deal. My cousin had this done a few months ago. She was awake as they inserted an instrument that was very hot as it was meant to BURN the lining of her uterus. YES she could feel it!!! That was supposed to stop the bleeding she had been having. Instead, after she was home, she started to hemmorage and continued to do so for 3 days. The next step is to have a coil inserted in her fallopian tube to prevent the egg from escaping. The other option is to have a hyterectomy. I had one 2 yrs ago in April and feel better than I have in years. My hair which had gotten so thin is thick and beautiful again like it was when I was 20. Why be a guina pig when you can find a very good doctor who has done a number of hysterectomies safely. If you wish to have more children that is a different story. My child was 22, so I was done. Think long and hard before you decide and for goodness sake, do your homework! CHeck out the dr and ask for references. Remember, the earlier you have a hysterectomy the more likly you will get cervical cancer. Not sure what Barbaraf4 meant. I notice my skin is thicker feeling, not as baby soft. It is soft, but after 1 1/2 years it feels tougher, thicker. It is hard to describe. It is gradual.

Reply to this comment

by barbaraf4 March 5, 2008 12:46 PM EST

If you are having a hysterectomy, have it while you are in your early 20s. Your skin and youthful appearance will thank you for it when you reach middle age!

Reply to this comment

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[michellem99-2009]

I read the article, I still have every thing. I will not have them remove my ladie''s parts. While I hated the periods and thet stopped at 37. What I was not perpard for was I strong then a waeking due to the harmornes shutting down. I COULD LIFT A 20LB SACK OF DOG FOOD. NOW CAN''T CARRY 5 LBS. This is what the change of life did to me. I am on harmores as my body don''t make them. Even with harmores replacement the dr have me don''y make me strong. Yer dry as well. Sexx is painful after the change. A lot to think about. Barbara I am 53 and can pass as a 20 year old. Dear Lady, if ye feel mot right about that bloody Dr removing yer parts then if it were me I tell him to take a hike as yer not going to DO an osparation that I am having 2rd thots on and yer not forcing it on me. I am a layperson. i had my tubes fixed so no babies.

[chgo4]

im 37yrs old and i dont know what to do for the first time in my life!my doctor told me i need a hysterectomy,and in my heart i feel that he is wrong.yes im in pain and i dont want to be so i said to him ok lets do this,but i ask myself every day should i or should''nt i. ps my life will change on march 28th at 7am that is the day of my surgery

[mythoughtsr]

The endometrial ablation ONLY works if you have a "compatible uterus". I know because I had it done and it didn''t work. THEN they said, oh let''s do the older roller ball ablation, that''ll work! NOPE! That didn''t work. Finally, I just had the hysterectomy. Wonderful results, new life, still have my ovaries, no more suffering. Thank goodness my doctors had the common sense to sedate me and keep me for several nights after the hysterectomy.

Deesean40, "normal" for me as a teenage girl was 12 days of agony and pain, two of them curled in bed in the fetal position.

I do not feel butchered. I am a new woman. With grown children, no more periods and a new lease on life, I HIGHLY recommend the hysterectomy to any woman suffering from unbearable periods.

[godofredo29]

The same complaint could be voiced about hernia repairs in men. It''s like the medical profession sees these surgical procedures as if they were like having a tooth pulled or something rather than the serious invasive procedures that they are--requiring careful monitoring afterwards and sometimes even rehab.

[deesean40]

For women between 35-50 years of age I recommend the embolization if your fibroids are not too bad. I had this procedure 3 years ago and it worked perfectly for me. My uterus shrunk down to a normal size and my period is as normal as a teenage girl. A hysterectomy changes your life forever. I''ve heard this from many woman. The *** drives disappears, urinary tract infections become common, the hot flashes kick in, the hair thins and some woman become very dry. Unwarranted Hysterectomies just keep the Dr''s with fat pockets and the love to recommend this surgery on women of color. Don''t let them butcher you....pray and seek an alternative early in the process.

[diamonddoll9]

First of all after listening to this Dr I can safely say I would NEVER go to her. Her description of "warm, hot" (which is it?) on the ablation was very misleading. She made it seem like no big deal. My cousin had this done a few months ago. She was awake as they inserted an instrument that was very hot as it was meant to BURN the lining of her uterus. YES she could feel it!!! That was supposed to stop the bleeding she had been having. Instead, after she was home, she started to hemmorage and continued to do so for 3 days. The next step is to have a coil inserted in her fallopian tube to prevent the egg from escaping. The other option is to have a hyterectomy. I had one 2 yrs ago in April and feel better than I have in years. My hair which had gotten so thin is thick and beautiful again like it was when I was 20. Why be a guina pig when you can find a very good doctor who has done a number of hysterectomies safely. If you wish to have more children that is a different story. My child was 22, so I was done. Think long and hard before you decide and for goodness sake, do your homework! CHeck out the dr and ask for references. Remember, the earlier you have a hysterectomy the more likly you will get cervical cancer. Not sure what Barbaraf4 meant. I notice my skin is thicker feeling, not as baby soft. It is soft, but after 1 1/2 years it feels tougher, thicker. It is hard to describe. It is gradual.

[barbaraf4]

If you are having a hysterectomy, have it while you are in your early 20s. Your skin and youthful appearance will thank you for it when you reach middle age!