Surgery to Avoid #1: Hysterectomy

One of 5 operations you don’t want to get—and what to do instead.


One of 5 operations you don't want to get—and what to do instead.

Theres long been a concern, at least among many women, about the high rates of hysterectomy (a procedure to remove the uterus) in the United States. American women undergo twice as many hysterectomies per capita as British women and four times as many as Swedish women.

The surgery—either traditional open (large incision) or laparoscopic (small incision) — is commonly used to treat persistent vaginal bleeding or to remove benign fibroids and painful endometriosis tissue. And if both the uterus and ovaries are removed, it takes away your sources of estrogen and testosterone. Without these hormones, your risk of heart disease and osteoporosis rises markedly. There are also potential side effects, from newfound pelvic problems to lower sexual desire and reduced pleasure. Hysterectomies got more negative press after a landmark 2005 University of California, Los Angeles (UCLA), study revealed that, unless a woman is at very high risk of ovarian cancer, removing her ovaries during hysterectomy actually raised her health risks.

So why are doctors still performing the double-whammy surgery? “Our profession is entrenched in terms of doing hysterectomies,” says Ernst Bartsich, MD, a gynecological surgeon at Weill-Cornell Medical Center in New York. “Im not proud of that. It may be an acceptable procedure, but it isnt necessary in so many cases.” In fact, he adds, of the 617,000 hysterectomies performed annually, “from 76 to 85 percent” may be unnecessary.

Although hysterectomy should be considered for uterine cancer, some 90 percent of procedures in the United States today are performed for reasons other than treating cancer, according to William H. Parker, MD, clinical professor of gynecology at UCLA and author of the 05 study. The bottom line, he says: If a hysterectomy is recommended, get a second opinion and consider the alternatives.

What to do instead
Go knife-free. Endometrial ablation, a nonsurgical procedure that targets the uterine lining, is another fix for persistent vaginal bleeding.

Focus on fibroids. Fibroids are a problem for 20 to 25 percent of women, but there are several specific routes to relief that arent nearly as drastic as hysterectomy. For instance, myomectomy, which removes just the fibroids and not the uterus, is becoming increasingly popular. And there are other less-invasive treatments out there, too.

In France in the early 1990s, a doctor who was prepping women for fibroid surgery—by blocking, or embolizing, the arteries that supplied blood to the fibroids in the uterus—noticed a number of the benign tumors either soon shrank or disappeared, and, voila, Jacques Ravina, MD, had discovered uterine fibroid embolization (UFE). Since then, interventional radiologists in the United States have expanded their use of UFE (typically a one- to three-hour procedure), using injectable pellets that shrink and “starve” fibroids into submission. Based on research from David Siegel, MD, chief of vascular and interventional radiology at Long Island Jewish Medical Center, New Hyde Park, New York, some 15,000 to 18,000 UFEs are performed here each year, and up to 80 percent of women with fibroids are candidates for it.

Another new fibroid treatment is high-intensity focused ultrasound, or HIFU. This even less invasive, more forgiving new procedure treats and shrinks fibroids. Its whats called a no-scalpel surgery that combines MRI (an imaging machine) mapping followed by powerful sound-wave “shaving” of tumor tissue.
Curt Pesmen
Last Updated: February 25, 2008

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