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Doctors, spare our wombs!

Updated on September 8, 2013

Hysterectomy myths and facts


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Introduction

"First do no harm" is one of the most important principles in medicine. Nevertheless, every year, 600,000 American women undergo a surgery that can do more harm than good. In addition to certain sterility, they risk premature menopause, damage to other organs, death, and a three times higher risk of cardiovascular diseases than women who have not undergone this procedure. The name of this surgery is hysterectomy, from the Greek words "hystero" (womb) and "ektomia" (cutting out of). Why are so many American ladies willingly going under the knife to lose this important part of their reproductive systems, risking their lives and health? Surely, these procedures must be necessary, otherwise they would not have been performed? The answer to that is discouraging. In fact, "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."(http://www.cbsnews.com/2100-500165_162-3908231.html,http://www.today.com/id/23736952/ns/today-today_health/t/are-too-many-women-getting-hysterectomies/ ). In that case, why are so many hysterectomies still being performed? Are American women being informed about alternatives and risks? These are the questions this hub seeks to address.

Facts and figures

Fact 1: The United States has one of the highest hysterectomy rates among developed nations, as show in the table below. Only Germany, Australia, Belgium, and Switzerland have significantly higher rates than the United States. The United Kingdom, on the other hand, has a rate of nearly one fourth that of the United States, while Denmark, Spain, and Sweden have rates at less than half that of the US. The procedure is so common in this country that nearly a third of American women will have undergone a hysterectomy by age 60 (http://www.idph.state.il.us/about/womenshealth/factsheets/hyster.htm) .


Fact 2: The woman will not be able to bear children after a hysterectomy. (http://www.health.ny.gov/community/adults/women/hysterectomy/)


Fact 3: The woman will no longer menstruate after a hysterectomy, even if her ovaries are not removed. The only exception is in the case of a supracervical hysterectomy, where "menstrual bleeding can continue, but at a much lighter level than prior to the hysterectomy." (http://www.obgynofatlanta.com/hysterectomy).


Fact 4: While a hysterectomy may be inevitable in some cases, alternative treatments are available for most conditions treated by a hysterectomy.


Fact 5: The functions of the uterus are not limited to menstruation and reproduction. It also "provides structural integrity and support to the bladder, bowel, pelvic bones and organs as well. It separates the bladder and the bowels.

The networks of blood vessels and nerves of the uterus direct the blood flow to the pelvis and to the external genitalia, including the ovaries, vagina, labia, and clitoris for sexual response. The uterus is needed for uterine orgasm to occur."(http://www.news-medical.net/health/What-Does-the-Uterus-Do.aspx)





Hysterectomy rates by country (vaginal only, inpatient only)

(click column header to sort results)
Country  
Hysterectomy rate (1)  
Year  
United States
104.9
2010
Germany
177.6
2010
Australia
123.8
2009
Canada
90.8
2009
Italy
64.5
2009
Denmark
52.1
2010
Austria
106.9
2010
Belgium
141.3
2008
Netherlands
78.7
2009
New Zealand
44.9
2010
Portugal
42.5
2009
Spain
52
2010
Sweden
41.5
2010
Switzerland
123.1
2010
United Kingdom
26.9
2010
(1) per 100,000 females References: http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#

Types of hysterectomies

Source

Different types of hysterectomies

Hysterectomies vary in terms of both extent and method. As far as the extent is concerned, there are three types of hysterectomies. A partial, or supracervical (above the cervix) hysterectomy involves the removal of the upper part of the uterus only, with the cervix intact(http://women.webmd.com/guide/hysterectomy.) A patient who has undergone this procedure will still have to undergo Pap smears, as the risk of cervical cancer still exists. A total hysterectomy takes place when the entire uterus and the cervix are removed. A radical hysterectomy involves the removal of the upper part of the vagina, the ovaries, and the Fallopian tubes as well. "Radical hysterectomy is generally only done when cancer is present."(ibid)

There are several ways to perform a hysterectomy. The most common method is a laparotomy (a large abdominal incision, also known as open surgery), with " U.S. surgical data shows that abdominal hysterectomy is performed in 66% of cases, vaginal hysterectomy in 22% of cases, and laparoscopic hysterectomy in 12% of cases.."(http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Gynecologic%20Practice/Choosing%20the%20Route%20of%20Hysterectomy%20for%20Benign%20Disease.aspx) . WIth an abdominal hysterectomy, "A transverse (Pfannenstiel) incision is made through the abdominal wall, usually above the pubic bone, as close to the upper hair line of the individual's lower pelvis as possible, similar to the incision made for a caesarean section." (http://www.news-medical.net/health/Hysterectomy-Techniques.aspx) It gives doctors easy access to the woman's internal reproductive organs, but it involves a longer hospital stay than other methods, as well as " the invasiveness of the procedure the surgery requires general anesthesia, and has risk factors associated with abdominal surgery such as blood loss, pain and infection, and longer recovery."(http://obgyn.ucla.edu/body.cfm?id=283) Vaginal hysterectomies are sometimes performed, where an incision is made in the vagina and the uterus is then removed. They have the advantages of "causing fewer short- and long-term complications, more favorable effect on sexual experience with shorter recovery times and fewer costs. It is however not possible or very difficult to perform some more complicated surgeries using this technique." (ibid) Vaginal hysterectomies are not suitable for large fibroids, a large uterus, or if cancer is suspected. (http://www.emedicinehealth.com/hysterectomy-health/page4_em.htm) Also, this type of procedure may not be suitable for women who have never had a vaginal birth (http://emedicine.medscape.com/article/1839938-overview).Laparoscopy is another way to perform a hysterectomy, and involves making several small openings, with one in the navel, where a lighted camera is inserted. The advantages of a laparoscopic hysterectomy include "less blood loss, less scarring and less post-operative pain."(http://mydoctor.kaiserpermanente.org/ncal/facilities/region/eastbay/area_master/departments/laparoscopy/laparoscopy_gyn/laparoscopic_hysterectomy.jsp), as well as a lower risk of infection, a shorter hospital stay, and a faster recovery (ibid). Nevertheless, there are disadvantages, such as higher costs, longer operating time, and "increased risk of damage to the urinary tract" (http://www.womhealth.org.au/conditions-and-treatments/211-hysterectomy)

Laparoscopic vs abdominal incisions

Different types of incisions for a hysterectomy
Different types of incisions for a hysterectomy | Source

Common reasons for a hysterectomy and alternatives

Reason
Alternatives
pre-cancer
hormones, D&C
cancer
radiation, hormones, chemotherapy
fibroids
pills, IUDs, myomectomy, ablation
menorrhagia
NSAIDs, iron supplements, hormones, D&C, endometrial ablation
placenta accreta/increta/percreta
catheterization, artery ligation, conservative surgery
heavy non-menstrual bleeding
oral contraceptives,Depo-Provera, IUD, endometrial ablation
uterine prolapse
Kegels, uterine pessary, other surgery
chronic pelvic pain
pain pills, hormones, PT, laparascopy
ovarian cysts
oral contraceptives, wait and see, cystectomy
endometriosis
pain meds, hormones, conservative surgery
pelvic adhesions
expectant management, hormones, pain meds, conservative surgery
post-partum hemorrhage
pitocin, removal of placenta, blood transfusion, uterine massage, D&C

Hysterectomy risks

We have discussed the excessive numbers of hysterectomies, the different types, the fact that the role of the uterus is not limited to reproduction, as well as alternative treatments. Still, isn't hysterectomy safe, one might ask. After all, so many women have them and do fine. The answer is not as simple as one might hope for, unfortunately. According to the Mayo Clinic, while the procedure is " is generally very safe, but with any major surgery comes the risk of complications." Major is the key word here. Even a minor procedure such as a D&C is not without risks, so how could a hysterectomy, which are usually performed via an abdominal incision, be absolutely safe? What are the risks of hysterectomy and how common are they? is the next reasonable question. Let us discuss these below.

There are multiple risks of a hysterectomy. Major risks include bleeding requiring a blood transfusion (2.5 percent to 3 percent), injury to neighboring organs (zero to one percent), dehiscence (wound coming open) (zero to 0.5 percent), hematoma requiring surgical drainage (one percent), and blood clots in the lungs (zero to one percent). The risks of a major complication are six percent for an abdominal hysterectomy and 9.5 percent for a vaginal hysterectomy. Minor risks include heavy bleeding not requiring a transfusion (one percent), fever (three to seven percent), infection (fourteen to sixteen percent), and hematoma not requiring surgical drainage (six percent. The overall risk of a minor complication was twenty seven percent for abdominal hysterectomies and twenty eight percent for vaginal hysterectomies. (http://www.seton.net/healthwise/articles/hysterectomy#risks_of_hysterectomy).



Conclusion

In summation, hysterectomy is one of the most common surgeries performed on women in the United States, more frequently than on women in most developed countries. There are several types of hysterectomies, each with its own advantages and disadvantages. While there are situations, such as cancer, when a hysterectomy may be the only option, or if other options have been attempted and have not been successful, most women have other options that should be attempted first. The problem is, "Many women don’t know there are alternatives or less-invasive options, like laparoscopic surgery" (http://www.womens-health-advisor.com/hysterectomy.html). The uterus is an important organ, with its functions extending beyond reproduction, and removing it is not without risks and complications, which include death and sterility. Hysterectomy should only be performed as the last resort. The message to the gynecologists should be, with few exceptions, "Doctors, spare our wombs!"

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    • PamelaTroester profile image

      Pamela Troester 3 years ago from Austin, TX

      I found your article very interesting. Having just had a total laproscopic hysterectomy via the Da Vinci robot almost two weeks ago I have to say that I did a lot of research before the surgery, and lived with pain for many years. Pain during sex, a menstrual cycle that caused me to be doubled over in bed and be useless to anyone, passing large blood clots and chunks of tissue every month, ovarian cysts, endometriosis, andenomyosis, etc. I tried lots of alternatives, but they did no good. In the end, I believe I made the best decision and already feel much better. I felt that you were a bit condescending in your article. The many women I've talked with who've had hysterectomies did so after years of trying "alternatives" and living in pain, and to suggest to them, and me, that this was not necessary is a bit irritating. Additionally, perhaps the fact that a country safely performs so many surgeries is not necessarily a bad thing.

    • sakinah profile image
      Author

      sakinah 3 years ago from Nibong Tebal, Pulau Pinang, Malaysia

      I am sorry if I sounded condescending. I am also sorry about your suffering and glad to hear you are feeling better. You and other women you have mentioned endured a great deal, and alternatives did not work for them, well, then, by all means, go for it. I have known women in your position as well, and they fell happier afterwards. It's women who undergo this procedure because that's what the doctor suggested, before trying the alternatives, that I feel sorry for and hope this does not happen to anyone. Also, about many surgeries not being a bad thing, I disagree with you. Unnecessary surgeries are unnecessary surgeries. Even if the patient does not suffer any harm, a life-changing, irreversible procedure is unacceptable.

    • sakinah profile image
      Author

      sakinah 3 years ago from Nibong Tebal, Pulau Pinang, Malaysia

      sorry for the typo above. I meant to say "felt happier" not "fell happier". Also, in my last sentence, I mean to say "Even if the patient does not suffer any harm, an unnecessary, life-changing, irreversible procedure is unacceptable."

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