First of all, let me go on record as saying that I have no vested financial interest in whether or not women have hysterectomies, since I confine my practice to surgical procedures that I can do in the office.
Second, let’s get our terms straight. A hysterectomy is removal of the uterus. Removal of the ovaries is called an oophorectomy. While it is true that sometimes both procedures are done at the same time, one must be careful to speak of these procedures separately, because they have different indications and different outcomes.
Okay, now that we have that settled, let’s talk.
It is estimated that in 1999, the last year for which we have data, there were some 600,000 hysterectomies performed in the United States.
Is that too many hysterectomies? I’m sure it is. Are there unnecessary hysterectomies being performed? I’d bet money on it. Are there non-surgical options for many of the conditions we use hysterectomy to treat? You bet there are.
But this does not mean that hysterectomies are bad operations.
That’s not what the HERS folks think. They want to see hysterectomies abolished. They tout data from uncontrolled studies and surveys to prove that hysterectomies lead to everything from decreased libido to impaired sexual function to obesity. And that anything other than a hysterectomy is better than the hysterectomy. The media don’t always help the discussion, especially when the only data they quote is the uncontrolled survery data from HERS. It’s all so simple for them. Hysterectomy = Bad. Anything else = Good.
What they do not tell you is that when it is indicated, a hysterectomy can save lives, restore sexual function, eliminate bleeding, resolve pain and improve the quality of life overall. But no one talks about the positive aspects of the surgery.
And no one talks about the many, many women out there who are suffering from heavy bleeding, pain and reduced quality of life because they have been led to believe that hysterectomy is a bad operation. They may spend years trying every other option under the sun so that they can avoid the dreaded operation that might give them back their lives. Some will make it finally to menopause with their uterus intact, but will have lost those years to pain and bleeding in return. Others will eventually give up the good fight and have the dreaded hysterectomy. And the most frequent comment I hear from these latter patients is this – “Why did I wait so long?’
It’s true. When hysterectomies are performed for indicated conditions, and when women make a well-informed decision to have the surgery, they tell me they would make the same decision over again.
This has not been my experience with my patients who have had myomectomies, the favorite surgery of the HERs foundation.
I have had more than a few patients regret their decision to have a myomectomy when, less than 5 years later, they are back with new fibroids larger and more symptomatic than their previous ones. “Why didn’t I just have a hysterectomy then?” they will say, or more disturbing to me “Why did I let everyone talk me out of a hysterectomy”?
Look, if you are 25 and have fibroids and haven’t had your kids yet, then absolutely a myomectomy is the operation you most likely will want. The surgery carries risks, but these pale for most women compared with the thought of not being able to have children.
But women who are done childbearing, and are taking the time out of their busy lives to have major surgery, should at least be given the opportuity to consider having the operation that will solve the problem forever – a hysterectomy.
As to the long term effect of hysterectomy, there are a number of well-done prospective studies showing that removal of the uterus alone does not impact sexual function. In fact, if reserved for women who really need it, sexual function in my practice experience, is often improved.
Is hysterectomy the only option for the conditions I listed above? For most benign conditions, the answer is absolutely not. But it is an option, and a very viable option. For many women, it is their best option.
Hysterectomy deserves consideration and discussion as much as any other procedure. To label it as being bad, or to try to convince women that they should not have this surgery is as much a disservice to women as performing an unnecessary hysterectomy.