Hysterectomy Alternatives Often Underutilized Leaving Women With Unnecessary Surgery as Only Option
By Alicia Armeli

In the US alone, more than 400,000 hysterectomies are performed each year, with 68 percent of these done to treat noncancerous conditions. The American Congress of Obstetricians and Gynecologists (ACOG) supports the use of alternatives to hysterectomy to treat non-life threatening gynecologic conditions. Yet, a recent study published in the American Journal of Obstetrics and Gynecology1 showed that these guidelines aren’t always followed and, as a result, women are undergoing unnecessary surgery.

Over a ten-month period in 2013, a team of researchers led by L. E. Corona analyzed the medical charts of women from 52 Michigan-based hospitals participating in the Michigan Surgical Quality Collaborative. Their goal was to investigate whether alternative treatments are offered to women with benign gynecologic diseases—such as fibroids, abnormal uterine bleeding, endometriosis, and pelvic pain—before proceeding to hysterectomy. Alternative treatments can include medical therapy such as pain management and levonorgestrel intrauterine devices or minimally invasive procedures like endometrial ablation and hysteroscopy.

Overall 3397 women underwent hysterectomy for benign conditions and results showed that among this group of women, nearly 40 percent didn’t have documentation of receiving any alternative treatments before surgery.

Of those who were provided with alternative treatments, 24 percent underwent minor procedures alone, while 18 percent were given medical therapy only. What’s more, the majority of women had been given no more than one documented therapy. The authors noted, “more than one therapy may have resulted in adequate treatment without the need for hysterectomy.”

Other factors such as age played a role in whether women received womb-sparing treatments. Sixty-eight percent of women younger than 40 years of age received alternative treatments in comparison to 62 percent of those 40-50 years old and 56 percent of women 50 years and older.

The end of the study revealed another key finding. Was hysterectomy appropriate for each woman?

Pathological reports following surgery showed that 18.3 percent of women did not have a supportive need for hysterectomy. When broken down by age groups, unsupportive hysterectomy was highest among women younger than 40 years of age. More than one-third of women (37.8%) under 40 had unsupportive hysterectomies versus those 40-50 years of age (12%) and over 50 years (7.5%).

This rate of unsupportive surgery, the authors contend, reflects the likelihood that a significant number of women who undergo hysterectomy for reasons like abnormal uterine bleeding are doing so for reasons inconsistent with ACOG guidelines that recommend medical therapy before surgery.

Although the number of hysterectomies performed in the US has reportedly declined, the appropriateness of hysterectomy is still an area of concern, the authors stressed. “The fact that 18 percent of women did not have pathology supportive of the need for hysterectomy and that the majority of women consider at most one alternative treatment prior to hysterectomy indicates that there are opportunities to decrease the utilization of hysterectomy.”

REFERENCES

1. Corona, L.E., Swenson, C.W., Sheetz, K.H., et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. American Journal of Obstetrics and Gynecology, 212: 304e1-7.