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Reduce healthcare costs. Cut hysterectomies. 70% found inappropriate

Hysterectomy is the second most frequently performed surgery for womenof reproductive age in the United States, after Cesarean section (“surgical birth”). Approximately 615,000 hysterectomies are performed annually in the United States and an estimated 20 million U.S. women have had a hysterectomy, 3.1 Million in 2000 to 20004, more than any other industrialized nation. The estimated cost of hysterectomy is $5 Billion per year (Matteson et al., 2006), not counting care for subsequent problems. 

Hysterectomy is the surgical removal of the uterus; sometimes the cervix, ovaries, and fallopian tubes also are removed. The medical term for removal of the ovaries is castration.

Some obstetricians say 90% of hysterectomies could be avoided by using well known alternatives, especially removing fibroids (non-cancerous tumors) and leaving the uterus intact. Ten percent are necessary due to cancer.

Research shows at least 70% of recommendations for hysterectomy are for indications judged inappropriate by a multispecialty physician panel using widely accepted methods. And 76% failed to meet American Congress of ObGYns criteria. The leading reasons for “inappropriate” advice to have a hysterectomy were lack of proper diagnostic evaluation and failure to try alternative treatments – quick knives.  (Broder et al, 2000). The Hysterectomy Educational Resources and Services (HERS Foundation), endorsed by CDC, reports 98% of women they referred for second opinions found they did not need a hysterectomy.

The condition most often associated with hysterectomy is uterine leiomyoma, that is “fibroids” (38.7 - 44.2%), followed by endometriosis and uterine prolapse. So, the majority of hysterectomies are done to improve quality of life. But critics argue most are unnecessary, cause lifelong loss of sexual pleasure and put women at risk for a long list of adverse health consequences. 

A new study suggests part of the reason women undergo unnecessary or ill-advised hysterectomy is their low health literacy– meaning, in this case, lack of knowledge about how their bodies work. For example, the researchers report 13% of 1273 women they interviewed believed the uterus is not required for pregnancy (it is!). That’s pretty basic; still in this Puritan culture, we do not talk in polite society or in schools about how bodies work, we rely on doctors’ specialized knowledge. But doctors’ views on women’s sexuality are controversial. For example, the new study reports 35% of women “mistakenly” think the uterus is involved in sexual pleasure. Some us know from memorable experience that many women experience orgasm in the uterus. And despite well-documented attendant risks to health and quality of life, doctors often present hysterectomy as routine, standard cure  for problems like fibroids and PMS (Cronje et al, 2004). But not all doctors; the rate of hysterectomy decreased slightly from 5.4 per 1000 women in 2000 to 5.1 per 1000 in 2004.

Baby Step to Better Care

1.     Learn the basics of how a woman’s body works. Even if you or a woman in your case load are not advised to have hysterectomy, see the Female Anatomy Video  You can print the text and you can order a DVD for teaching purposes.

2.     Write out a question to ask a doctor who recommends hysterectomy.

References


Hysterectomy Educational Resources and Services (HERS Foundation)
The HERS Foundation is an independent non-profit national and international women's health education organization. It provides full, accurate information about hysterectomy, its adverse effects, and alternative treatments

Broder, MS, Kanouse DE, Mittman BS, & Bernstin SJ.(2000) The Appropriateness of Recommendations for Hysterectomy. Obestetrics & Gynecology I (2), 199-205.

Cronje WH, Vashisht A, & Studd JWW (2004) Hysterectomy7 and bilateral oopherectimy for severe premenstrual syndrome.

Matteson KA, Peipert JF, Hirway P, Cotter K, et al. (2006) Factors Associated with  Increased Charges for Hysterectomy. Obestetrics & Gynecology107 (5), 1057-1063.
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