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Do You Really Need a Hysterectomy?

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One of every three women will have an operation to remove her uterus before she turns 60 years old. Something is wrong with that statistic. Shedding a uterus should not be a rite of passage, like sporting silver hair or joining AARP. Doctors may tell you that the operation is no biggie, but removing a body part is always a big deal. Hysterectomies involve anesthesia, often an abdominal incision and, like all surgery, the risk that something will go wrong.

If you’ve been told that hysterectomy is the best option to clear up a uterine problem such as endometriosis (a painful condition whereby uterine tissue grows outside of the uterus), fibroids (noncancerous growths) or abnormal bleeding—or if you know someone who was advised to have a hysterectomy—hold on. Although there are times when having a hysterectomy is the right move, such as when cancer is a threat, some procedures are unnecessary, according to researchers from University of Michigan. In fact, a lot of women are getting hysterectomies for no good reason at all. What’s more, alternative treatments to hysterectomy don’t look like they are being tried as often as they should be.

HOLD ON TO YOUR UTERUS

The University of Michigan team looked through the medical records of 52 Michigan hospitals to evaluate how many of the hysterectomies done in the first 10 months of 2013 were actually appropriate. After weeding out women who had medically valid reasons for heading straight to surgery, such as those with cancer or a life-threatening hemorrhage, the researchers ended up with a study population of about 3,400 women. For each of these, the researchers looked for documentation that other medical treatments had been either tried or at least recommended before the woman’s hysterectomy. These other treatments included drug or hormone therapy, endometrial ablation (therapeutic removal of cells that line the uterus) and various other uterus-sparing surgical procedures.

The results. About two-thirds of the women considered or tried at least one other treatment before having a hysterectomy, but most still had hysterectomies done for conditions for which uterus-sparing procedures were available. Most alarming is that nearly one in every five women had her uterus surgically removed for no clear reason. This was particularly seen among the younger women—the rate of needless hysterectomies was 38% in women younger than 40 compared with 8% in women older than 50.

Why would a woman have a hysterectomy for seemingly no medically valid reason? The researchers only went by what they could find in the patients’ medical records and did not interview any of the patients or their physicians. Their educated guess is that many of the younger women were having hysterectomies to correct abnormal bleeding caused by ovulatory dysfunction. But ovulatory dysfunction is usually a hormonal problem and should be first treated with hormones or other medicines—not a scalpel–according to the American Congress of Obstetricians and Gynecologists. So if young women really are getting hysterectomies to solve bleeding problems, many of the doctors recommending and performing the procedures may be out of line. (But another study will to be done to investigate if this is really so.)

KNOW YOUR OPTIONS

Before agreeing to a hysterectomy, make sure it is the best and most appropriate treatment for what ails you. Make sure that the doctor fully explains your diagnosis, how the problem can be treated, and the risks and benefits of each and every treatment option. Then, with your doctor, make a list of options to try in order of preference so if the most preferred doesn’t work, another option or two can be tried before resorting to a hysterectomy.

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Source: Source: Daniel M. Morgan, MD, associate professor, department of obstetrics & gynecology, University of Michigan Medical School, Ann Arbor. His study appeared in the American Journal of Obstetrics & Gynecology. Date: February 16, 2015 Publication: Bottom Line Health
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