Too Many Hysterectomies?

By Nancy Larson

One-third of all women get a hysterectomy before they turn 60. Some experts think two-thirds of them don’t need it.

Searing back pain. Endless periods with clots the size of plums. Bloating that turns even your “fat” pants into a tourniquet. Every year, symptoms like these drive thousands of women to consider getting a hysterectomy. The surgery is so popular, in fact, that one-third of all women will have a hysterectomy before they turn 60. For many, the procedure provides real relief. But here’s a shocker: More than two-thirds of the 600,000 hysterectomies performed every year may be unnecessary, experts say. The truth: Several other approaches are available that may have fewer complications and shorter recovery times. And some research suggests that hysterectomy may lead to sexual problems, incontinence, and a slight loss of physical strength. Other studies dispute those findings.

If you ever face this surgery, “ideally, you’ll have time to consider all your options,” says Lauren Streicher, MD, a clinical assistant professor of obstetrics and gynecology at Northwestern University. The four women profiled on the next few pages each chose a different procedure, with different results. Get to know the possibilities, then talk them through with your doctor.

Endometrial ablation

Shortly after having her tubes tied, Cherry needed two pads and a tampon to make it through even a few hours of her period. “I was bleeding half the month,” she says, “and I was tired from being anemic the other half.”

Sex—and life as she knew it—had stopped. Feeling her uterus had outlived its usefulness, Cherry told her doctor, “Just take it out!”

Then, one day on the Internet, she read about an alternative called endometrial ablation—removal of the uterine lining but not the uterus—which would spare her major surgery. Cherry was impressed with the statistics that 50 percent of women never bleed again after having the procedure and 40 percent have lighter periods.

One day after the procedure, Cherry felt great. That was seven years ago, and she hasn’t bled since. “It really changed my life,” she says. She’s back to being a morning person with energy to spare, and she and her husband enjoy dancing.

Robotic laparoscopic myomectomy

For about a year, Purifoy thought her abdominal cramps came from a bladder infection. “Even the pressure from my underwear hurt,” she says. After a pelvic ultrasound revealed a large fibroid (a benign uterine tumor), Purifoy considered having a hysterectomy.

Compared with Caucasian women, African-Americans like Purifoy are thought to be three times as likely to have fibroids. Hysterectomy can permanently solve the problem, but Purifoy felt she was too young to have her uterus removed. So when her doctor told her about a new, uncommon procedure called robotic laparoscopic myomectomy—the fibroids are cut out through tiny abdominal incisions using robotic arms and instruments—she jumped at the idea. It’s a more precise type of surgery than traditional myomectomy (in which a surgeon makes a bigger incision and cuts out the fibroids herself) and may improve healing, says David Eisenstein, MD, senior staff physician in OB-GYN at Henry Ford Hospital in Detroit.

Purifoy’s recovery was a breeze. There’s a risk her fibroids will return, but for now she is symptom-free. “I used to sit up and cry from the pain, but no more,” she says.