Women's Health

More Hysterectomies, More Inappropriate Reasons

Jan. 31, 2000 (New York) -- Hysterectomy is the second most common surgical procedure performed on women in the U.S., but a new study suggests that it may be overused. The study finds that many doctors may be going against set recommendations and performing hysterectomies even when the woman does not meet all the criteria and other sources of pain and bleeding have not been ruled out.

Of nearly 500 hysterectomies studied, 70% did not meet a physician expert panel's criteria for hysterectomy and 76% did not meet criteria established by the American College of Obstetricians and Gynecologists (ACOG). The study appears in the February issue of the journal Obstetrics and Gynecology.

Hysterectomy involves the removal of the uterus (partial hysterectomy), the removal of the uterus and the cervix (complete hysterectomy) or the removal of the uterus and all attached structures (radical hysterectomy). A hysterectomy may be recommended to treat and relieve severe bleeding and pain resulting from infection, cancer, fibroids, endometriosis, or prolapse, in which the floor of the uterus sags, causing bladder- and bowel-control problems.

In the new study, author Michael S. Broder, MD, and colleagues from UCLA looked at the women who had endometriosis, chronic pelvic pain, or premenopausal abnormal bleeding. Of those cases, hysterectomy was judged to be inappropriate 53% of the time by a panel of physicians and in 76% of cases where strict ACOG criteria were applied.

Broder and colleagues found that procedures such as exploratory surgeries and biopsies of the uterus, which should be done prior to hysterectomy to rule out other sources of pain and bleeding, were not done in 77% of cases where women had pain and in 45% of cases where they had abnormal bleeding. An additional 21% of eligible women were not offered alternative treatments or procedures such as hormone therapy to eliminate pain or bleeding prior to hysterectomy.

Suzanne Trupin, MD, who reviewed the report for WebMD, says the findings are not too surprising. Trupin, a clinical professor in the department of obstetrics and gynecology at the University of Illinois College of Medicine in Urbana, says there is a general feeling among researchers, patients, and health care insurers that some hysterectomies can be avoided and that more efforts should be focused on reducing hysterectomy rates, especially in areas of the country where they are unacceptably high.

"We've known for some time that there are some percentage of hysterectomies that probably are unnecessary and therefore probably wouldn't meet rigid criteria for hysterectomy. The message from this article is that 76% did not meet ACOG criteria preoperatively [before surgery] for hysterectomy, but that doesn't mean that all of those patients shouldn't have had hysterectomy or that hysterectomy wasn't appropriate," Trupin says.