SATURDAY, April 26, 2003 (HealthDayNews) -- Hysterectomies are the second most common surgery for American women, after Caesarean births.
But they shouldn't be the preferred treatment for women with uterine problems, particularly fibroids, a Cleveland Clinic gynecologist says.
About one-third of U.S. women have had a hysterectomy by the age of 60, according to the National Women's Health Information Center, and that figure is far too high, says Dr. Linda Bradley.
"There is a current cultural concept of a hysterectomy as a method that's tried and true. But surgery should be the last option after failed medical therapy, or where other options may have less success," says Bradley, director of the Cleveland Clinic Foundation's Hysteroscopic Services.
This is particularly true when treating uterine fibroids in women in their 30s and 40s, Bradley says. The average age for a hysterectomy is 42, the National Women's Health Information Center says, largely because hysterectomy is the first-line treatment for fibroids.
However, less-invasive procedures that remove the fibroids but leave the uterus intact could be a better option for many women of childbearing age, Bradley says.
These procedures carry their own risks. One, called a myomectomy, removes the fibroids but carries the chance that the fibroids will return. But this is a worthwhile option for women who wish to remain fertile, she says.
"If a woman has fewer than four fibroids, there is a less than 5 percent chance of recurrence of the fibroids," Bradley says. "So a hysterectomy would be an awful choice for a woman with few fibroids in her 20s or 30s."
Similarly, Bradley says, a woman approaching menopause who is considering a hysterectomy to remove fibroids should know that time is on her side, and simply removing the fibroids alone might be enough.
"Fibroids occur less frequently with menopause, so for a woman aged 48 -- the average age of menopause is 51 -- the odds of the fibroids returning are low," she says.
Bradley isn't opposed to hysterectomies, only that they not be performed without weighing other options.
Beverly Johnson, a 50-year-old former model who had a hysterectomy to treat her fibroid tumors when she was 46, concurs.
"I thought it was a routine operation, and everything would be hunky dory, and it was not. It was major surgery," says Johnson, a spokeswoman for the Healthy U campaign, designed to inform women about their options in treating uterine illnesses.
Johnson's mother and grandmother both had hysterectomies to treat their fibroid tumors and their operations went smoothly. But Johnson was bedridden for two months after her hysterectomy, and had two follow-up surgeries before she was healthy again.
"I'm sure I needed it, but I would have liked to known about other options. The recovery took a year and it was pretty traumatic," she says.
The Healthy U campaign was launched by the National Women's Health Resource Center. It is funded by a grant from GYNECARE, a division of Ethicon, Inc., part of Johnson & Johnson Co.
About 600,000 American women a year have hysterectomies, which is the removal of the uterus and usually the cervix. The operation is typically performed to remove fibroid tumors in the uterus. Other reasons for hysterectomies include endometriosis, chronic pelvic pain or heavy bleeding during or between periods. About 10 percent of hysterectomies are performed to treat cancers in the pelvic area, according to the National Women's Health Information Center.
"I'm not saying that a hysterectomy is never called for, but a woman must never feel rushed into having the operation," Bradley says.
She recommends finding a doctor who is familiar with the new technologies and can talk to you about other options. If you're able to make an informed decision, even if it does mean a hysterectomy, you'll be better off, she says.
"Women who have had time to reach their decision are more comfortable with the outcome, Bradley says.
More information
The National Women's Health Information Center has lots of information about hysterectomies. The National Women's Health Resource Center offers a free copy of the booklet, Your Guide to Uterine Health.
