U.S. Hysterectomy Rates Still High

New Zealand research group finds unnecessary operations still the bulk of them

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By
HealthDay Reporter

THURSDAY, Jan. 31 , 2002 (HealthDayNews) -- U.S. hysterectomy rates still soar above those of other countries, and unnecessary operations are still the reason, a group of New Zealand doctors claims.

As part of a continuing effort to stem the tide of needless hysterectomies, women all over the world have been urged to "just say no," or at least question the reason for an operation that removes the entire uterus, and sometimes the ovaries. However, the new findings, based on eight years of data, show the voices of American women have apparently not been heard.

"I had thought there might be a 10 percent or so drop over eight years," says the study's author, Dr. Cynthia Farquhar, an associate professor of reproductive medicine at the University of Auckland. The findings appear in today's Journal of the American College of Obstetricians and Gynecologists.

What she found instead was the rate in the United States had gone up: from 5.5 operations per 1,000 women in 1990, to 5.6 in 1997.

That means that more than 600,000 American women have hysterectomies each year, which is three to four times the rate of other countries, including New Zealand, Australia and most European nations, the researchers say.

The study also found up to 40 percent of all U.S. hysterectomies were for fibroid tumors -- typically benign tumors that grow in and around the uterus, frequently causing severe bleeding. The surgery was performed, researchers say, even when less drastic solutions were available.

In some instances, Farquhar adds, even women with asymptomatic fibroids -- tumors that are not causing any problems - were advised to have a hysterectomy.

For New York City gynecologist Dr. Ernst Bartsich, the findings are both distressing and revealing.

"Clearly, women are not getting the message from their doctors. Or doctors are not listening to what women are saying, or we would have seen some kind of decrease in the number of operations by now," says Bartsich, an associate clinical professor of obstetrics and gynecology at New York Weill Cornell Medical Center.

A decade ago, because the number of hysterectomies for fibroid tumors was so high, many state health departments began passing legislation requiring that doctors incorporate all treatment options into the operation consent form to make sure women were being told about all their choices.

This newest research reveals these efforts were in vain, Bartsich says.

"And that is really such a shame, because there are so many wonderful treatments now available for fibroid tumors -- procedures that treat only the tumor itself and leave the rest of the reproductive system intact," he says. "A hysterectomy need never be considered a first-line defense for this problem."

The study generated its data from a nationwide registry of hospital discharge records from 1990 through 1997. In addition to looking at the total number of hysterectomies, the study also examined the various methods used to perform the surgery, including their impact on hospital stay, cost and recovery time.

They found that an abdominal hysterectomy -- the most dramatic operation, which removes organs through a major incision -- represented more than 63 percent of the surgeries, even though it required the longest hospital stay, the longest recovery time and the greatest cost.

Other forms of surgery included a laparoscopic hysterectomy -- where the organs were removed through a tiny incision -- which accounted for 10 percent of the operations, and a vaginal hysterectomy -- where the organs are removed through the vagina -- which was performed in fewer than 25 percent of cases. The vaginal method is considered the least traumatic and involves the shortest hospital stay -- two days, compared to at least 10 days for the abdominal hysterectomy.

Bartsich, however, takes the study authors to task over their breakdown of the operation by type.

"If you distract women with information about recovery times and costs, you pull their attention away from the main issue, which is that the operation itself, in any form, is still unnecessary in a great many number of cases," he says.

In addition to fibroid tumors, Farquhar's study found hysterectomies were also performed for the menstrual disorder endometriosis, and for pelvic inflammation and pain. More than two-thirds of the women diagnosed with these problems had this surgery. The other reason for a hysterectomy was uterine cancer.

According to Bartsich, cancer is the only diagnosis for which a hysterectomy is considered unquestionably necessary.

What To Do

For more information on alternative treatments for fibroid tumors, and to learn whether a hysterectomy might be right for you, visit HERS, the Hysterectomy Educational Resources and Services Foundation.

You can also find information at the Washington University Comprehensive Fibroid Center .

For an illustration of what fibroid tumors look like and how and where they grow, clickhere.

SOURCES: Interviews with Cynthia Farquhar, M.D., associate professor, reproductive medicine, Department of Obstetrics and Gynecology, University of Auckland, National Women's Hospital, Auckland, New Zealand; Ernst Bartsich, M.D., associate clinical professor, obstetrics and gynecology, New York Weill Cornell Medical Center, New York City; February 2002 Journal of the American College of Obstetricians and Gynecologists

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