The first involves a non-surgical treatment, requires a day or less in the hospital, has virtually no lasting side effects and offers a full recovery in 24 to 48 hours.
The second involves major surgery removing several organs, a lengthy hospital stay, weeks of recuperation and the possibility that you may suffer lifelong emotional and physical consequences.
Considering that either option would take care of your problem equally well, the choice seems obvious.
Not if you're a woman.
According to the U.S. Centers for Disease Control and Prevention, each year some 600,000 American women bypass relatively fast and simple medical procedures and choose instead a life-altering and -- in many instances, some say -- unnecessary operation known as a hysterectomy.
"It is hard to believe that in this day and age women are being pushed into surgeries they don't need. But this is exactly what is happening when it comes to hysterectomy -- an operation that is being needlessly performed time and again, even though we have so many other less drastic procedures available," says gynecologist Dr. Ernst Bartsich, an associate clinical professor of obstetrics and gynecology at New York Weill Cornell Medical Center in New York City.
A study published earlier this year in the journal Obstetrics and Gynecology found that while rates of hysterectomy are declining in most other developed countries, U.S. rates are on the rise. American women are four times more likely to have this surgery than women in other countries, including New Zealand, Australia and most European nations, according to the research.
A hysterectomy removes a woman's uterus, and sometimes her ovaries and fallopian tubes. Once considered the gold standard for virtually any uterine-related complaint, it was commonly used to treat everything from dysfunctional menstrual bleeding to pelvic pain, endometriosis and especially fibroid tumors -- which now account for 40 percent or more of the hysterectomies performed in the United States.
However, in the past two decades, and particularly the last 10 years, an array of new and less drastic treatment options have become available. They include some that help fibroid tumors shrivel and die on their own.
So why aren't women taking advantage of these new treatment options?
Bartsich puts the blame almost exclusively on his own profession.
"It's a sad but simple reason -- women are not being told the truth, and it's doctors who are deceiving them, particularly about what these options can accomplish," he says.
While some doctors stubbornly refuse to recommend treatments they don't personally perform, others remain painfully unaware -- or misinformed -- about what is available, Bartsich contends.
Dr. Robert Vogelzang, chief of radiology at Northwestern Memorial Hospital in Chicago, agrees. He is a radiologist who has extensively studied uterine fibroid embolization, a radiological treatment that destroys fibroids while leaving the uterus intact.
"In at least one study we conducted, only one in 10 women heard about our treatment from their gynecologist. And more than half of these women were told they needed a hysterectomy when, in fact, they did not," Vogelzang says.
Vogelzang adds that women in the study were told by their doctors that uterine fibroid embolization would result in severe pain, and that it was ineffective. Both statements, he says, are false.
Complicating matters further: Some doctors aren't being truthful about the consequences of a hysterectomy, critics of the procedure say.
In a survey of more than 600 hysterectomy patients conducted by the HERS Foundation (Hysterectomy Educational Resources and Services), nearly 78 percent of the women unexpectedly reported everything from a personality change to increased irritability and profound fatigue following surgery. Nearly 75 percent cited a loss of sexual desire they did not anticipate, while more than half experienced unexpected memory loss, and loss of sensuality and sexuality.
Scarier still: According to the American College of Obstetricians and Gynecologists, 12 out of every 10,000 women do not survive a hysterectomy.
"I really doubt that a woman would choose this option if she knew just how dramatic and life-altering the consequences can be," Bartsich says.
The only time this operation should be considered is if the diagnosis is cancer, which accounts for about 15 percent of current hysterectomies, Bartsich says.
Various states have enacted legislation requiring doctors to inform patients of all their treatment options before asking them to consent to a hysterectomy. In New York state, where this legislation went into effect in 1990, the rate of hysterectomy remains the lowest in the country.
Earlier this year, the U.S. Senate introduced the "Uterine Fibroids Research and Education Act of 2002." The proposal would authorize some $10 million in funding to the National Institutes of Health for both research and public awareness campaigns about alternative treatments for fibroid tumors.
The bill has been endorsed by the Society for Interventional Radiology, the American College of Obstetricians and Gynecologists, the American College of Surgeons and the National Medical Association.
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