Too Many Hysterectomies?

The new issue of the American Journal of Obstetrics & Gynecology reports that women too frequently undergo hysterectomies rather than alternatives to surgery for abnormal uterine bleeding, uterine fibroids, endometriosis or pelvic pain.

Women probably undergo hysterectomies more often than necessary--but not as often as the journal authors claim. Among the article’s weaknesses:

• It examined alternatives that would not be appropriate for certain patients with uterine fibroids.
• It did not account for uterine artery embolization, which is the best alternative for symptomatic fibroids.
• It overlooked many disease-related symptoms that are important considerations when determining the appropriateness of surgery.

Furthermore, it is difficult to conclude what doctor/patient discussions took place by reviewing medical records after the fact. If many physicians discussed alternatives with patients without clearly documenting those talks in the medical record, it would not surprise me.

In the past, physicians clearly performed hysterectomies too frequently. Thankfully, those numbers have dropped significantly over the past several years, with the occurrence in the US close to the appropriate number.

There are still some overly aggressive gynecologic physicians who perform hysterectomies without clear indications and without discussing alternatives with the patient. Nonetheless, the vast majority of patients are properly counselled and very often undergo hysterectomy alternatives--or at least get offered alternative treatments.

All in all, I applaud the authors for trying to determine if hysterectomies in the US are overutilized. It is an important question to ask that it is a very difficult question to answer. There are many factors that influence a patient’s decision. Ultimately it depends not only on the obstetrician/gynecologist properly informing the patient of her options, but also on the patient herself.

This post was written by Adi Davidov, MD, ob/gyn at Staten Island University Hospital.

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