Are Too Many Hysterectomies Being Performed?

Many hysterectomies are being done unnecessarily, with physicians failing to provide alternative treatments prior to the surgery, a study of Michigan women found.

The study, published last month in the American Journal of Obstetrics & Gynecology, revealed that postsurgical pathology indicated that nearly one (18%) of five hysterectomies that were done for benign indications were unnecessary. The findings are even more striking when looking at women younger than 40. Among the younger women, nearly 38% of hysterectomies had unsupportive pathology.

Key Findings:

- Too many women are having a hysterectomy without being offered an alternative therapy prior to surgery, researchers found.

- In addition, many
of the hysterectomies were performed unnecessarily, according to postsurgical pathology.

The frequency of unsupportive pathology was highest among women with a preoperative diagnosis of endometriosis or chronic pain.

While other reports have revealed a steady decline in the rate of hysterectomies, the authors said their findings indicate there remains a concern over the appropriateness of hysterectomy.

"This study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain," said senior investigator Daniel M. Morgan, MD, associate professor of obstetrics and gynecology at the University of Michigan.

The study involved an analysis of the medical records of 3,397 women who underwent hysterectomies for benign conditions in Michigan. The aim of the study was to assess how often alternatives to the procedure were recommended prior to performing a hysterectomy. The data was collected from January 1, 2013, through November 8, 2013, and involved 52 hospitals. The women who had the surgery did so for the following reasons: uterine fibroids, abnormal uterine bleeding, endometriosis, and pelvic pain.

Nearly 40% of women did not have documentation of alternative treatment before their hysterectomy, the researchers found. Younger women were more likely to receive alternative treatments, with 68% of those under 40 given an alternative treatment prior to hysterectomy.