Hysterectomy Hysteria

One in three women in the U.S. has undergone a hysterectomy by age 60, making it the second most common surgery among women of reproductive age. It is thought to be the best treatment for many women's health conditions, including severe fibroids, chronic vaginal bleeding or pelvic pain, endometriosis, and uterine prolapse. It is also an aggressive treatment often used to treat uterine, ovarian , and cervical cancer. Roughly half of all hysterectomies involve the removal of both ovaries along with the uterus. However, new findings are beginning to call into question the efficacy-and safety-of this practice.

Too radical? A hysterectomy with bilateral oophorectomy(removal of both ovaries) is often performed to treat ovarian disease or simply to reduce the risk of ovarian cancer. Yet, in the May 2009 issue of Obstetrics and Gynecology, a landmark study concluded that although removal of both ovaries decrease the risk of ovarian and breast cancer in non cancerous hysterectomy patients, those who kept their ovaries lived longer than those who opted to have them removed. The researchers conducted 24years of follow-up and found that women undergoing hysterectomy with bilateral oophorectomy had a 17% higher risk of heart disease. This effect was especially dramatic in women under age 45, who had a 26% higher risk of a cardiac events. In addition, their all-cause mortality rate was 12% higher than those of women undergoing an ovary-intact hysterectomy. Despite lower risks of cancers, the researchers point out that even for the ovary-retaining group, the risks of ovarian cancer remained low, at 0.26 %. While cancer patients and those with a family history of ovarian cancer may reasonably consider ovary removal, patients without cancer- 90% of hysterectomy cases-should know that prophylactic removal of the ovaries does not seem to improve survival at any age. In fact, leaving the ovaries in place may improve long-term health and survival. What's more, in a review performed by the Mayo Clinic last year, women with surgically induced menopause performed worse on cognitive tests than those undergoing natural menopause. The former group was also more prone to Parkinsonism, depression, anxiety, sexual dissatisfaction, and osteoporosis. In some cases, younger oophorectomy patients suffered the greatest declines.

For some conditions, there are newer treatment options that don't involve any type of hysterectomy. For heavy periods, bioidentical hormones, endometrial ablations, can significantly slow menstrual flow , as can IUD devices that contain progesterone only. ExAblate is another procedure using ultrasound beams with MRI guidance that can be used against Fibroids. With some of these options, there is often no pain and the patient can return to work the next day. Talk to your medical care provider about some of the alternatives out there along with their pros and cons.

Mark Holthouse MD