Hysterics: Are Hysterectomies Too Common?

By Anna Clark, RH Reality Check. Posted June 24, 2008.

A lot of women have a lot to say about hysterectomies. It's the best thing that ever happened to them; it's the worst thing that ever happened. They feel liberated; they feel rage. They wish they'd done it sooner; they wish they hadn't been pushed into it. You can get gal-pal advice from the HysterSisters, or you can get cautionary information from Hysterectomy Educational Resources and Services (HERS).

Or, of course, you can hear directly from women who've had the operation. It's not difficult to find them; 600,000 women have a hysterectomy each year, says Dr. Jeffrey Goldberg, director of the Jefferson Fibroid Center at Jefferson Medical College in Philadelphia.

Put another way: One in three women has a hysterectomy before her 60th birthday. Yet treatment for life-threatening illnesses -- uterine and ovarian cancers -- accounts for only 10 percent of the procedures.

The other reasons? About 40 percent of hysterectomies are performed due to fibroids. Endometriosis, a condition in which uterine tissue grows outside of the uterus, accounts for others. Heavy bleeding, a uterine prolapse (when the organ slips out of place), a caution against cancer, birth control, and, for trans men, sexual reassignment surgery, are all among other reasons for hysterectomies.

Many who have the operation are making their best choice, and have never felt better. But what are the real implications of removing a major reproductive organ from a woman's body -- even when she doesn't desire giving birth to children? "In truth," Natalie Angier writes in Woman: An Intimate Geography,"

...we know remarkably little about the purpose of the various opiates, chemicals, hormones, and hormone precursors that the uterus secretes with such vigor. We don't know how important the output is to our overall health and well-being beyond considerations of reproduction, nor do we know whether the various secretory skills continue past menopause. ... We should be humbled by the fact that scientists discovered the very dramatic concentrations of anandamide in the uterus as recently as the late 1990s. And that humbleness should in turn enhance our vigilance against removing the uterus in all but the most extreme circumstances.

Women who have a hysterectomy require six to twelve weeks of recovery time -- a testament to the procedure's gravity. And HERS chronicles a long list of adverse consequences of the operation that call its widespread acceptance into question. Among the after-affects reported by women who had hysterectomies include personality change (79 percent); profound fatigue (76.9 percent); diminished or absent sexual desire (75.2 percent); short term memory loss (66.9 percent); insomnia (60.5 percent); and pain in joints and bones (59.9%). In Woman, Angier reports that hysterectomies -- even surgeries that preserve the ovaries -- cause a woman a "heightened risk of high blood pressure and heart disease ... possibly because the extraction of the uterus eliminates one source of prostaglandins that help protect blood vessels."

Deborah McConnell, a nurse at Boston's Brigham and Women's Hospital, said that hysterectomies that remove the ovaries cause immediate menopause, because of sudden disappearance of hormones ovaries release. "The sudden drop [in hormones] can have affects on bone health, heart health and mood effects as well," McConnell says.

So it's surprising that for illnesses that can be treated less invasively, alternative treatments aren't offered more often. And there are many possible treatments for fibroids, endometriosis, and pain: mymoectomies or lapatotomies to remove fibroids; uterine fibroid embolization (blocks blood supply to fibroids for shrinkage); endometrial ablation (uses microwaves to destroy endometrial lining in a five-minute procedure); pain medications; hormonal agents; lifestyle changes; a progesterone IUD; medications; and HIFUS (High Intensity Frequency Ultrasound), which targets fibroids with an MRI-guided ultrasound system. And Goldberg reports that alternative treatments for conditions that lead many women to hysterectomies are among the best-funded research projects, so we can expect still more options soon.

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