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When It Comes to Hysterectomy, Most Women Don't Have Reproductive Choice

As many as two-thirds of hysterectomies may be unnecessary because un- and under-insured women continue to lack a full range of health care options.
 
 
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The news that two-thirds of the hysterectomies performed in the United States may be unnecessary caught my attention last week. One-third of all women will have a hysterectomy before they turn 60 and now researchers believe that two-thirds of those procedures aren't necessary. With some 600,000 hysterectomies being performed each year, this news shouldn't be ignored.

Hysterectomies are recommended to women who have medical conditions including cancer of the uterus, ovaries, or cervix. Fibroids, excessive bleeding and endometriosis are also conditions for which hysterectomy might be recommended and the procedure may also be recommended to women who have tried other treatments without success.

But why are doctors and researchers saying that as many as two-thirds of the hysterectomies performed in the United States were not necessary? Well, less invasive treatments are available that provide some women with choices other than hysterectomy. Endometrial ablation, myomectomy and robotic laparoscopic myomectomy are a few of the alternative treatments to hysterectomy.

Endometrial ablation is a procedure that destroys the uterine lining using a laser beam, heat, electricity or freezing. The uterine lining heals by scarring that usually reduces or stops uterine bleeding. Myomectomy is the surgical removal of fibroids from the uterus. Robotic laparoscopic myomectomy is a less invasive surgery to remove fibroids from the uterus.

With less invasive treatments available, why would unnecessary hysterectomies be so common? One answer is that some doctors recommend hysterectomy for various reasons such as the complications of myomectomy or additional medical factors for the individual patient. Another answer may be found between reading between the lines -- and that also happens to be where many uninsured and underinsured women fall.

A quick review of one common condition resulting in hysterectomy provides some insight. Fibroids are solid benign tumors on the outside, inside, or within the wall of the uterus. An estimated 30 percent of all women get fibroids by age thirty-five. Black women are more likely to have them and more likely to develop them at a younger age.

Many treatment options for fibroids depend on how early they are diagnosed and many women are first diagnosed with fibroids during a pelvic exam. Pelvic exams require medical visits and many women are unable to afford those appointments. Access to affordable dependable healthcare plays a large role in whether a woman is left with several options or few alternatives. And it is at that entry point where access meets coverage where some disturbing facts are found.

The number of underinsured Americans continues to grow as premiums rise and benefits are cut. Some 45 million Americans are uninsured and the women of that number are not getting access to cutting edge treatments or a variety of medical opinions.

The there is the issue of access to women's clinics. My fibroids were first diagnosed during my yearly exam at a Planned Parenthood clinic. When I later visited a gynecologist he harshly told me "it" was just going to have to come out. I was able to use my health insurance to change doctors and pursue less invasive treatments and eventually had a successful myomectomy. But the success of my treatment began when my fibroids were noticed during my pelvic exam at Planed Parenthood. As clinics continue to fight anti-choice efforts to shut them down they are fighting for the rights of all women to be empowered through dependable and affordable medical care.

The less invasive alternatives to hysterectomy require either money or solid insurance coverage. Early diagnosis of the conditions that often lead to hysterectomy is dependent upon access to affordable healthcare through dependable healthcare providers. The issue is not simply that there are new and less invasive options available, but that many women face an economic obstacle course that robs them of both time and opportunity.

Pamela Merritt is a staff writer for RH Reality Check, a contributor to the Shakespeare's Sister blog, and a featured contributor on National Public Radio’s (NPR) “Tell Me More” with Michel Martin. Her work has been published in the Chicago Sun-Times, on Salon.com and featured in Salon.com's Broadsheet. Pamela serves as PAC Chair for PROMO (Missouri’s Statewide LGBT Equality Rights Group), is a mentor through Big Sisters and teaches various classes at several shelters in St. Louis, Missouri. She also writes and maintains her personal blog .