About 1 in 3 women in the United States will have a hysterectomy by the time they’re 60, but too many do so without fully exploring alternative treatments, according to a study by researchers at the Michigan Surgical Quality Collaborative, a consortium of hospitals overseen by Blues plans. Their study, published in the American Journal of Obstetrics & Gynecology, tracked about 3,400 women who got the procedure as a treatment for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain.
When the researchers looked at pathology reports written from Jan. 1 through Nov. 8, 2013, at 52 hospitals in Michigan, they found that the reports did not justify hysterectomy in 18% of the cases, most of which involved women under the age of 40. What’s more, 38% (1,281 out of 3,397) of the women who had hysterectomies had not considered alternative treatments prior to the procedure, the researchers found. The alternative treatments included hormonal therapy, pain management, levonorgestrel IUD, hysteroscopy, and endometrial ablation. Women younger than 40 were more likely to consider alternative treatments than those older than 40.
Considering the alternatives to hysterectomy
Source: Corona LE et al., American Journal of Obstetrics & Gynecology, March 2015 (published online Dec. 2014).
Lauren E. Corona, the lead author, said she and her colleagues focused on consideration of alternative treatments, instead of treatments received, in part because they wanted to know whether women were appropriately counseled about less-invasive and less-risky options to hysterectomy. The Michigan researchers suggest that a systems-based quality improvement approach to hysterectomy could help standardize treatment and ensure that appropriate alternatives have been offered to women deciding about the procedure.
Number of hysterectomies performed by year
Source: Wright JD et al., Obstetrics & Gynecology, Aug. 2013.
The news isn’t all bad, as researchers noted the substantial decline in the number of hysterectomies performed in the United States. In 2013, Columbia University researchers reported trend data showing that the number of inpatient hysterectomies in this country declined from 681,234 in 2002 to 433,621 in 2012, a decrease of about 36% over the decade. By indication, the largest percentage decreases were hysterectomies for endometriosis (65.3%) and for benign ovarian masses (63.1%). Some of the decrease in inpatient hysterectomies might be explained by a shift toward the procedure being done on an outpatient basis.