Hysterectomy is the second most common surgery performed on reproductive-age women in the United States, after the cesarean section. An estimated 1 in 3 women in this country will have had their uterus removed by age 60.
Though the number of inpatient hysterectomies has declined in recent years, a new Michigan-based study of nearly 3,400 women suggests there is still plenty of reason to question whether hysterectomies are being used appropriately for women who have no clear high-risk indications like cancer.
Nearly 1 in 5 women who underwent a hysterectomy for benign conditions -- such as uterine fibroids, abnormal bleeding, endometriosis or pelvic pain -- may not have needed the surgery, researchers with the University of Michigan and Wayne State University found.
For younger women, those age 40 and under, the researchers found that pathology analyses for nearly 2 out of 5 did not support use of the procedure.
"The issue is surgical appropriateness, the question of 'Are we using this at the right time?'" study author Dr. Daniel Morgan, an associate professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School, told The Huffington Post. Hysterectomies are major surgery, ending menstruation and a woman's ability to conceive.
The study, published in the American Journal of Obstetrics and Gynecology this week, relied on the medical records of women who had hysterectomies in 52 Michigan hospitals during a 10-month stretch in 2013.
Researchers found that alternatives to hysterectomy for women with certain benign conditions -- options that do not necessarily require invasive surgery -- were largely underutilized. For example, one type of long-term contraceptive, the levonorgestrel IUD, has been shown to help many women manage abnormal uterine bleeding. Yet based on their medical records, only 12 percent of women in the study considered it. Among those women, only one-third actually tried it.
Overall, the medical records for nearly 40 percent of the women did not show any use of alternative treatment before they underwent a hysterectomy.
Dr. Lauren Streicher, an associate professor of obstetrics and gynecology with Northwestern University's Feinberg School of Medicine and author of The Essential Guide to Hysterectomy, cautioned that it is possible the women in the study had been presented with the full range of options and that this was simply not reflected in their medical records, which do not always capture a complete picture of the interactions between patients and health care providers.
Still, Streicher, who did not work on the Michigan study, said she was not at all surprised by how underutilized alternatives to hysterectomy appeared to be.
"While many women do need a hysterectomy -- they benefit from it enormously and say it's the best thing that ever happened to them -- many, many women are not being given their options," she said.
"I think this is a wonderful opportunity to tell women, if you have been told that you need a hysterectomy, the first question to ask is 'What are my alternatives?'" Streicher added. Sometimes no other option exists, and other times hysterectomy is absolutely the best choice among the alternatives, she said.
"That's fine," Streicher said, "but know your options."
Clarification: Language has been added to indicate that the decline in hysterectomies has been specifically in inpatient procedures.