Overused and Underinformed: The Secrets of the Hysterectomy in the U.S.


Updated 5/20/2010, 2:15pm EST: A point of clarification, for the record, from Mrs. Maloney’s legislative office: Congresswoman Maloney is not contemplating introducing a bill and, in fact, in response to a question from an audience member during the forum, made clear that she is considering looking into if GAO can do a study, not legislation. Indeed, she doesn’t like the idea of Congress mandating that a particular video should be shown prior to any medical procedure. Nonetheless, in 1978 and 1993, Congressional hearings highlighted the issue of unnecessary hysterectomies, and Congress does have a role to play in investigating the reasons why so many women are being encouraged to undergo hysterectomies when less invasive alternatives are often available, particularly since they can have a negative impact on women’s health.

Rep. Carolyn Maloney is wondering why people aren’t more outraged. Hundreds of thousands of women undergo hysterectomies in this country every year, but many don’t fully understand the extent to which this surgery will impact their health and lives. As a consequence, the Manhattan Democrat, according to an article in Womens eNews today, “Maloney Mulls GAO Study on Hysterectomy,” is on a mission to figure out whether or not mandating informed consent, by watching a video about the adverse effects prior to having a hysterectomy, is feasible.

It started when Maloney considered undergoing a hysterectomy herself but then was, according to the article, persuaded not to by friends who were women’s health advocates.

Why?

According to the HERS Foundation, a nonprofit organization which provides information about the alternatives to – and consequences of – hysterectomies and which held the event where Maloney spoke about this issue recently, the effects of a hysterectomy’s damage are “lifelong” and 98 percent of women who have the surgery do not, in fact, need the surgery.

In addition, according to an ongoing study led by HERS,  

“99.7% percent of women…were given little or no prior information about the acknowledged adverse effects of hysterectomy — information that is a legal requisite of consent.”

Because of this, the HERS Foundation has created a video that they want women to view prior to the surgery taking place. Writes Cerra Whittelsey in Womens eNews:

About 600,000 American women undergo hysterectomies every year. Rarely do they hear anything from their doctors about adverse effects other than the inability to have more children, said Nora Coffey, founder of HERS, during an interview.

Many people are not aware that there are different types of hysterectomies which can involve the removal of not just the uterus, but may also involve the removal of the cervix, ovaries and/or upper part of the vagina. HERS says some types of hysterectomies are considered “castration” and clearly some women who have been through the various procedures agree.

This is drastic surgery and from all available evidence women do not seem to be fully informed of the drastic consequences. From urinary incontinence to loss of sexual desire to an increase in the risk of heart disease and osteoporosis, the list of after effects of a hysterectomy is a long one.

Indiana’s House of Representatives held a hearing on the issue after one of their representatives, Rep. Borders, spoke up about his own wife’s hysterectomy, the unexpectedly debilitating impacts and the subsequent decision that they were lied to about her need for the surgery. Borders has been a vocal advocate for informed consent prior to hysterectomies in his own state.

The full Womens eNews article is here and worth a read.

In case you’re not convinced that this should be a priority for women’s health advocates, the performance of a hysterectomy, according to the Department of Health and Human Services, is the second most common surgery for women in the U.S. And, by the way – the first? Cesarean sections. So, not only are hysterectomies and c-sections the most common surgeries for women in this country, but there is now growing evidence that they are two of the most overused.

I’d say it’s time for a reality check amongst womens’ health advocates. Understanding that the medical establishment is being allowed to persuade women that we “need” these invasive – incredibly invasive – surgeries related to our reproductive and sexual health should lead us to swift and concrete action.

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  • nycprochoicemd

    Hysterectomies are *way* overused, especially now that we have the LNG-IUS (Mirena) as our first line treatment for dysfunctional uterine bleeding (one of the most common reasons for hysterectomy).  We have many less invasive ways of treating fibroids, such as uterine artery ablation or endometrial ablation.  The sad truth is that gynecologists make a lot more money by simply performing a hysterectomy; they get much more reimbursement and don’t have to spend the time listening to women and trying to understand why they have the symptoms they have.

     

    As for the “HERS” site, it appears to have blatantly biased information from women who have intentionally sought out information on the harms of hysterectomy.  While I don’t doubt that many women have had unexpected side effects from the procedure, and sometimes severe side effects, the symptoms they report can hardly be considered typical.

     

    Thank you for bringing to light another of the many unnecessary procedures women go through.

  • norawcoffey

    The previous comment is a promotion for Mirena, a product that has caused harm to many women. Perhaps NYprochoiceMD is unaware of the Class Action lawsuits against the manufacturer.

    You attempt to trivialize the adverse effects of hysterectomy reported on HERS website by 1,000 women. The consequences of hysterectomy are not “side effects”. Side effects may happen to some people, but not others. Every woman who undergoes a hysterectomy permanently loses the ability to experience uterine orgasm. During a hysterectomy the vagina is shortened, made into a close pocket, and sutured shut at the top of the vagina. 

    When the uterus is removed women have a 3X greater incidence of cardiovascular disease, and when the ovaries are removed the incidence is 7X greater. 

    These are but a few of the “typical” adverse effects of hysterectomy. The author of the previous comment could become better educated about the life long functions of the female organs and the consequences of their removal by watching the short educational video “Female Anatomy: the Functions of the Female Organs” at http://www.hersfoundation.org/anatomy.

     

     

  • nycprochoicemd

    To Nora, I agree that many women have problems after hysterectomy (and some have significant adverse effects).  What I am pointing out is that any study that is solicited by an organization that specifically looks to educate people about the harms of hysterectomy and performs a retrospective analysis of a convenience sample without a comparison group is not sufficient to provide information that can be applied on a population level.

     

    I don’t know what a uterine orgasm is, so I can’t comment on that.

     

    There isn’t any credible evidence that I could find that removal of the uterus alone is associated with a higher risk of cardiovascular disease; it doesn’t make sense from a physiological point of view. Removal of the ovaries before age 65 is associated with increased cardiovascular disease and death, and routine removal of the ovaries is no longer recommended.

     

    The LNG-IUS has been well-studied and is now the first choice for dysfunctional uterine bleeding.  As with any medical procedure, some people have adverse consequences.  I feel like having this new option to control symptoms that can be very bothersome to people has been a great innovation that saves many women from undergoing surgery.