Uterine Fibroids and Hysterectomy - Hysterectomy

Highlights	Complications	Other Procedures
Introduction	Diagnosis	Hysterectomy
Causes	Lifestyle Changes	Resources
Symptoms	Medications	References
Risk Factors	Surgery

Hysterectomy

Hysterectomy is the surgical removal of the uterus and is the second most frequently performed surgery in premenopausal women (Cesarean sections are first). About 600,000 hysterectomies are performed each year in the US, which is the highest rate among any nations with published data on this procedure. By age 60, about a third of American women have had this procedure. The highest hysterectomy rates are in women between ages 40 and 44. Women in the South and Midwest are more likely to have the operation than those in the Northeast and West.

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The number of procedures has continued to increase, but the rise has slowed substantially in recent years. The percentage of hysterectomies performed because of fibroids, however, has risen significantly. Fibroids now account for 38% of these operations, but the rates vary widely by ethnic group. In a major 2002 government report 68% of fibroid-related hysterectomies were performed in African American women, 33% in Caucasians, and 45% among women of other ethnic groups.

Most women are satisfied with the procedure. A major analysis of evidence on hysterectomies reported that symptoms related to menstrual problems decline significantly in most women (although none completely disappear for all women). Most women also experience improved quality of life and mood, although in one study 8% of women who were not depressed and 12% of women who were not anxious before the procedure developed these emotional states afterward.

Still, in one study in 70% of cases when physicians recommended hysterectomies, they did not give their patients alternative choices or adequate diagnostic evaluations. Any woman, even one who has reached menopause, who is uncertain about a recommendation for a hysterectomy for fibroids should certainly seek a second opinion.

Determining the Extent of the Hysterectomy

Once a decision for a hysterectomy has been made, the patient should discuss with her physician what will be removed. The common choices are:

Total Hysterectomy (removal of uterus and cervix).
Supracervical Hysterectomy (removal of uterus and preservation of the cervix). Procedure is performed in about 20% to 25% of cases.
Bilateral Salpingo-Oophorectomy (removal of the ovaries). It can be used with either total or supracervical hysterectomy.

Total Hysterectomy. In a total hysterectomy the uterus and cervix are removed; this eliminates the risk of uterine and cervical cancer. (Given technical advances and growing surgical experience, a total hysterectomy may eventually be unnecessary except in special circumstances, such as when cancer is present.)