Hysterectomies Can Pose Risks as Women Age

Patient Expert

A hysterectomy is a common medical procedure for women. However, new evidence suggests that women should really talk to their doctor about the type of hysterectomy being considered, as well as the long-term consequences involved in this type of surgery.

First, let's learn a little more about this procedure. A 2013 study found that almost one-third of women in the United States have undergone a hysterectomy by the time they are 60. The vast majority of these procedures are performed to improve quality life and are associated with few complications.

Hysterectomies are done for a variety of reasons. These include:

  • Gynecologic cancer, such as cancer of the uterus or cervix
  • Fibroids, which are benign uterine tumors that can cause persistent bleeding, anemia, pelvic pain or bladder pressure
  • Endometriosis, in which the tissue lining inside the uterus grows outside the uterus onto the ovaries, fallopian tubes, or other pelvic or abdominal organs
  • Uterine prolapse, in which the uterus descends into the vagina. This can lead to urinary incontinence, pelvic pressure and difficulty having bowel movements.
  • Abnormal vaginal bleeding
  • Chronic pelvic pain

There are several types of hysterectomies. The first is an abdominal hysterectomy in which the uterus is removed through an incision in the lower abdomen. A partial hysterectomy removes only the uterus, whereas a total hysterectomy removes both the uterus and the cervix. Additionally, a total hysterectomy with salpingo-oophorectomy includes the removal of one or both ovaries, as well as the fallopian types.

In recent years, studies have increasingly shown that there may be long-term adverse effects of having this procedure on the pelvic floor, as well as unwanted effects on other aspects of a woman's health. Furthermore, experts have been concerned that one specific procedure for hysterectomy may cause the spread of undetected cancers. A new study out of Columbia University College of Physicians and Surgeons delved into this issue. These researchers looked at data from 232,882 women who had minimally invasive hysterectomy from 2006-2012. The procedure, known as morcellation, which involves fragmenting the uterus into small pieces in order to remove it, was used in 15.7 percent of the operations in this study.

The researchers wanted to determine the risk of cancer spreading through the morcellation procedure. They found that among the women who underwent morcellation, 99 cases of uterine cancer were identified, as were 26 cases of other gynecologic malignancies, 39 uterine neoplasms that had an uncertain malignant potential, and 368 cases of endometrial hyperplasia.

The researchers' analysis also found that morcellation was increasingly associated with underlying cancer as well as endometrial hyperplasia as women get older. "You are essentially cutting through a cancer [if it is present] and that could theoretically spread the cancer to outside the uterus," said Dr. Jason Wright, chief of gynecologic oncology at the Columbia University College of Physicians and Surgeons and the study's lead author. The researchers found that this risk isn't present when the uterus is removed intact.

Therefore, talking to your doctor about a potential hysterectomy is very important. In fact, the Society of Gynecologic Oncology recommends that patients who are being considered for minimally invasive surgery that might require morcellation should be evaluated to see if they might have a uterine or cervical malignancy. Additionally, women should talk to a doctor about the potential consequences, such as pelvic organ prolapse, urinary incontinence, bowel dysfunction, sexual dysfunction and pelvic organ fistula formation prior to surgery so they can make an informed decision. Researchers also point out that with women experiencing a longer life expectancy, these potential consequences loom larger since they could occur a long time after the hysterectomy and could lead to a significantly lower quality of life.

Primary Resources for This Sharepost:

Forsgren, C. & Altman, D. (2013). Long-term effects of hysterectomy: A focus on the aging patient. Medscape.com.

Mayo Clinic. (2012). Abdominal hysterectomy.

MedlinePlus. (2014). Technique used in some hysterectomies may help spread cancer: study.

Society of Gynecologic Oncology. (2013). SGO position statement: Morcellation.

Wright, J. D., et al. (2014). Uterine pathology in women undergoing invasive hysterectomy using morcellation. JAMA.