You might be surprised to learn that hysterectomy, the surgical removal of the uterus, is the most common gynecologic surgical procedure performed in the United States. With 600,000 performed annually, they are the most common surgery women undergo, after cesarean section, and by the age of 85, 43 percent of women will have had their uterus surgically removed. So, what should you know about this common procedure that accounts for a whopping five billion health care dollars per year?
Most hysterectomies are performed prior to menopause, and only 10 percent of hysterectomies are performed for cancer. The most common indications for hysterectomies are uterine fibroids, benign muscle tumors of the uterus; endometriosis, the presence of endometrial glands outside of the uterus; and pelvic organ prolapse, which occurs when internal organs drop from their original position.
Traditionally, hysterectomies were performed via laparotomy, a large abdominal incision, which has a high complication rate and often requires several nights in the hospital and six weeks or more for recovery. Today, hysterectomies can be accomplished in a minimally invasive fashion through vaginal, laparoscopic, or robotic techniques, sometimes requiring no hospital stay at all and as little as two weeks’ recovery. The American Congress of Obstetricians and Gynecologists (ACOG), the guiding organization for obstetricians and gynecologists in the United States, recommends that all hysterectomies be performed through vaginal or laparoscopic methods whenever possible, due to the lower complication rate and faster recovery time.
These surgical methods provide the patient with the least amount of pain, blood loss, and time spent in the hospital. In fact, a national survey of obstetricians and gynecologists found that over 90 percent would prefer a vaginal or laparoscopic hysterectomy for themselves or their spouses. Unfortunately, nearly two-thirds of hysterectomies are still performed via a laparotomy, despite these recommendations and technological advances in surgical technique. The most common reasons cited for not performing vaginal or laparoscopic hysterectomy include lack of training, lack of surgeon experience and perceived difficulty of the case. If you are planning to undergo a hysterectomy, ask your physician if the procedure can be performed vaginally or laparoscopically, and if not, request a second opinion.
Contrary to popular belief, undergoing a hysterectomy does not necessarily mean removing all of the gynecologic organs, such as the cervix, tubes and ovaries. In fact, a study in 2005 suggested that women undergoing a hysterectomy may retain their ovaries up until age 65 if the ovaries are normal and there is no family or personal history of cancer. Unlike the uterus, which is only for childbearing, the ovaries produce estrogen, the hormone necessary for bone and heart health. Even after menopause, the ovaries continue to make a small amount of estrogen. Similarly, the cervix, which is the opening to the uterus, may be left in place prior to menopause if the patient desires and there is no history of abnormal pap smears or concern for cancer. Leaving the cervix in place may help maintain normal pelvic support and structure after a hysterectomy; however, this has yet to be scientifically proven.
Multiple studies have shown that 95 percent of women who undergo a hysterectomy are highly satisfied afterward. Women who underwent a hysterectomy had a greater increase in their quality of life over women who chose non-surgical treatments instead. However, medical treatments have advanced in recent years just like surgical treatments. Ask your physician if there are alternatives to a hysterectomy prior to undergoing one. Patient awareness and satisfaction is of utmost importance when making the decision to undergo a hysterectomy.
Dr. Kelly Wright is a minimally invasive gynecologic surgeon at Lahey Medical Center in Peabody. She completed her residency training at Brigham and Women’s and Massachusetts General hospitals and fellowship training at Newton-Wellesley Hospital in a nationally renowned minimally invasive gynecologic surgery program. She is available for consultation for many types of advanced minimally invasive gynecologic surgical procedures, including hysterectomy.