Alternatives to Hysterectomy New Technologies, More Options: More Than 1 in 4 U.S. Women Will Have a Hysterectomy by the Time They Are 60 Years Old, According to the Centers for Disease Control and Prevention (CDC)
Bren, Linda, FDA Consumer
A hysterectomy--removal of the uterus--can be a life-saving operation for women with certain types of cancer or uterine hemorrhage. It can also improve the quality of life for thousands of women each year who experience abnormal uterine bleeding and noncancerous growths of muscle tissue in and around the uterus (fibroids), or the falling of the uterus from its normal position into or outside of the vagina (uterine prolapse).
When the ovaries are also removed, a hysterectomy can relieve the pain of endometriosis--the growth of the tissue lining the uterus (endometrial tissue) outside the uterus.
The United States has one of the highest rates of hysterectomy in the world, with about 5 out of every 1,000 women each year having the operation, according to the CDC. Other industrialized countries show lower rates; in England, for example, the rate is less than 3 per 1,000 women annually. In Norway, it's less than 2 in 1,000.
Some are concerned that many hysterectomies are done unnecessarily in this country. "There are some cases where hysterectomy is the only option, for instance, for some types of cancer," says Anthony Scialli, M.D., director of the obstetrics and gynecology residency program at Georgetown University Hospital in Washington, D.C. "But I think we perform too many hysterectomies. It's a matter of American gynecologists being accustomed to performing a hysterectomy and American women being accustomed to getting one--based on their mother or other female relative having one. The one thing in favor of a hysterectomy is that it works for abnormal uterine bleeding--but it should be the last step, not the first step."
Of the more than 600,000 hysterectomies performed on American women in 1999, more than one-third of them were to treat fibroids or abnormal uterine bleeding.
Today, women have other options--new medications, technologies, and procedures--to treat noncancerous uterine conditions. Some of these less invasive procedures translate into lower risk, quicker recovery, and less expense. And some preserve the ability to get pregnant, unlike hysterectomy.
However, these procedures also have the disadvantage inherent with any new treatment--the lack of data demonstrating long-term safety and effectiveness. "But it's never a bad thing for a woman to ask a doctor for alternatives," says Scialli. "She should ask, `What other options are there to manage this problem and what are the pros and cons?'"
Abnormal Uterine Bleeding
In women younger than 30, most hysterectomies are done to treat abnormal uterine bleeding. Abnormal uterine bleeding can occur as frequent, irregular and unpredictable bleeding, lengthy menstrual periods, bleeding between periods, or a heavy flow during periods. This bleeding may be caused by hormonal imbalances, growth of endometrial tissue into the wrong place, fibroids, or other conditions. And sometimes the bleeding has no identifiable abnormality associated with it.
However it occurs, abnormal uterine bleeding is an inconvenience, and it can be accompanied by painful cramping. It can also be exhausting, embarrassing and--when it results in anemia--dangerous.
After diagnosing the cause of bleeding, doctors usually turn to medications as the first therapy for treating abnormal uterine bleeding. Some estrogens and progestins are approved by the Food and Drug Administration to treat abnormal uterine bleeding in certain circumstances. Although the FDA has not approved oral contraceptives to treat abnormal uterine bleeding, some doctors prescribe them for this purpose. As with other approved medications, doctors may prescribe oral contraceptives "off label" for an unapproved use if, in their professional judgment, a patient will benefit from them.
"Ninety-five percent of abnormal bleeding associated with or without fibroids can be controlled with birth control pills," says Scialli. However, oral contraceptives may not be effective in reducing bleeding to acceptable levels in some women. …