In findings that are sure to cause quite a stir in the medical community, California researchers have reported that the removal of ovaries during common hysterectomy surgery not only has no significant health benefit, but actually increases women’s risk of death from heart disease and hip fracture.
The study also questions the frequency with which hysterectomies are being performed.
In more than half of the hysterectomies performed in the U.S., perfectly healthy ovaries are removed in the hopes pf preventing ovarian cancer. Although ovarian cancer is deadly, it is also rare. According to Dr. William H. Parker, clinical professor of gynecology at the University of California, Los Angeles, and lead author of the new study, women are 25 times more likely to die of heart disease.
Many experts have always believed that there has never been any strong medical evidence to suggest that the practice of removing healthy ovaries was a good idea and yet, it has become a rather routine practice in the U.S.
Removal of healthy ovaries (oophorectomy), the equivalent of “castration,” is unnecessary and can also be quite detrimental. Even after menopause, ovaries produce estrogen, testosterone and androstenedione, which muscle and fat cells use to make estrogen. Without these important hormones, the risk of heart disease, bone thinning, osteoporosis and the associated risk of hip fracture all increase.
In addition to removing healthy ovaries, American surgeons also often extract the cervix during a hysterectomy. Cervical cancer is even rarer than ovarian cancer and can be detected easily with regular Pap smears.
Also of great concern to the research team and other experts in the field is the enormous number of hysterectomies being performed each year in the U.S. Although the rate of hysterectomies in the United States dropped slightly in 2003, American women are twice as likely as British women to have a hysterectomy and four times as likely as Swedish women to have the procedure.
Dr. Parker views this as a “cultural” anomaly caused by “the way doctors have been taught and what women expect" as opposed to a financial matter.
To those who oppose the wholesale use of hysterectomies as a broad preventative measure that is performed much too frequently (615,000 per year) the existence of perfectly acceptable alternative procedures may indicate that many of these surgeries are unnecessary and the result of women being unaware that there are other (healthier) options available to them.
Hysterectomies, which are certainly required in cases of uterine cancer, are nonetheless performed 90 % of time in the U.S. to treat other problems including fibroids, endometriosis, abnormal bleeding, or a prolapsed or fallen uterus. Highly effective alternative surgical and nonsurgical means are available to treat these conditions.
For fibroids and benign growths in the uterus, pain can often be managed until menopause when the conditions often clear themselves up. Alternative surgical treatments include myomectomy (surgical removal of the fibroids alone) and uterine artery embolization, in which tiny plastic pellets are inserted into the blood vessels supplying the uterus to cut off blood supply.
Laparoscopic surgery done through a “keyhole” incision in the abdomen is an option when a mass is detected on an ovary that may or may not be cancer. This minimally invasive procedure can also be used to treat endometriosis, a growth of uterine-like tissue outside the womb that is often extremely painful.
For heavy bleeding due to problems other than fibroids, doctors can use ablation to destroy the uterine lining with hot water, radio frequency waves or electric current. For a prolapsed uterus, surgeons can put in stitches to suspend the uterus more securely in the pelvis.
Hysterectomy also carries with it the risk of diminished sexual satisfaction since uterine contractions can be part of orgasm and because removing the cervix cuts nerves to the external genitalia, including the clitoris and labia. To be sure, however, many women do not suffer such problems.
As a result of the findings, the study encourages women who have been told they need a hysterectomy to ask about less radical alternative procedures and treatments for the particular condition they have been diagnosed with and to seek a second opinion before committing to what may be an unnecessary procedure with long-term risks rather than benefits.