Are Most Hysterectomies Unnecessary?

Elyse Fine's gynecologist told her she needed a hysterectomy to treat a uterine fibroid that was causing heavy bleeding. But Fine, a 44-year-old mother of two, did not agree.

Every minute of every day in this country a woman has her uterus removed in a hysterectomy. Most of the surgeries are done on women under age 50, and the vast majority are performed to treat fibroids, benign tumors that develop in the uterus. Fibroids occur in as many as 80 percent of women. While the growths can cause pain and heavy bleeding, most do not need treatment.

Non-Surgical Option

Fine said she told her doctor, "I'm pretty partial to my body parts and I'd like to keep them. I have two children. I'm not having any more, but I really didn't want any more surgery."

Some experts say alternative treatments are better suited to treating most uterine fibroids. They say as many as 75 percent of the 600,000 hysterectomies performed annually in the United States for various conditions may be unnecessary.

Carla Dionne, who founded the National Uterine Fibroids Foundation after undergoing the procedure herself, says women need to hear more about their options. "I don't think any woman should have to undergo a hysterectomy when there are other viable options for uterine fibroids. And I think it's ridiculous that the other options aren't being made available to women across the country," Dionne said.

One option is fibroid embolization — a nonsurgical procedure that destroys fibroids by cutting off their blood supply. The procedure is typically performed by a radiologist.

Caught in a Turf War

But Dionne says most women aren't going to hear about it from their gynecologist. "There's a huge war between gynecologists and interventional radiologists," she said. "It has scared the dickens out of women so they wouldn't undergo fibroid embolization. Oh, the horror stories women have been told by their gynecologists about the procedure. It's ridiculous."

Hysterectomies are a big moneymaker for doctors and hospitals.

A gynecologist loses several thousand dollars each time a fibroid patient gets treated with embolization instead of surgery. It has fueled an ongoing battle between specialists — and some say Cheryl King got caught in the middle.

King, a 44-year-old wife and mother, teacher, and guidance counselor in New Jersey suffered from heavy menstrual bleeding. By the autumn of 2001 it had gotten much worse.

According to her husband, Tom, her gynecologist said the excessive bleeding was caused by a very large fibroid tumor that needed to be removed. His recommendation, Tom King says, was to remove the tumor by performing a hysterectomy.

Cheryl had researched fibroid embolization as an alternative to hysterectomy and told her gynecologist she believed it was the right choice for her. But her doctor disagreed. He told her the procedure wouldn't work in her case, her husband says, and that she was going to end up having a hysterectomy later on anyway, even if she chose fibroid embolization for her current tumor.

Still, Cheryl wanted to learn more about the embolization procedure. She spoke with family members in Atlanta who knew of a local interventional radiologist who did fibroid embolizations. The Kings made an appointment to see him, and the radiologist felt fibroid embolization would be an appropriate treatment for Cheryl.

The teacher scheduled the procedure for a few months later to coincide with her spring break, but she never made it back to Atlanta.

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