You Heard it Here First: Hysterectomy for Benign Conditions isnt so Benign After All
May/June 2011
Long-time NWHN members know that we are critical of U.S. gynecologists for doing way too hysterectomies. Now research confirms that both having a hysterectomy for many common conditions, and removing the ovaries during hysterectomy, can have dangerous impacts on women’s health.
As far back as the 1970s, NHWN knew that whether or not a woman had a hysterectomy in her 40s or 50s depended far more on where she lived than on her medical condition. When we compared rates in the U.S. to rates in other countries, we saw that other countries had far lower rates: in Britain, for example, rates were just 30% of the rates in the U.S.. And, when women talked to each other, they realized that sometimes their doctors just weren’t telling them the truth, and were incorrectly implying that certain conditions (such as dysplasia, “dropped” uterus, or fibroids) had to be treated by removing the uterus. To make matters worse, there were not only too many hysterectomies, but also, most of the time, surgeons removed the ovaries as well (this procedure is called an oophorectomy.
After the women’s health movement challenged this situation, supportive physicians admitted they were taught in medical school that “after age 45, there’s no uterus worth saving”. Some gyns tried to justify this adage by explaining that removing the ovaries prevents ovarian cancer, but most women — just like most men — don’t want their healthy reproductive organs removed “just in case”.
Over time, hysterectomy rates dropped, but not enough, and some women who had hysterectomies, but not the majority, kept their ovaries. When gynecologists wouldn’t change quickly enough, NWHN continued to educate women about unnecessary hysterectomies. We advised women about alternative treatments for the common conditions that lead doctors to promote hysterectomy, and cautioned both women and clinicians about hysterectomy’s possible negative effects, whether or not the ovaries were also removed.
We also conducted advocacy campaigns about the overuse of hysterectomy whenever and wherever possible, such as in our 2002 publication, The Truth About Hormone Replacement Therapy (HRT). We have consistently called for research to assess whether hysterectomy is actually the only effective treatment for common conditions, and whether ovary removal is a useful preventive strategy. We have met with NIH officials; encouraged Congressional hearings, such as those held by Senator Barbara Mikulski (D-MD) in 1992; and even served on the oversight committee of a clinical trial comparing hysterectomy to uterus-sparing treatments. As a result, we now know that many common conditions can be treated effectively without hysterectomy, and we’re starting to learn more about the effect of ovary removal and hysterectomy on women’s long-term health.
Several well-conducted recent studies confirm that women’s health isn’t benefited by removing the ovaries. Yes, ovarian cancer is prevented in nearly all cases, but overall, women’s ability to live to a ripe old age is undermined by ovary removal, not helped. Taking out healthy ovaries increases a woman’s risk of developing heart disease later in life, and, shockingly, even increases her likelihood of death. According to researchers associated with the Nurses’ Health Study, which followed nearly 30,000 women for 24 years, one additional death is expected for every nine oopherectomies performed.1 Other studies aren’t as large as the Nurses’ Health Study, but have similar results: removing healthy ovaries doesn’t help women stay healthy, overall.2
What about hysterectomy without ovary removal — does it impair women’s general long-term health? (There’s not enough space in this article to address concerns raised by women who have experienced problems with their sexuality after hysterectomy. For more information on this, you can turn to Our Bodies, Ourselves: Menopause, or the Hysterectomy Educational Resources and Services (HERS) Foundation.)There have been some hints that hysterectomy increases the risk of heart disease, but earlier studies were not able to conduct the kind of long-term follow-up needed to say for sure.3 Now, thanks to some dedicated researchers in Sweden (where they provide health care for all and keep really good records) we know more about hysterectomy. The Swedish study, published late last year, reaffirms what the NWHN has been warning women about for so many years: hysterectomy, especially when done before menopause, increases women’s risk of cardiovascular disease, including stroke and heart attack.4
The Swedish study involved over 800,000 women, enabling the researchers to identify a small, but meaningful, increased cardiovascular disease risk of 18%. Given how common cardiovascular disease – it’s the leading killer of older women – an 18% increased risk is very important, and reducing the unnecessary risk could save lives. (Remember, just an 8% decrease in the U.S. breast cancer rate, which occurred after women stopped the unnecessary use of menopause hormone therapy, resulted in 16,000 fewer cases of breast cancer every year.) This risk wasn’t statistically significant in women whose hysterectomies were performed after menopause.
What can you do? If you’re unlucky enough to have a family history of ovarian cancer, we recommend talking with a genetic counselor before making any decisions about preventive surgery. It might be the right choice for you, but not all women make that decision. If you don’t have a family history of ovarian cancer, and a physician suggests a hysterectomy, take the time you need to explore other options. Many women find other options that effectively treat conditions such as fibroids, heavy/painful periods, or endometriosis. If you’ve done your research and you’re sure that hysterectomy is the right choice for you, hold on to your ovaries!
References:
1. Parker, WH, et al. “Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study”. Obstetrics & Gynecology 2009; 113:1027-1037.
2. Rocca W, et al. “Survival patterns after oophorectomy in premenopausal women: a population-based cohort study.” Lancet Oncology 2006; 7: 821-828.
3. Howard, BV, et al. “Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the Women’s Health Initiative Observational Study.” Circulation 2005; 111:1462-1470.
4. Ingelsson, E, et a. “Hysterectomy and risk of cardiovascular disease: a population based cohort study.” European Heart Journal advance access published December 24, 2010.
