HYSTERECTOMY & STERILIZATION
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diagnosis and treatment by a qualified, licensed professional.
Hysterectomy surveillance--United States, 1980-1993.
Lepine LA, et al.
MMWR CDC Surveill Summ, 46(4):1-15 1997 Aug 8.The results of this study show that in the U.S., every year, an estimated 600,000 women undergo hysterectomy. In the period 1980-1993, approximately 8.6 billion women had their uterus removed. The most frequent indication for hysterectomy was uterine fibroid (a benign uterine growth), with 60% of black women, 30% of white women, and 45% of women of other races undergoing hysterectomy because of this condition. During 1988-1993 increasingly more women undergoing hysterectomy also had both of their ovaries removed.
Hysterectomy: indications, alternatives and predictors.
Kramer MG, Reiter RC.
Am Fam Physician 1997 Feb 15;55(3):827-34.This article emphasizes that every year in the United States over 570,000 women undergo hysterectomy, even though, according to the opinion of several experts, the procedure is often not justified by valid medical indications. Hysterectomy is frequently performed for uterine fibroids, dysfunctional uterine bleeding, endometriosis/adenomyosis, chronic pelvic pain and genital prolapse. This practice occurs against the current literature that recommends conservative treatment of most nonmalignant conditions, and advocates hysterectomy in refractory cases only.
The appropriateness of recommendations for hysterectomy.
Broder MS, Kanouse DE, Mittman BS, Bernstein SJ.
Obstet Gynecol 2000 Feb;95(2):199-205.The results of this study show that 70% of the hysterectomies performed in the U.S. are recommended inappropriately. The study was conducted on approximately 500 women who underwent hysterectomy mainly for fibroids (60%), pelvic relaxation (11%), pain (9%), and bleeding (8%). The authors recommend that physicians explore alternative treatments before resorting to removal of the uterus.
Alternatives to hysterectomy for benign conditions.
Scialli AR.
Int J Fertil Womens Med 1998 Jul-Aug;43(4):186-91.This article emphasizes that in the U.S. approximately 590,000 hysterectomies are performed every year, implying that approximately one in three women will have their uterus removed at some point in their life. Alternative solutions to hysterectomy are presented and include simple expectant management for uncomplicated uterine fibroids, endoscopic removal or hormonal therapy for symptomatic uterine fibroids, hormone therapy for endometriosis, pain treatment for pelvic pain, and pelvic floor exercises for pelvic prolapse. In many cases, several options are available before resolving to hysterectomy.
The epidemiology of hysterectomy: findings in a large cohort study.
Vessey MP, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D.
Br J Obstet Gynaecol, 99(5):402-7 1992 May.The results of this study show that approximately 20% of women will have their uterus removed by the time they reach their mid-fifties. The most frequent indication for hysterectomy is the presence of uterine fibroids, (benign tumors that commonly occur in middle-aged women), followed by menstrual disorders.
Hysterectomy charges: geographic variations United States, 1994.
Mushinski M.
Stat Bull Metrop Insur Co, 77(1):2-12 1996 Jan-Mar.The results of this study show that the cost of hysterectomy varies considerably from state to state. For examples, having a hysterectomy performed in Florida costs twice as much as having it performed in Oklahoma. Charges for abdominal hysterectomy are 60% higher in California than in Tennessee, and those for vaginal hysterectomy are 42% higher in California than in North Carolina.
Hysterectomy. A critical review.
Bachmann GA.
J Reprod Med 1990 Sep;35(9):839-62.This article highlights that the risk of death in women undergoing hysterectomy is 12 for every 10,000 procedures performed. While the benefits derived from the operation in women with uterine cancer or other life-threatening diseases are unquestionable, improvements in quality of life are difficult to establish for women who undergo hysterectomy merely for symptoms alleviation, indicating that risks and benefits of the procedure should be carefully weighed, before resolving to surgery.
Self-reported long-term outcomes of hysterectomy.
Schofield MJ; Bennett A; Redman S; Walters WA; Sanson-Fisher RW.
Br J Obstet Gynaecol, 98(11):1129-36 1991 Nov.The results of this study show that more than 50% of women who underwent hysterectomy subsequently developed symptoms that they believed were caused or worsened by the procedure.
Hysterectomy and urinary incontinence: a systematic review.
Brown JS, Sawaya G, Thom DH, Grady D.
Lancet 2000; 356: 535-539.The results of this study show that urinary incontinence is a common long-term complication of hysterectomy. In the study, analysis of the English scientific literature on the subject revealed that women with hysterectomy have a 60% higher risk of developing urinary incontinence by 60 years or older, compared to those with an intact uterus. This finding is important, since hysterectomy is performed in 90% of cases for non-life threatening conditions such as pelvic pain, vaginal bleeding and uterine fibroids. Doctors should inform their patients that resolving to surgery for the symptomatic relief of symptoms could result in more disability later in life.
The place of hysterectomy in the management of benign uterine disease.
Mawson AR.
HMO Pract 1996 Jun;10(2):69-74.This article emphasizes that the long-term benefits of hysterectomy to this day are still uncertain. Less radical treatments can be as effective as hysterectomy and have the benefits of sparing the woman' uterus and ovaries.
Hysterectomy, oophorectomy, and heart disease risk factors in older women.
Kritz-Silverstein D, Barrett-Connor E, Wingard DL.
Am J Public Health 1997 Apr;87(4):676-80.
The results of this study show that women aged 50-89 years who undergo hysterectomy in combination with bilateral oophorectomy (removal of the ovaries) have increased value of serum lipids, lipoproteins, glucose, and insulin, and increased blood pressure values, compared to women who undergo hysterectomy with ovarian preservation. These results indicate that removal of the ovaries may result in increased risk of cardiovascular disease; these adverse effects are not offset by estrogen replacement therapy.
Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy.
Lahteenmaki P, et al.
BMJ 1998 Apr 11;316(7138):1122-6.In this study 56 women scheduled to receive hysterectomy for excessive uterine bleeding, were randomized to receive either hormone treatment with an intrauterine system releasing the progestin levonorgestrel, or to continue their preexistent treatment for excessive or painful bleeding. After 6 months, two-thirds of the women treated with levonorgestrel and 14% of those who continued preexistent treatment cancelled the operation. These results indicate that hysterectomy for excessive bleeding can be avoided in a large number of patients, if medical treatment and expectant management are employed before surgery.
A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years
Aberdeen Endometrial Ablation Trials Group.
Br J Obstet Gynaecol 1999 Apr;106(4):360-6.The results of this study show that endometrial ablation (the surgical removal of a portion of the lining of the uterus) in women with dysfunctional uterine bleeding is a valid alternative to hysterectomy. Only 24% of 102 women, who, instead of having their uterus removed, underwent endometrial ablation, required hysterectomy in the subsequent four years.
Does persistent postmenopausal bleeding justify hysterectomy?
Fung Kee Fung M, Burnett M, Faught W.
Eur J Gynaecol Oncol, 18(1):26-8 1997.The results of this study show that persistent postmenopausal vaginal bleeding is not a valid reason for performing hysterectomy, because this symptom, contrary to common belief, is not associated with increased risk of uterine cancer.
Long-term outcome of nonconservative surgery (hysterectomy) for endometriosis-associated pain in women <30 years old.
MacDonald SR, Klock SC, Milad MP.
Am J Obstet Gynecol 1999 Jun;180(6 Pt 1):1360-3.The results of this study show that women who undergo hysterectomy for painful endometriosis before the age of 30, experience significant more residual symptoms such as painful sexual intercourse and painful urination, significant more sense of loss and significant more disruption of different life' aspects, compared to women who had their uterus removed after the age of 40.
Surgical sterilization in the United States: prevalence and characteristics, 1965-95.
Chandra A.
Vital Health Stat 23 1998 Jun;(20):1-33.This article shows that in the U.S, the percentage of women undergoing surgical sterilization increased from 16% in 1965 to 41% in 1995.
Tubal sterilization and risk of subsequent hospital admission for menstrual disorders.
Shy KK, Stergachis A, Grothaus LG, Wagner EH, Hecht J, Anderson G.
Am J Obstet Gynecol, 166(6 Pt 1):1698-705; 1992 Jun.The results of this study show that after tubal sterilization the risk for a woman to be hospitalized for menstrual disorders increases by 2.4 times. The risk increases by 6 times in women sterilized at the age of 20 through 24.
Tubal sterilization and the long-term risk of hysterectomy.
Stergachis A, et al.
JAMA 1990 Dec 12;264(22):2893-8.The results of this study show that women sterilized by tubal ligation at the age of 20-29, have a subsequent 3.4-fold increased risk of undergoing hysterectomy, compared to women with intact tubes.
Higher hysterectomy risk for sterilized than nonsterilized women: findings from the U.S. Collaborative Review of Sterilization. The U.S. Collaborative Review of Sterilization Working Group.
Hillis SD, Marchbanks PA, Tylor LR, Peterson HB.
Obstet Gynecol 1998 Feb;91(2):241-6.The results of this study show that women sterilized by tubal ligation have a 4.5-fold increased risk of undergoing hysterectomy within 5 years from the procedure, compared to women who did not undergo this procedure and whose husbands had been vasectomized. The risk of hysterectomy after tubal ligation was similar in women of all age groups.
Long-term risk of hysterectomy among 80,007 sterilized and comparison women at Kaiser Permanente, 1971-1987.
Goldhaber MK.
Am J Epidemiol 1993 Oct 1;138(7):508-21.The results of this study show that women of all age who undergo tubal sterilization are at increased risk of hysterectomy. The risk is particularly elevated in younger women. The most frequent indications for hysterectomy in sterilized women are menstrual disorders and pelvic pain.
Complications of female sterilization: immediate and delayed.
Huggins GR, Sondheimer SJ.
Fertil Steril 1984 Mar;41(3):337-55.This article emphasizes that a significant number of women who undergo tubal sterilization subsequently develop gynecological and psychological problems defined as "post-tubal ligation syndrome". One hypothesis is that tubal ligation may compromise blood and nerve supply to the ovaries, causing gynecological disturbances.
Sequelae of tubal ligation: an analysis of 75 consecutive hysterectomies.
Stock RJ.
South Med J 1984 Oct;77(10):1255-60.This article reports that 20 out of 75 patients who underwent tubal sterilization went on to develop post-tubal-ligation syndrome, a clinical condition characterized by symptoms of pelvic pain and /or abnormally profuse menstrual flow.
Hematosalpinx with pelvic pain after endometrial ablation confirms the
postablation-tubal sterilization syndrome.
Webb JC, Bush MR, Wood MD, Park GS.
J Am Assoc Gynecol Laparosc 1996 May;3(3):419-21.This article reports on the case of a 39-year old women previously sterilized by tubal ligation, who underwent hysterectomy for debilitating pelvic pain. Pathologic evaluation of the specimen revealed the presence of blood accumulation in both tubes, confirming the presence of post-tubal-sterilization syndrome.
Oestrogen deficiency after tubal ligation.
Cattanach J.
Lancet 1985 Apr 13;1(8433):847-9.This article shows that 4 of 7 women who underwent tubal ligation developed estrogen deficiency, dysfunctional uterine bleeding and abnormally profuse menstrual flow in the 7 years following the procedure. The authors propose that occlusion of the tubes may increase the pressure in the ovarian arterial circle, and indirectly affect ovarian estrogen production.
Tubal sterilization and subsequent ectopic pregnancy. A case-control study.
Holt VL, Chu J, Daling JR, Stergachis AS, Weiss NS.
JAMA, 266(2):242-6 1991.The results of this study show that women who undergo tubal sterilization have a 3.7-fold increased risk of ectopic pregnancy, compared to women who use oral contraceptives, and a 2.8-folds increased risk of ectopic pregnancy, compared to those who use barrier contraceptive methods.
The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization.
Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J.
Am J Obstet Gynecol, 174(4):1161-8; 1996 Apr.The results of this study show that the risk of pregnancy after tubal ligation is approximately 50 per 1000 women sterilized.
The risk of ectopic pregnancy after tubal sterilization.
U.S. Collaborative Review of Sterilization Working Group.
Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J.
N Engl J Med, 336(11):762-7 1997 Mar 13.The results of this study show that ectopic pregnancy can still occur as a complication even in women who have been sterilized several years before. The incidence of ectopic pregnancy varies with the type of procedure performed, and women who have undergone bipolar tubal coagulation have a 27-fold increased risk of ectopic pregnancy, compared to those who have received partial salpingectomy after delivery (32 vs. 1.2 ectopic pregnancy for 1,000 sterilization).
Acute pelvic inflammatory disease after surgical sterilization.
Green MM; Vicario SJ; Sanfilippo JS; Lochhead SA.
Ann Emerg Med, 20(4):344-7 1991 Apr.The results of this study indicate that women who undergo tubal sterilization are at increased risk of pelvic inflammatory disease, compared to women who are not sterilized.
Tubal sterilization and the risk of endometrial cancer.
Castellsague X, Thompson WD, Dubrow R.
Int J Cancer, 65(5):607-12 1996 Mar 1The results of this study indicate that tubal ligation may be associated with a 20% increased risk of uterine cancer.
