Unnecessary hysterectomy

In the province of Ontario, where I live, hysterectomy is the most commonly performed surgical procedure. More than twenty thousand were performed in 1994-95 alone. The choice of hysterectomy may coincide more with the inclinations and surgical abilities of local gynecologists than with medical imperatives; there seems to be little rhyme or reason in how doctors prescribe and perform this often life-altering operation. According to the Toronto Institute for Clinical Evaluative Sciences (ICES), the rate of hysterectomy per region ranges from 274 to 797 per 100,000 women. Not surprisingly, in early 1998, the Ontario Medical Association published a report (not circulated to the public) stating that too many hysterectomies were being performed in Ontario.

But a report addressing the issue of the overuse of hysterectomy in Canada was made public in June 2002. It confirmed that Canada's situation is similar to that of the United States. Dr. Donna Stewart, professor at the University of Toronto and chair of Women's Health at the University Health Network, led the expert panel on hysterectomy practices in Ontario. A complete copy of the panel's report can be viewed at www.ontariowomenscouncil.on.ca. (See Medical Resources in Part III for more information on the Ontario Women's Council.)

According to Dr. Stewart, there are many factors contributing to the high rate of hysterectomy. For instance, many doctors are unwilling to explore other less invasive treatments with their patients. This is an unfortunate situation in itself, because if a woman is not offered less drastic options, she is not given the opportunity to make an informed choice.

Education and social class are two other important factors, and Dr. Stewart's report shows that the hysterectomy rate is highest in poor, rural regions where the level of education is low. Similarly in the U.S., the hysterectomy rate is highest in the southern states. And surprisingly, some women view hysterectomy as a permanent solution for birth control, while others feel it's the "thing to do" because it's what their mothers and sisters did before them. In any case, none of the above explanations justify a prolongation of the current situation of unnecessary surgeries performed on female patients, but all confirm the need for greater education efforts to help women and their doctors discuss less invasive alternatives to hysterectomy.

These numbers are all the more disturbing when we consider that the substantial majority of hysterectomies are very likely unnecessary. Along with Dr. West, Sandra Simkin, author of The Case against Hysterectomy, argues that 90 percent of hysterectomies are unwarranted and do not effectively treat the conditions for which they are prescribed. Surgically excising the uterus, Fallopian tubes, cervix, and/or ovaries is necessary only if cancer has been detected in one of these organs. Often, however, women are convinced to surrender their healthy reproductive organs "just in case" they might one day become cancerous. The logic of this approach is fundamentally flawed, and reveals how little the medical profession seems to value women's reproductive organs. Doctors rarely, if ever, urge men to surgically excise healthy testicles "just in case" they might one day become cancerous! As you will read in my personal story, my family physician used this scare tactic, among others, to get me to agree to a hysterectomy. It worked.