US hysterectomy rate held steady through 1990s

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US hysterectomy rate held steady through 1990s

By Mulvihill

NEW YORK, Jan 31 (Reuters Health) - Among US women, the hysterectomy

rate barely changed through the 1990s, despite concerns that the

procedure is overused in this country, according to a new report.

Nearly one in three US women will have had a hysterectomy by the time

they are 60 years old, the researchers note. Concerns have been raised

that the procedure is overused in America, researchers say; hysterectomy

rates in the US are three to four times higher than in Australia, New

Zealand and most European countries.

US statistics on the procedure showed that the annual hysterectomy rate

was 55 per 10,000 women in 1990, and rose slightly to 56 per 10,000 by

1997, according to Drs. M. Farquhar and A. Steiner of

the Agency of Healthcare Research and Quality in Rockville, land.

About 600,000 US women undergo the procedure each year.

But the way in which the procedure is performed has changed, they note

in their report, which is published in the February issue of the journal

Obstetrics & Gynecology.

Hysterectomy--the removal of the uterus--is performed in three basic

ways. Abdominal hysterectomy involves removing the uterus through a

large incision in the abdomen. In vaginal hysterectomy, the organ is

removed via the vagina. In laparoscopic hysterectomy, the uterus also is

removed via the vagina, with the aid of a tiny camera inserted through a

small incision in the abdomen.

Abdominal surgery remains the most common type, representing 63% of all

procedures in 1997, Farquhar and Steiner found. Laparoscopic

hysterectomy, first introduced in the 1980s, now represents nearly 10%

of hysterectomy procedures--a 30-fold increase over the 8-year study

period. Twenty-three percent of hysterectomies were performed by the

vaginal method in 1997.

" It is likely that we are seeing some abdominal procedures being

replaced by laparoscopic procedures, " Steiner told Reuters Health in an

interview.

Laparoscopic surgery may have fewer complications, including less pain

and a shorter recovery period than abdominal hysterectomy, she

explained.

" Plus there is no incision across the abdomen, " she added.

Hysterectomy is performed largely to treat uterine fibroids, the report

indicates. Uterine fibroids occur in about 25% of women and can cause

excessive menstrual bleeding, pelvic pain and frequent urination.

Still, Steiner notes that hysterectomy isn't a woman's only option for

treating fibroids.

" There are several therapeutic techniques to treat (fibroids)--but it

would appear that these have not affected the overall rate of

hysterectomy, " she said.

Steiner is referring to a procedure that cuts off the blood supply to

fibroids, called uterine artery embolization, and another called

endometrial ablation--an increasingly popular nonsurgical procedure used

to control heavy menstrual bleeding. These procedures have been found to

help some women avoid hysterectomy.

Another interesting finding, according to Steiner, is the fact that " the

(hysterectomy) rate has remained unchanged despite a fair amount of

attention to the concern about inappropriate overuse of hysterectomy in

the US. "

The researchers conclude that " if further declines in hysterectomy rates

are to occur, effective treatments for managing common reproductive

conditions need to be considered, and future research needs to focus on

nonsurgical alternatives for fibroid management. "

SOURCE: Obstetrics & Gynecology 2002;99:229-234.