Medical Health Encyclopedia

Women should discuss each option with their physician. Deciding on the surgical procedure depends on the location, size, and number of fibroids and the experience of the physician. The risk for complications diminish with the surgeon's additional experience, so patients are urged to evaluate the surgeon's track record. [For detailed information, see In-Depth Report #73 Uterine Fibroids.]

Hysterectomy

Hysterectomy is the surgical removal of the uterus. About 600,000 hysterectomies are performed each year in the US, which is the highest rate among any nations with published data on this procedure. By age 60, about a third of American women have had this procedure. The highest hysterectomy rates are in women between ages 40 and 44. Women in the South and Midwest are more likely to have the operation than those in the Northeast and West.

Click the icon to see an illustrated series detailing a hysterectomy.

Heavy bleeding, often from fibroids, is the reason for about two-thirds of all hysterectomies. However, in about half of these hysterectomies, no abnormalities are detected to explain the bleeding. In one European study, women with menorrhagia were more likely to choose hysterectomy over conservative treatment if they also had pelvic pain and were inconvenienced by the heavy bleeding. The number of procedures has continued to increase, but the rise has slowed substantially in recent years.

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In its support, hysterectomy, unlike medical treatments and less invasive procedures, cures menorrhagia completely, and most women are satisfied with the procedure. Less invasive hysterectomy procedures are also improving recovery rates and increasing satisfaction afterward.

Still, in one study in 70% of cases when physicians recommended hysterectomies, they did not give their patients alternative choices or adequate diagnostic evaluations. It should be noted that some evidence suggests that the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena, FibroPlant) might help avoid hysterectomy in 80% of cases. Any woman, even one who has reached menopause, who is uncertain about a recommendation for a hysterectomy for fibroids or heavy bleeding should certainly seek a second opinion.