When is a Hysterectomy Needed?

By OBOS Common Medical Conditions Contributors | October 15, 2011

The United States has the highest hysterectomy rate in the industrialized world. Statistics from 2004 indicate that about one-third of all U.S. women have had a hysterectomy by the age of 60. Today, about 90 percent of hysterectomies are done by choice and not as an emergency or lifesaving procedure. Various studies have concluded that anywhere from 10 percent to 90 percent of those operations were not really needed, but many physicians continue to recommend them.

In certain circumstances, hysterectomies save lives and restore health. However, as major surgery, hysterectomies can have long-term effects on women’s health, sexuality, and life expectancy. There is increasing understanding that a woman’s uterus and ovaries have value during midlife and beyond, so the view of a woman’s uterus and ovaries as “expendable” during later periods in our lives is now obsolete.

Because of the controversy over high hysterectomy rates, many insurance plans now require a second opinion from another physician before agreeing to pay for the procedures. Because some surgeons recommend hysterectomy routinely, women need to understand when the surgery is truly necessary.

When is it necessary?

Hysterectomy may be recommended for several life-threatening conditions. If you have any of the following conditions, hysterectomy may save your life and also free you from significant pain and discomfort.

  • Invasive cancer of the uterus, cervix, vagina, fallopian tubes, and/or ovaries. Only 8 to 12 percent of hysterectomies are performed to treat cancer.
  • Severe, uncontrollable pelvic inflammatory disease (PID)
  • Severe, uncontrollable uterine bleeding (rare, usually associated with childbirth)
  • Rare but serious complications during childbirth, including rupture of the uterus

Hysterectomy may be justified as treatment for some conditions that are not life-threatening, but these usually can be treated without resorting to major surgery:

  • Precancerous changes of the endometrium, called hyperplasia. (Remember, however, that hyperplasia can often be reversed with medication.)
  • Extensive endometriosis causing debilitating pain and/or involving other organs. (More conservative surgery and/or medication is usually an effective treatment in these circumstances.)
  • Fibroid tumors that are extensive, are large, involve other organs, or cause debilitating bleeding. (However, fibroids usually can be removed by myomectomy, thereby preserving the uterus.)
  • Pelvic relaxation (uterine prolapse) that is causing severe symptoms. (Another treatment option in this case is uterine suspension surgery or a pessary.)
  • Severe bleeding leading to anemia and not correctable with iron supplementation. (Birth control pills, the Mirena IUD, and endometrial ablation are alternative treatments that can be used before resorting to hysterectomy.)

Hysterectomies should not be performed for mild abnormal uterine bleeding, fibroids without symptoms, and pelvic congestion (menstrual irregularities and low back pain). These problems typically respond to safer alternatives.

Fortunately, diagnostic and therapeutic techniques such as sonography, Pap tests, hysteroscopy, endometrial ablation, and laparoscopy make it possible to avoid or delay many hysterectomies that might have been done in the past. It is important to consider and utilize these techniques before resorting to major surgeries.

For information on types of hysterectomies and what to expect if you do need a hysterectomy, see Hysterectomy. For information on when, if you do need a hysterectomy, it might be possible to retain your ovaries, see Hysterectomy and Ovarian Conservation.