The Early Show

Too Many Hysterectomies?

March 5, 2008 / 9:15 AM EST / CBS

Some 600,000 hysterectomies are performed in the United States each year, according to the Department of Health and Human Services, and fully a-third of women will have had one by the time they turn 60.

But experts are raising the yellow flag, saying many of the procedures -- perhaps as many as two-thirds -- may be unnecessary, particularly when new alternatives are considered.

On The Early Show Wednesday, Dr. Rebecca Brightman, an obstetrician/gynecologist at New York's Mt. Sinai Medical Center, stressed that, in many cases, a hysterectomy can be life saving.

But, she added, with the newer technologies, many women may not need the invasive surgery, which involves the removal of the uterus, and often, the ovaries as well. Hysterectomies leave women unable to give birth, and there's a risk of bladder and bowel injury.

"I think a lot of women are encouraged (to have a hysterectomy) by their physicians," Brightman told co-anchor Maggie Rodriguez, "and I think the most important thing for women to realize now is that there are alternatives. Not every woman is a candidate for these alternatives, and there are certain times when a woman absolutely needs a hysterectomy."

The 600,000 figure represents a slight decline, but is still too high, Brightman says, adding that the statistics amaze her, since less invasive procedures are constantly evolving. Women, she says, need to know the newer technology exists and take advantage of it.

Women who NEED hysterectomies include those with cancer of the uterus, ovaries, or cervix, those with intolerable pain, and those who've tried other things without success, Brightman points out.

In general, she says, other conditions that might call for hysterectomies include:

Fibroids: They're very common, even more so in black women than white women. Their seriousness depends on their location. Fibroids are typically benign and slow-growing, thought their frequency tends to increase when women hit their 40's, due to increased levels of estrogen in their systems.

Excessive bleeding: It has to be evaluated. It can be caused by many things, but can be treated in ways other than having a hysterectomy. Women would need an ultrasound and, as they approach menopause, would need a biopsy of their uterine lining to determine whether cancer is present.

Endometriosis: This is the growth of tissue outside of uterus. Women used to routinely have a hysterectomy for it. Not anymore. It can be controlled with hormones, such as those in low-dose birth control pills.

Once cancer, fibroids or polyps (which can be removed without a hysterectomy) have been ruled out, hysterectomy alternatives include:

Hormone therapy: Not everyone is a candidate for it. "There are certain contra-indications to using hormones," Brightman told Rodriguez. One could be patients with breast cancer. Women who are candidates for hormone treatment would be those "without an underlying structural abnormality" -- a woman without fibroids, without a uterine polyp, a woman who just has frequent heavy menstrual bleeding.

Thermal Ablation: A new procedure that destroys the lining of the uterus to decrease bleeding. It leaves women unable to have a baby. In it, a warm, hot balloon is inserted into the uterine cavity. Some women with fibroids, many times women without them, have it.

Uterine Artery Embolization can be tried for fibroids. The "great, new procedure," Brightman says, diminishes the blood supply to the uterus, shrinking fibroids and the amount of bleeding, if the fibroids were causing it. This procedure doesn't always work, though, and some women will still need a hysterectomy.

Every situation is different, Brightman emphasized, and it all comes down to a woman being thoroughly evaluated and properly informed of non-surgical or less invasive approaches. Women should have a full understanding of options other than hysterectomies, and should discuss the fertility question as well -- most women who have hysterectomies are between the ages of 40-44.

And -- go for a second opinion.

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