March 21, 2007 / 5:56 PM / 13 years ago

Hysterectomy rates have declined

NEW YORK (Reuters Health) - The overall rate of hysterectomies has declined substantially in the United States since 1965, although the rate of decline has recently slowed down and increased among women between the ages of 75 and 84 years old, according to a report in the American Journal of Obstetrics & Gynecology.

Hysterectomy is the surgical removal of the uterus only (partial hysterectomy), removal of the uterus and cervix (total hysterectomy) or removal of the uterus, cervix, a portion of the vagina (radical hysterectomy). The procedure is often performed for gynecological cancers, severe cases of endometriosis or fibroid tumors that cause persistent symptoms.

A population-based study of women living in Olmstead County, Minnesota, between 1965 and 2002 was conducted by Dr. Adil E. Bharucha and colleagues from the Mayo Clinic in Rochester, Minnesota.

During that period, there were a total of 9,278 hysterectomies performed, with 3,126 of these also involving pelvic floor repairs. Pelvic floor disorders are the result of weakness or injury to the pelvic ligaments, connective tissue and muscles, which cause the pelvic organs to sag, or “prolapse,” and in some cases protrude through the vagina.

After the researchers adjusted their data to account for the effect of age, the rate for hysterectomy alone declined 13 percent, from 395 per 100,000 women between 1965 and 1974, to 342 per 100,000 women between 1995 and 2002. The rate for hysterectomy and pelvic floor repair declined 63 percent, from 349 to 130 per 100,000 women.

As mentioned, although the overall hysterectomy rate declined, rates increased by 45 percent among women between 75 and 84 years old, Bharucha said in correspondence with Reuters Health. “Thus, the age at which women have a hysterectomy has increased over time.”

Fibroid tumors accounted for 28 percent of hysterectomies, precancerous conditions accounted for 23 percent and pelvic floor disorders accounted for 12 percent.

What is the reason for the overall decline in hysterectomies? “Though our study did not examine this subject, we suspect that hysterectomy...rates declined for a variety of reasons,” Bharucha said. “Perhaps the most important is that precancerous lesions are identified at an earlier stage, when they can be treated by newer therapeutic approaches that do not entail a hysterectomy.”

In addition, Bharucha and colleagues note in their paper, “the introduction of newer therapies to treat common benign conditions (fibroids, heavy menstrual bleeding, endometriosis) have provided women with less invasive options to treat those conditions, which may allow them to either forego or postpone hysterectomy.”

SOURCE: American Journal of Obstetrics & Gynecology.

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