Onehysterectomy every minute (costing over $5 billion): In United States, approximately 6,00,000 hysterectomies are performed each year [1] .
Hysterectomy is second only to caesarean section operation among women of reproductive age.
25-30% of American women have undergone hysterectomy by the age of 60 years.

In United Kingdom, women have a one in five chances of having a hysterectomy by the age of 55 years. [2]

source:
PROF. S N Mukherjee

Fifty-five per cent of hysterectomies were performed in women between the ages of 35 and 49 years old. The average age at hysterectomy is 44.5 years. [3]

WHY ARE HYSTERECTOMIES DONE?

Uterine fibroids and
Dysfunctional Uterine Bleeding (DUB) are the two most common benign conditions for which total abdominal hysterectomy is performed by gynecologists.

Most hysterectomies are performed for non-cancerous conditions. In many of these, no disease in present and the term DUB is used to describe these cases. The indications of hysterectomy for benign gynaecological causes are numerous – common are uterine fibroids, DUB, uterine prolapse, endometrosis and pelvic pain. McPherson et al6 noted that the most common indication for surgery was DUB (46%), followed by fibroids (19%) and prolapse (19%), while other indications were endometriosis and adenomyosis (5%) and pelvic mass (3%).
Leiomyomas, DUB and chronic pelvic pain were responsible for 60% hysterectomies in reproductive aged women4. One report7 estimates that nearly 16% of Indian women between the ages 20 and 50 years have fibroids and they are mostly treated with hysterectomy.

WHAT ARE THE TYPES OF HYSTERECTOMIES?
Three main types of hysterectomy are now performed

abdominal,
vaginal and
laparoscopic.

IS HYSTERECTOMY ALWAYS SAFE AND NECESSARY?

Hysterectomy is associated with a long-term risk of death? Hysterectomy rarely leads to death during or just after surgery. The incidence of severe morbidity complicating hysterectomy is stated to be low.
Long-term outcomes of hysterectomy are important to patients

quality of life,
sexual function,
pelvic pain,
bowel and
urinary function and
vaginal prolapse.

In UK,

67% hysterectomies are performed by abdominal route,
30% by vaginal route and
3% laproscopically.

Hysterectomy is a well established and relatively safe operation with an overall visceral damage rate being 0.5-2% and an overall mortality rate of 0.5 to 2 per 1000. Hysterectomy rarely leads to peri-operative death.

In a national large hysterectomy study in UK, Maresh et al9 observed that operative complication rate was 3.5% and postoperative complication rate was 9%. There was no operative death, but 14 deaths were reported within six-week postoperative period – a crude mortality rate soon after surgery of 0.38 per thousand.

Hysterectomy for

fibroids had highest risk of complications, operative 4.4% and postoperative 1.2%,
DUB carried risk of 3.6% and 1%,
prolapse of 2.7% and 1.1%,
endometrosis / adenomyosis of 3.1% and 0.8%, and
pelvic mass of 3.7% and 0.8%.

[1] Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, et al — Hysterectomy serveillance-United States: 1980-1995. MMWR CDC Surveill Summ 1997; 46: 1-15.
[2] Vessey MP, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D — The epidemiolog of hysterectomy : findings in a large cohort study. Br J Obstet Gynaecol 1992; 99: 402-7.
[3] Jain A, Santoro N — Endocrine mechanisms and management for abnormal bleeding due to perimenopausal changes. Clin Obstet Gynecol 2005; 48: 295-311.

Source

STUDY AUTHOR
S N Mukherjee
DGO, MD, FACS, FAMS, FICOG, FICMCH, Senior Consultant Obstetrician and Gynaecologist, New Delhi 110092 and Ex-Professor and Head of the Department of Obstetrics and Gynaecology, JIPMER, Pondicherry 605006, Indira Gandhi Medical College, Simla 171001, UCMS and Safdarjung Hospiral, New Delhi 110095, Maulana Azad Medical College and LNJPN Hospital, New Delhi 110002

See
http://jimaonline.org.in/Apr%202008/April2008_5.htm

Dr. Ashok Koparday
_{MBBS, FC SEPI}
Medical Director
Samadhan India
Center for Therapy, Education, Research in
Sex, Marriage, Relationships

Ex. Teaching Faculty
Seth G. S. Medical College and K. E. M. Hospital and
Grant Medical College and Sir J. J. Group of Hospitals
University of Mumbai, India

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