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Pros and Cons of Hysterectomy

Updated: Jun 10


The pros and cons of hysterectomy procedures are discussed by Dr. Michael Lalezarian, a fibroid specialist. He discusses where a hysterectomy fits in with more modern fibroid treatment options.



Hysterectomy is a major surgical procedure most-commonly performed by a gynecologist in a hospital setting. The goal of the procedure is to partially or completely remove the uterus. By removing the uterus surgically, fibroids within the uterus (the source of symptoms) are also removed. A hysterectomy can be total or partial, but regardless of the type of hysterectomy, women who choose to undergo hysterectomy will no longer be able to become pregnant.


In our last article, we discussed the impact of uterine fibroids on fertility, concluding that high rates of hysterectomy are the main contributor to lost childbearing potential in women with uterine fibroids. While significantly less invasive, fertility-sparing alternatives to hysterectomy are now available, there are still cases in which hysterectomy can make a lot of sense. As we strive to better inform women with uterine fibroids and the healthcare professionals that care for them, we wrote this article to discuss the pros and cons of hysterectomy and its place in modern fibroid treatment. Read on to learn more.



The Pros of Hysterectomy


Pro: hysterectomy prevents fibroid recurrence

The most compelling argument in favor of hysterectomy is that, because it involves complete removal of the uterus, it completely eliminates the risk of the fibroids growing back or new fibroids emerging (recurrence). Alternative treatment options – uterine fibroid embolization (UFE) and myomectomy – see a fibroid recurrence rate of about 10% at 2 years following treatment, meaning that around 10% of women that opt for less extreme treatments are likely to require a follow-up procedure to remain fibroid free. Follow-up procedures are equally common to address anomalies that can arise with hysterectomy (around 10% of cases), but not because of recurrence.¹


Pro: hysterectomy may prevent cancer

By definition, uterine fibroids are benign tumors, meaning that they are not cancerous. However, in rare cases, cancerous tumors called leiomyosarcomas are mistaken for benign fibroids. While data on the exact incidence of leiomyosarcomas is lacking, it’s estimated that somewhere between 1 in every 340 (0.3%) and 1 in every 2000 (0.05%) women with suspected uterine fibroids are actually dealing with cancerous masses. Unfortunately, there’s no protocol in place to test whether or not suspected fibroids are actually cancerous to inform when hysterectomy is absolutely necessary.² It bears restating that this incidence is very low but not trivial.



The Cons of Hysterectomy


Con: hysterectomy is a major surgery

Hysterectomy is certainly the most invasive treatment option for uterine fibroids, and the most serious type of surgery that one can undergo for uterine fibroids. The procedure is classified as a ‘major surgery’ and around 3% of recipients experience a major complication.³ Major complications include hemorrhage, bowel injury, bladder injury, pulmonary embolism, adverse reactions to anesthesia, wound dehiscence, and hematoma. And between 10% and 15% of women who undergo hysterectomy require blood transfusions.¹These statistics aren’t meant to be scary, but it’s important to keep in mind that any major surgery carries risk of morbidity.


Con: hysterectomy eliminates the possibility of having children

While it’s generally accepted that fibroids themselves can cause reproductive challenges,⁴⁻⁵ hysterectomies are by far the biggest contributor to lost childbearing potential in women with uterine fibroids.⁶⁻⁷ Many women are diagnosed with uterine fibroids and hysterectomized with several good childbearing years left. We imagine that in a fair amount of these cases, the decision to be hysterectomized may later be a source of regret. Although fertility is not guaranteed with any uterine fibroid treatment, alternative options are not as final as hysterectomy, and examples of successful full-term pregnancies are well-documented for both UFE and myomectomy.⁸


Con: hysterectomy requires extensive recovery time

Because it’s a major surgery, hysterectomy is always performed inpatient, meaning that it requires at least an overnight hospital stay. Depending on the hysterectomy technique used and the protocol of the hospital where it’s performed, women can expect to spend anywhere from 1 to 3 days in the hospital for their procedure. The trauma of a major surgery also necessitates an extensive recovery time that ranges between 2 and 6 weeks.⁹

For the purposes of comparison, UFE is the least invasive treatment option for women with uterine fibroids, and typically requires just 4-6 hours of observation following the procedure and 1 week of recovery time. The higher quality studies comparing hysterectomy and UFE have also demonstrated that women who undergo hysterectomy require more time to resume regular activities and return to work.¹



Making the Hysterectomy Decision


Taking stock of the pros and cons, it’s clear that hysterectomy is not at all ideal for women seeking to preserve their fertility, nor for those who cannot afford to undergo an extensive recovery period. On the other side of it, there are many women suffering from symptomatic uterine fibroids that are passed their childbearing years or are certain that they have no interest in becoming pregnant in the future. The peace of mind that fibroids cannot recur may also justify the extensive recovery period and increased risk of morbidity that comes with hysterectomy.


Unfortunately, there’s no ‘silver bullet’ treatment for uterine fibroids that perfectly addresses all outcomes and ultimately, it’s up to each individual patient to decide what’s best for her. We encourage everyone suffering from uterine fibroids to read up on their treatment options before committing to major surgery.


About the Author


Dr. Michael Lalezarian is a practicing interventional radiologist with the Fibroid Specialists of University Vascular in Los Angeles, CA. In addition to patient care, Dr. Lalezarian teaches and supervises medical students, residents, and fellows as a full time teaching Professor in the Department of Radiology at UCLA. He is regarded as an expert in uterine fibroid embolization. You can view Dr. Lalezarian's full bio here.


This blog post was written with research and editorial assistance from OnChart™.



References


[1] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).

[2] Seagle, B. L. L., Alexander, A. L., Strohl, A. E., & Shahabi, S. (2018). Discussing sarcoma risks during informed consent for nonhysterectomy management of fibroids: an unmet need. American Journal of Obstetrics and Gynecology, 218(1), 103.e1-103.e5.

[3] Garry, R. (2004). The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. Bmj, 328(7432), 129–0.

[4] Duhan, N., & Sirohiwal, D. (2010). Uterine myomas revisited. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 119–125.

[5] Donnez, J., & Dolmans, M. M. (2016). Uterine fibroid management: From the present to the future. Human Reproduction Update, 22(6), 665–686.

[6] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.

[7] Bonafede, M. M., Pohlman, S. K., Miller, J. D., Thiel, E., Troeger, K. A., & Miller, C. E. (2018). Women with Newly Diagnosed Uterine Fibroids: Treatment Patterns and Cost Comparison for Select Treatment Options. Population Health Management, 21(S1), S-13-S-20.

[8] Karlsen, K., Hrobjartsson, A., Korsholm, M., Mogensen, O., Humaidan, P., & Ravn, P. (2018). Fertility after uterine artery embolization of fibroids: a systematic review. Archives of Gynecology and Obstetrics, 297(1), 13–25.

[9] Shiber, L.-D. J., & Pasic, R. (2018). Choosing the Correct Hysterectomy Technique. In I. Alkatout & L. Mettler (Eds.), Hysterectomy: A Comprehensive Surgical Approach (pp. 143–147). Cham: Springer International Publishing.



Medical Disclaimer


The Materials available on the FibroidSpecialists.org blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.

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