The role of hysterectomy for menstrual conditions

Recent mainstream news about BBC presenter Naga Munchetty revealing she has adenomyosis has  increased awareness of treatment options for women with debilitating menstrual conditions  – including in severe cases the need for a hysterectomy.

With this in mind, author Tim Simpson asks, where should hysterectomy sit on the patient pathway, and what does the future hold? 

The role of hysterectomy is as complex as it is old. Hysterectomies date back to ancient times, with the procedure allegedly performed by Soranus of Ephesus in 120 AD.[1] Today, hysterectomy remains one of the most frequently performed gynaecological operations, with around 55,000 procedures in the UK every year.[2,3]  

There are different ways to perform hysterectomies, dependent on the condition and the importance of preserving the womb and reproductive system. There are also many reasons hysterectomies are performed, from fibroids and adenomyosis to endometriosis. [4] 

While we know that hysterectomy plays a major role in modern gynaecological surgery, there has been discussion on its potential overuse as well as the introduction of several less invasive alternatives.  

 

Hysterectomy: a major surgery and its impact 

Given hysterectomy is one of the most common gynaecological procedures, it is important to evaluate and consider all risk factors involved – including quality of life.[1]  What we know is that while hysterectomy is a major surgical procedure and does come with risk, it is generally very safe.[5,6] 

However, there are impacts for the patient, with data showing that 41.7% of women experienced one or more readmissions to hospital overall within five years post-procedure. [7] The recovery can also take a while, as patients often face on average a five day post-surgery stay in hospital, and approximately six to eight weeks to fully recover, dependent on the type of hysterectomy.[5] This can have wider economic implications for women, such as needing time off work. 

Another big impact is on fertility, as for some women preserving their fertility is vital so a hysterectomy has a significant effect on their mental wellbeing. [8]  

These considerations, alongside impact on hospital costs including length of stay and capacity, need to be evaluated in any decision involving hysterectomy and if it’s the right choice for a woman. 

 

Where should hysterectomy sit on the treatment pathway for benign conditions?  

With alternative surgical options available, the question many are asking is whether hysterectomy should be a first line surgical solution for benign conditions such as heavy menstrual bleeding and fibroids?  

When healthcare professionals are considering their recommendation, it is best to consult with the wider team and in dialogue with their patients, to ensure their voice and preference is heard. While for some women hysterectomy is their preferred treatment choice, it does come with emotional and personal aspects to consider.  

It’s also important to consider the impact of menstrual conditions on women’s lives. For example, we know that heavy menstrual bleeding, can have a significant impact. Our research has found that over a quarter of women affected said heavy menstrual bleeding has impacted their mental health, with one in three reporting not being able to leave the house. [9] 

For some of these women they may decide a hysterectomy is the best choice. On the other hand, we know that some women may prefer minimally invasive procedures such as endometrial ablation techniques, as they can be offered in an outpatient setting which means women do not need to stay in hospital overnight and the recovery time is quicker. [10] 

It is important for healthcare professionals to remember one size does not fit all and each woman’s experience of living with conditions such as heavy menstrual bleeding, is unique, so all options need to be explored. A final decision must take into account patient preference, what is recommended in local guidelines and also by the healthcare professional.  

 

Women at the centre of decision making regarding their treatment and management  

Today, women’s health is starting to garner more attention. Scientific breakthroughs, new technologies, and policies are providing unique opportunities to improve women’s health and avert significant tolls in terms of burden, societal and economic costs.  

The imperative for women’s health is clear when it comes to hysterectomy procedures and that the case for thorough evaluation of the impact of this operation on quality of life needs to be considered. Moreover, complete patient counselling and presentation of all available options to a patient, including all hysterectomy approaches, is important in preserving the uterus for women and avoiding unnecessary hysterectomies. This is also crucial in ensuring each woman is at the centre of her care and supported to make the right choice for them. 

It’s encouraging to see more discussion about not only hysterectomies, but also how conditions such as heavy menstrual bleeding, endometriosis and adenomyosis can have a huge impact on women’s daily lives. However, we need to see action taken from these discussions on the risk factors, diagnosis and treatments of such conditions, so that we can reduce their impact on women’s lives. 

 

Author, Tim Simpson, General Manager, Hologic UK & Ireland: 

Tim joined Hologic in 2019 as UK Country Business Manager, before becoming Hologic UK and Ireland’s General Manager in February 2022. Prior to joining Hologic he worked at Nikon UK for fourteen years.  

Tim leads Hologic’s business in the UK across Gynae Solutions, Molecular Diagnostics and Breast and Skeletal Health. Having worked in the industry for a number of years, Tim is dedicated to championing women’s health to improve and save lives, through earlier diagnosis and treatment.  

 

References:

1 Sutton, CJG. 1 Hysterectomy: a historical perspective. Baillière’s Clinical Obstetrics and Gynaecology. 1997;11(1):1-22

2 Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia Grau I, Gregersen PK et al. Menstruation: science and society. Am J Obstet Gynecol. 2020; 223(5):624-664.

3 Hysterectomy association [Internet] Hysterectomy information. Available at: https://hysterectomy-association.org.uk/ Last accessed: 31 May 2023

4 NHS [Internet] Why it’s necessary hysterectomy [2022, Oct 11] Available at: https://www.nhs.uk/conditions/hysterectomy/why-its-done/#:~:text=The%20most%20common%20reasons%20for,prolapse%20of%20the%20uterus Last accessed 31 May 2023

5 NHS Hysterectomy. Recovery. Available online at: https://www.nhs.uk/conditions/hysterectomy/ . Last accessed 2 December 2022.

6 Hysterectomy Surgery Risks. Available online at: https://www.hysterectomy.com/hysterectomy-surgery-risks . Last accessed 2 February 2023.

7 Clarke A, Judge A, Herbert A, McPherson K, Bridgman S, Maresh M, Overton C et al.Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study. BMJ Quality & Safety 2005;14:41-47.

8 Leppert PC, Legro, RS, Kjerulff K. Hysterectomy and loss of fertility: Implications for women’s mental health. Journal of Psychosomatic Research. 2007;63(3):269-274

9 Survey of 2,000 Women aged 18-55 plus top up 1,000 UK women who have heavy menstrual bleeding during October 20th – 27th 2022. Hologic data on file. MISC-08708-GBR-EN

10 Ajmi A, Das S. Outpatient endometrial ablation: audit of outcomes and patient satisfaction. J Obstet Gynaecol. 2020;40(8):1145-1147