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]