Some procedures don’t belong on assembly line

The endless parade of medical studies that make their way into the media are enough to make the healthiest head hurt.

Case in point: Last week the Associated Press reported on a Mayo Clinic study that suggests that women who have their ovaries removed before menopause run a heightened risk of developing dementia or other mental problems later in life, unless they take estrogen until age 50.

As with most of these types of studies, “Experts said the research needs to be confirmed by further study.” Of course.

Or, in the interest of women’s health, experts could urge women to never have their ovaries removed unless they are being treated for ovarian cancer.

The article never mentions the great concern about the high rates of hysterectomy in the United States. Each year, more than 600,000 hysterectomies are performed. Ninety percent are performed for benign diseases, such as uterine fibroids or endometriosis. Others are done as precaution against ovarian cancer. American women undergo twice as many hysterectomies per capita as British women and four times as many as Swedish women. While the procedure is technically the removal of the uterus, half of American women have their ovaries removed during hysterectomy.

A landmark UCLA study in 2005 revealed that unless a woman is at very high risk of ovarian cancer, removing her ovaries during hysterectomy actually raised her health risks.

Keeping the ovaries is clearly best for women up to age 65 who are at average risk of getting ovarian cancer and get a hysterectomy for non-cancerous conditions, said study author Dr. William Parker.

In his review of 20 years of published data from various sources, Parker and his team found that preserving the ovaries in this group of women reduces their risk for heart disease and hip fractures.

Despite the evidence against hysterectomy, and the emergence of several (surgical and nonsurgical) alternatives to treat benign conditions, the surgeries continue.

Ernst Bartsich, a gynecological surgeon at Weill-Cornell Medical Center in New York, told CNN, “Our profession is entrenched in terms of doing hysterectomies. I’m not proud of that. It may be an acceptable procedure, but it isn’t necessary in so many cases.” In fact, he estimates that “76 to 85 percent” of the 600,000 hysterectomies performed each year may be unnecessary.

Nothing against the researchers who found that women who have ovaries removed before menopause run a heightened risk of developing dementia, it’s just more evidence against hysterectomy. But in the interest of women’s health, we wish researchers would prominently note that, in the majority of cases, hysterectomies are unnecessary.

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