A Question of Hysterectomy

Hysterectomy is one of the most common surgical procedures performed on women in Canada, but according to a recent report of the Ontario Women’s Health Council, this may not always be a good thing.

The Council’s report, Achieving Best Practices in the Use of Hysterectomy, concludes that women living in Ontario and elsewhere in Canada are having hysterectomies too frequently as a first line of treatment for benign uterine conditions. Less invasive procedures exist to treat these non-life-threatening conditions, which include abnormal uterine bleeding, fibroids, endometriosis, and pelvic pain; however, hysterectomy remains the most common procedure utilized for the management of these conditions. Twenty-two per cent of Canadian women age 35 and older (1.8 million women) have had one. The majority of Canada’s hysterectomies are performed for discretionary reasons, to improve a woman’s quality of life rather than to save her life. Canada’s hysterectomy rates are double those of Britain, Sweden, the Netherlands and Norway.

In its report, the Council found that the rates of hysterectomy performed for discretionary reasons vary dramatically across the province. Dr. Donna Stewart, Chair of the Expert Panel that produced the report and a member of the Ontario Women’s Health Council explains, “Hysterectomy rates are more than twice as high in northern and rural Ontario as in southern Ontario metropolitan centers which have teaching hospitals. In part, this is because doctors in non-urban centers have less opportunity to learn the new, less invasive methods or access the required equipment. In addition, the physician shortage in rural and Northern Ontario means that women have to travel long distances to obtain medical care and endure long waits for follow up appointments. In such circumstances, women may consider hysterectomy the only acceptable option. This leads to questions about whether all Ontario hysterectomies are appropriate.”

The newer, less invasive methods to treat uterine problems include medical treatments, ablation therapies, myomectomy and embolization.

The Council’s report notes that it is desirable in most cases of hysterectomy performed for discretionary reasons to remove only the uterus and leave the healthy ovaries intact. However, 72 per cent of hysterectomies in Ontario are total – removal of uterus and cervix – with or without removal of the ovaries. Hysterectomy can be performed via the abdomen or vagina; vaginal hysterectomies are usually preferred because they are associated with a lower risk of complications following surgery, and a faster recovery time. However, in Ontario, vaginal hysterectomies performed for discretionary reasons are half as common as abdominal hysterectomies.

The Ontario Women’s Health Council report on hysterectomy best practices recommends improved patient education about hysterectomy, enhanced training of health providers, better medical and surgical management of benign uterine conditions and research into additional new and better ways to treat these health problems.

Dr. Donna Stewart explains, “Women need to be better informed about their health problems so that they can ask questions about procedures and treatment options. Whatever the health problem, women should ask questions, read widely about their condition, search reliable internet sites, and discuss possible options with their health providers. Women that we spoke to in the course of our research for this report told us quite clearly that they wanted more information and to be involved in the decision-making process about their own health.”

Dr. Nicholas A. Leyland, Head of Gynaecology at Mount Sinai Hospital, Toronto, and one of the report’s authors, concludes, “Hysterectomy is a necessary procedure for many women and in certain cases a patient may be advised that it is the recommended course of action. However, a patient should learn about all the potential options for treating a particular condition and together with her doctor determine if another solution may exist.”

The Ontario Women’s Health Council was established in 1998 by the Minister of Health and Long-Term Care to act as a catalyst for change in improving women’s health and health care in all stages of life. The Council’s 12 members were appointed by the Minister and comprise a variety of sectors. The Council has produced a number of groundbreaking reports on women’s health, addressing such topics as the use of caesarian sections, adjusting to chronic medical conditions, osteoporosis, health risk behaviours, among others. For additional information about the Council’s work or to view a copy of Achieving Best Practices in the Use of Hysterectomy, visit the Council’s web site at www.womenshealthcouncil.on.ca