Hysterectomy is the most common major surgery performed in North America today. In both Canada and the U.S. you have a 30 to 50 percent chance of having your uterus surgically removed by the time you are 65 years old. In contrast, if you live in Sweden or any of six other European countries, your chance of having a hysterectomy is only ten percent by that age.
The modern hysterectomy (or surgical removal of the uterus) was developed in the late 1800's. Initially, it was very risky and was reserved for life threatening situations. Over the last 50 years, the hysterectomy has become a much safer operation. In fact, from only 15 hysterectomies performed in the United States 67 years ago, there has been a million fold increase to over half a million hysterectomies every year. The annual cost in the U.S. is about three billion dollars annually. In Canada, about 60,000 hysterectomies are performed annually.
The number of hysterectomies in both countries has not increased over the last ten years. What has changed is that women are much more aware of the serious consequences of hysterectomies and the fact that any where between 30 and 50 percent of hysterectomies are clearly unnecessary.
Only about ten percent of hysterectomies are done for life threatening emergencies. The remainder are done electively, that means by choice through prior arrangement between a woman and her doctor. That means a woman has plenty of time to get a second opinion on whether the surgery is really necessary.
An estimated 63 percent of hysterectomies are done on women under age 45. The vast majority of hysterectomies are done on women between the ages of 20 and 49. Unfortunately, it is estimated that half the women over 40 who are having hysterectomies are also convinced to have both ovaries removed at the same time, although there is rarely a medical reason to do so. This is creating a whole new generation of women who are going into surgical menopause, with its increased risk of heart disease and bone loss. Removal of both ovaries may necessitate taking hormone replacement therapy for the rest of your life.
In fact, the percentage of hysterectomies where both ovaries are removed has increased from 25 to 41 percent between 1965 and 1984, especially in older women between age 35 to 64. Removal of both ovaries may necessitate taking hormones for the rest of your life.
Hysterectomy Rates Vary Across The Country
Hysterectomy rates very much depend on where you live, your socio-economic status and type of medical coverage. Hysterectomy rates in Atlantic Canada are much higher than in the rest of Canada. In fact, as Zelda Abramson says in her well researched article on hysterectomy. "If you live in Newfoundland, you have a 61 percent greater chance of having a hysterectomy than a woman living in Saskatchewan (Healthsharing, summer/90)."
In the U.S., women in the south and central parts of the country have two to three times the hysterectomy rate as women in the northeast and west coast. One study showed that the more education a woman had, the lower her chance of having a hysterectomy.
Also, in the U.S. women with health insurance had twice as many hysterectomies as those who do not have insurance. There are higher hysterectomy rates in countries where doctors are paid per operation than in those where they are paid by salary.
An interesting Swiss study showed that female gynecologists performed 50 percent fewer hysterectomies than male gynecologists.
When a study of unnecessary surgery was announced in Saskatchewan in 1971, the hysterectomy rate in the period following the announcement dropped sharply. The study showed that the number of unnecessary hysterectomies ranged from 17 to 59 percent in five different hospitals.
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