Hysterectomy is one of the most common surgeries performed in the United States, second only to cesarean section. Approximately 600,000 hysterectomies are performed annually in the United States.
Managing fibroids: one of the greatest challenges of gynecology
Fibroids are present in 70% of women over their lifetimes and are symptomatic enough to treat in 35% of women. Uterine fibroids are the leading cause of hysterectomy in the United States.
Most women with fibroids develop symptoms in the mid-forties. The most common symptoms are pelvic pressure and heavy, prolonged periods.
Conservative treatments for fibroids that cost under $5,000 are highly effective and include:
Lupron to shrink fibroids (cost $700 per dose X 3 monthly doses = @$2100)—reduces fibroid size by 50-70% over 3 months; fibroids can regrow after treatment.
Progesterone-releasing IUD manage bleeding (e.g. levonorgestrel IUD, trade name “Mirena”, costs about $700—lasts 5 years)
Endometrial ablation to reduce or eliminate bleeding from any benign cause (Cost @$3000); more permanent than some of the pharmaceutical options.
Mifepristone (a great option but not available in the U.S. for treatment of fibroids)
Aromatase inhibitors (breast cancer drugs e.g. anastrazole, trade name Arimidex—used “off-label” approved to treat fibroids) (Cost @$400-$700 for a 90-day course).
Hysteroscopic myomectomy (for certain fibroids < 3 cm that are located just below the endometrium, or surface lining of the uterus)
Conservative Treatments for Fibroids that Cost Over $5,000
Abdominal or Laparoscopic Myomectomy (surgery to remove fibroids but preserve fertility) Uterine Artery Embolization
High Frequency MR (magnetic resonance) directed ultrasound (works for certain types of large fibroids—>5 cm)
Hysterectomy: Why not
While hysterectomy is effective in relieving pain and pressure, up to ten percent of women have major complications from the surgery such as infection, hemorrhage, and inadvertent injury to the urinary tract.
Hysterectomy is the most expensive treatment: Total cost for the surgery can be $30,000 to $40,000 including hospital charges, surgeon’s fee, anesthesia fees, supplies, and operating room time.
Hysterectomy is not reversible: If you have hormonal problems or sexual dysfunction or urinary incontinence after hysterectomy, you can’t put it all back to fix the problem.
Hysterectomy is resource intensive—it is not sustainable healthcare. A hyst requires more personnel, supplies (most of which are used once and discarded, e.g. surgical drapes), energy, and other resources, than conservative treatments for fibroids and bleeding.
Conservative Treatments Have Substantially Reduced the Need for Hysterectomy
Reducing the need for hysterectomy is one way to provide sustainable health care.
Less invasive treatments for fibroids is one substantial way to reduce the need for hysterectomy. For example, in California, hysterectomy rates have declined 17% since 2001. As management of fibroids advances, hysterectomy is likely to become a "last ditch" resort to use if symptoms persist after less drastic treatments.
- Do you have fibroids? If so, do they bother you and how?
- If you have fibroids how have you treated them?
- What has been your satisfaction level with your treatment for fibroids?