Hysterectomies are of the most frequently performed operations in the developed world. But some experts say that removing healthy uteri and ovaries could have other health risks. But in certain cases, the experts agree, it could be a real lifesaver.

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But do doctors recommend hysterectomies too often?

"Between forty and fifty percent of hysterectomies that are performed in South Africa are probably unnecessary," according to Dr Alan Alperstein, leading Cape Town gynaecologist. "But is it appropriate at this time in medical science to be removing uteri for benign disease when there are alternatives to the management of these conditions?"

In a partial hysterectomy, only the uterus is removed, while the ovaries are left intact. In a total hysterectomy, both the uterus and the ovaries are removed.

So, what are the advantages and disadvantages of having a hysterectomy done?

The pros of a hysterectomy

• It eases abnormal bleeding, the main reason why many women have hysterectomies. Abnormal bleeding can be painful, draining and uncomfortable. But these days there are other treatments available for this condition, such as uterine balloon therapy. But this might not work in all cases.
• It prevents the possibility of future uterine cancer. Many women who have had cancerous growths, or who have a family history of them, choose to have hysterectomies in order to prevent future problems. A hysterectomy can literally be a lifesaver for some of these women, according to Dr Alperstein.
• It is used to treat uterine prolapse, which is a condition in which the uterus descends into or beyond the vagina.
• It solves the problem of uterine fibroids or growths. These can cause great discomfort, as when a woman suffers from endometriosis, and a hysterectomy can bring great relief. However, nowdays there are many alternative treatments, such as hormonal treatments and balloon uterine therapy that can be used to treat these conditions.

The cons of a hysterectomy

• A hysterectomy is a major surgical procedure that involves significant recovery time, discomfort, and, like all surgery, a small risk of death.
• Studies have shown that the removal of the ovaries can bring about health problems of their own. The ovaries carry on producing hormones, such as oestrogen, ovarian testosterone and androstenedione years after the menopause. Preserving the ovaries appears to reduce women's risk for heart disease and hip fracture, according to a study that appeared in the journal Obstetrics and Gynecology.
• The emotional impact of having a uterus removed is often huge, according to Dr Alperstein. If hormone therapy or other treatment can be used to prevent radical surgery, it would prevent emotional problems that some women experience after having a hysterectomy.
• A complete hysterectomy may necessitate the taking of hormone replacement therapy (HRT). While several studies have found HRT in the short term to be beneficial, long-term use of HRT may bring about health problems of its own.

(Susan Erasmus, Health24, October 2005)

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