Too Many Hysterectomies?

Hysterectomies were almost as common as tonsillectomies in the 1930s.

But a total hysterectomy, removing the ovaries as well as the uterus, was a drastic procedure that upset a woman's hormonal balance and was a possible danger to her emotional balance as well.

So, as medical treatments improved, the surgeons began to slow down on hysterectomies. But, says Manhattan's Dr.

Leonard L. Hyams, himself a gynecological surgeon, they have not slowed down enough. The fact is, he recently told the New York Academy of Medicine, that far too many hysterectomies are still being done on women under 40, when all that is really needed in many cases is a much more modest operation to remove benign fibroid tumors from the muscle wall of the womb.

To document his argument, Hyams reviewed 400 consecutive operations on the uterus at Woman's Hospital, part of the St. Luke's Hospital Center. In many of these cases, other surgeons might have performed hysterectomies.

The women had the common complaints of pelvic pain, a variety of menstrual disorders and, in 66 cases, infertility.

In five years, 68 of the women (17% ) have had to return to the hospital and undergo hysterectomy because more fibroids developed. For the remaining 332, the uterus and normal hormonal function have been preserved--an important consideration for women still in their childbearing years. Among the previously infertile women, there have been 13 successful pregnancies, all of which obviously would have been impossible if they had been subjected to hysterectomy.

The gynecological surgeon, Hyams concludes, should be more optimistic about his younger patients and give evidence of his confidence by omitting the traditional foreboding words, "possible hysterectomy," from his operating room schedule.

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