Doctors find one hysterectomy in three 'not needed'

Up to one woman in three who has her womb removed may be submitting herself to the operation unnecessarily, doctors suggest today.

There are an estimated 100,000 hysterectomies each year in Britain, making it one of the most common serious operations. Almost 10 per cent of patients suffer complications afterwards and the surgery requires up to three months' convalescence.

A study of 37,000 hysterectomies in 350 hospitals in England, Wales and Northern Ireland – the largest conducted in the world – found that almost half were on women who had complained of heavy menstrual periods.

The authors of the study, published in the International Journal of Obstetrics and Gynaecology, say that up to three-quarters of these – equivalent to one-third of the total number of hysterectomies – could have been avoided if the women and their doctors had opted for a simpler surgical procedure.

The procedure, known as endometrial ablation, involves stripping the lining of the uterus with a laser or with microwave radiation, leaving the womb intact. It requires no incision and can be done in a day. The technique stops the bleeding in most women without the need to remove the womb.

The research was done between 1994 and 1995 but analysis of the results was delayed by lack of funding. The consultant gynaecologist who led the study, Dr Mike Maresh, of St Mary's hospital, Manchester, said little had changed in the seven years since.

"Hysterectomies performed for heavy periods have gone down slightly but not dramatically. Replacing them with the simpler procedure is not an easy solution. You have got to change attitudes, not only among medical staff but among the women themselves."

He said he had had patients who were so fed up with heavy periods that they opted for hysterectomy, even though it was a bigger operation and carried more risks, because it was guaranteed to cure the problem.

"These other techniques [endometrial ablation] are only about 75 per cent effective. They are much more convenient and safer but they won't work for everyone. Some women say if you can't guarantee they will work, they want a hysterectomy."

Hysterectomies are most common among women from lower social classes and a cultural shift would be needed to change doctors' and patients' preferences. Dr Maresh said: "Some gynaecologists are happy to go ahead with a hysterectomy as long as the woman is happy but others will spend longer trying to persuade them to have another technique."

A spokeswoman for the Royal College of Obstetricians said: "The availability of newer, less invasive techniques for the treatment of heavy periods needs further consideration and both the Department of Health and Nice [National Institute for Clinical Excellence] should consider the need for national guidelines for women and doctors."

A second study published in the journal found that use of an IUD (intra-uterine device) usually prescribed as a contraceptive was effective in curing heavy periods. Fifty women awaiting hysterectomies for the condition were given the IUD called Mirena, which uses the hormone levonorgestrel. After five years, two-thirds of them had avoided surgery.