The two most common reasons for major surgery in the USA involve a woman's child-bearing organs. Caesarean section (in which the womb is opened to deliver a child) is first; second is hysterectomy, in which the womb is removed. The main reason hysterectomies are done include (a) uterine fibroids (30%); (b) abnormal uterine bleeding (20%); (c) endometriosis (20%); (d) genital prolapse (15%); and (e) chronic pelvic pain (10%). The death rates from elective hysterectomies range from 6 to 11 per 10,000, and postoperative complications occur in 24 to 48% of women, with major complications in about 3%. New procedures, like vaginal hysterectomy assisted by laparoscopy, have fewer complications and involve shorter hospital stays.
Two alternatives to hysterectomy for the cessation of abnormal uterine bleeding are transcervical endometrial resection (TCRE) and endometrial ablation, both of which serve in cutting the womb's lining. TCRE severs the lining with a current-bearing wire loop and endometrial ablation, with a laser beam. As TCRE is a recent discovery (5-6 years), its effects are currently under examination. Because uteri, bowels, bladders and arteries lie close to the womb, their chances of being lacerated is great. Although there exists great speculation as to the process' safety and necessity, some doctors and patients are hesitant to question its reliability because of TCRE's relative inexpensiveness.
One in 3 60 year-old American women has had a hysterectomy. In Italy, 1 in 6 have them, and in France, 1 in 18. In only 10% of cases, is the operation medically necessary.
Following concern over unnecessary gynaecological surgery, there has been a drop in the number of hysterectomies from about 750,000 per year in 1983 to around 590,000 in 1993. However, in Maine only 20% of women who had reached 70 years of age were likely to have had a hysterectomy; in other States the rate was 70%. New techniques have made some hysterectomies unnecessary, but consumer advocates argue that physician greed means that surgery is sometimes recommended before doctors exhaust less costly and less hazardous remedies. Even among members of a pre-paid health maintenance organization, where only doing the least costly procedures net the highest profits, 16% of "elective" hysterectomies were found to be clearly unnecessary and 25% were of uncertain necessity (the study excluded hysterectomies done to treat cancer or uncontrolled haemorrhage). In another study for the American Medical Association, only 58% of the hysterectomies were performed for appropriate reasons and 42% were inappropriate or uncertain.
According to a 1991 survey, 50% of hospitals with gynaecology departments in the UK offered the option of TCRE surgery. Although the survey reports only one death as a result of TCRE surgery from 1990-1991, some gynaecologists believed that 4 deaths were related to TCRE during that time. If these beliefs prove more accurate than the survey results, TCRE may be more risky than a hysterectomy, which carries a 1 in 10,000 chance of death.
Critics claim that too many doctors view hysterectomy as the obvious solution to any gynaecological problem of middle-aged patients, and can be dismissive or patronizing if a woman asks about other treatments.