Hysterectomy for Fibroids Among the Top 4 Surgeries to Avoid

A few weeks ago, I stumbled across an AARP article from 2011 on 4 surgeries to avoid at all costs if possible. Number 3 on the list was a hysterectomy for uterine fibroids. In order, the surgeries to avoid were:
1. Stents for stable angina.
2. Complex spinal fusion for stenosis.
3. Hysterectomy for uterine fibroids.
4. Knee arthroscopy for osteoarthritis.

The article stated that all of these surgeries are overperformed. Among the reasons given were that some of the surgeries are moneymakers for hospitals and physicians, others are expedient, and some offer short-term benefit. The advice given in the article was this: these surgeries have questionable long-term outcomes, and some may even cause harm-avoid them!

Of the approximately 600,000 hysterectomies performed each year, most are unnecessary, according to the article. Although a hysterectomy is critical in the treatment of certain cancers, those account for only about 10% of the hysterectomies performed. Quality-of-life concerns, such as heavy bleeding or pain caused by uterine fibroids, are the reasons cited for most of the procedures. (As intimated here, should quality-of-life issues be considered an illegitimate reason for this surgery?)

The article also mentions that complications are common and cited a University of California, San Francisco study that found that women who undergo a hysterectomy have a 60% increased risk of incontinence by age 60. In addition, a hysterectomy with oophorectomy causes instant menopause, which opens another can of worms in terms of symptoms and quality-of-life issues. According to William Parker, MD, author of A Gynecologist's Second Opinion and lead investigator of a 2009 study on the long-term health consequences of hysterectomy, women who undergo a hysterectomy also have a higher risk of heart disease and lung cancer.

The article suggests that patients talk to their doctors about alternatives to hysterectomy and suggest uterine artery embolization and focused ultrasound, the latter of which shrinks fibroids via ultrasound waves. Sound advice, in my opinion.

"It's kind of amazing that we've had all these alternative procedures for many years and they haven't gained a lot of traction," said Parker.

Clearly there have been advancements in the treatment of uterine fibroids, and some good alternatives to hysterectomy are available. In addition, the downside to hysterectomies are real and should not be downplayed. However, the part of this article that I react to is what's written between the lines: about 90% of hysterectomies performed are not really medically necessary.

My questions are these:
- Is this a fair assessment of hysterectomies for uterine fibroids?
- At what point does a hysterectomy become a “valid” treatment for uterine fibroids?

As always, your comments are welcome.

References:

Cheney K. 4 Surgeries to avoid. July/August 2011. AARP The Magazine. Available here. Accessed November 2, 2013.