TRENDS IN HYSTERECTOMY
More than 25 000 Australian women had hysterectomies in 1975 and at that rate it was estimated that at least four out of every ten would have this form of surgery by the time they turned sixty-five. Twenty years later, with an ageing population that includes a high proportion of older women, it is estimated that 30 000 hysterectomies are performed in Australia annually.
Current evidence suggests that 20-30% of Australian women will have a hysterectomy during their lifetime, usually between their mid-thirties and mid-fifties. About three-quarters of these are performed before women go through a natural menopause, that is, before their menstrual periods stop of their own accord. The Melbourne Women’s Midlife Health Project is documenting the situation in 2000 randomly selected Melbourne women aged from forty-five to fifty-five. The Project, undertaken by the Key Centre for Women’s Health in Society at the University of Melbourne, has found a 22% rate of hysterectomy among the women, and a peak age for the operation of just over forty years.
Another study, conducted by the Australian Institute of Health and Welfare, suggests that one explanation for an apparent downward trend in hysterectomy rates in Australia is the rapid introduction of the surgical procedures known as endometrial resection and ablation. This study has found that approximately 4000 Medicare benefit payments were made for endometrial resection in 1991-92, and in the same period the rate of hysterectomy (for heavy, uncontrolled bleeding) in public hospitals in Australia declined by one-third. Although the effects of endometrial resection on bleeding patterns are still being evaluated and the technique itself is still undergoing development, it appears to offer a credible alternative to hysterectomy for some women. Equally, it is fairly certain that hysterectomy will never be eliminated completely. For the several thousand women in Australia each year who are diagnosed as having cancer of the cervix or of the endometrium, survival itself may rely on a hysterectomy.
Recently, there has been a surge of interest in new treatment alternatives to hysterectomy, some of which are surgical, while others are psychological, medical and lifestyle-oriented. At the same time as we applaud the effort that is going into developing new or revamped treatment approaches, we believe that significant information gaps remain about their long-term safety and effectiveness. Research needs to continue and women must be informed of the current gaps in medical knowledge when making treatment decisions.
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