Hysterectomy: will it pay the bills in 2007?

Treatment of choice for cancer, but a choice of treatment for menorrhagia

To study the indications for hysterectomy is to study the interface between medicine and society. In California barely half of all women will carry their uterus to the grave,1 whereas a gynaecologist in Saudi Arabia may do no more than one hysterectomy a year and, as often as not, this will be a lifesaving operation for catastrophic obstetric haemorrhage. In Britain hysterectomy rates are somewhere between these two extremes. To understand the variations, do not gaze endlessly at histological specimens but examine the societies from which they originate.

Perceived abnormal bleeding accounts for 70% of hysterectomies in pre-menopausal British women, and in most cases of “menorrhagia,” menstrual blood loss is within the “normal” range.2 Much of the variation in hysterectomy rates is therefore attributable to the psychosocial factors that influence demand.3

Provider factors are also important. Women general practitioners are less likely than their male counterparts to refer women with menstrual symptoms for a specialist opinion;4 and hysterectomy, like cholecystectomy and tonsillectomy, varies considerably in frequency from surgeon to surgeon.5 This is not to say that …