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Hysterectomy, endometrial ablation, and levonorgestrel releasing intrauterine system (Mirena) for treatment of heavy menstrual bleeding: cost effectiveness analysis

BMJ 2011; 342 doi: (Published 26 April 2011) Cite this as: BMJ 2011;342:d2202

Hysterectomies save even more NHS money!

Dear Editor,

There are additional advantages for women who have a total
hysterectomy, especially if it is accompanied by a bilateral salpingo-
oophorectomy, that this study does not mention.

Furthermore, additional long term savings for the NHS and society are
accomplished if women have a total hysterectomy, especially if it is
accompanied by a bilateral salpingo-oophorectomy, that this study does not

For women, lifetime risks for cervical cancers, endometrial cancers,
sarcomas, salpingeal cancers, ovarian cancers, adenomyosis, endometriosis,
pelvic inflammatory disease, benign ovarian cysts, are nullified!

Their quality of life is improved, also because these women will not
have to undergo detailed screening procedures every year, for the rest of
their lives, to detect all these pathologies at an early stage.

New reviews claim that hysterectomy also increases sexual
satisfaction, a finding that has not been described, to this extent, in
women using medicated IUDs. [1]

As regards the NHS, a lot of money is going to be saved, that
otherwise would have funded thousands of Pap tests, HPV DNA tests,
colposcopies, ultrasound examinations, hysteroscopies, laparoscopies,
MRIs, CA 125 measurements, etc

Further studies in the future should find a way to precisely quantify
and include these long term savings in the analysis of the cost
effectiveness of hysterectomy.

[1] Hysterectomy and sexual wellbeing: prospective observational
study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total
abdominal hysterectomy.
Jan-Paul W R Roovers, Johanna G van der Bom, C Huub van der Vaart, A Peter
M Heintz
BMJ 2003;327:774 doi:10.1136/bmj.327.7418.774

Competing interests: No competing interests

23 May 2011
Stavros Saripanidis
Consultant in Obstetrics and Gyneacology in Greece
Private Sector, 55131