Prevalence and Characteristics of Women Who Have Had a Hysterectomy in a Community Survey

EDITORIAL COMMENT: This review contains important data and discussion which should interest all readers. Twenty years ago the increasing prevalence of hysterectomy performed for indications which were not an immediate threat to life provoked cost:benefit analyses which failed to either condemn or justify the trend; the mortality and morbidity of hysterectomy (pulmonary thromboembolism, wound infection/dehiscence, bowel obstruction) seemed to about balance the number of lives saved by prevention of cancer of the cervix, uterine body and ovary. The debate concerning the place of prophylactic oophorectomy at the time of abdominal hysterectomy in pre or postmenopausal women is a separate unresolved question. The rising tide of hysterectomy should be remembered when analyzing the recent changes in incidence of carcinoma of the cervix and the number of deaths from this cause, since an absent organ cannot become cancerous! In recent years the cost of hysterectomy argument has been changed by 2 factors; firstly hospital beds have become a ruinous expense to individual and State, and secondly because endometrial ablation, which has rapidly acquired a host of advocates, offers outpatient care and preservation of the uterus in the very group of patients most likely to become candidates for hysterectomy ‐ 35–40 year‐old multiparas with menorrhagia, uterine enlargement and a need for permanent contraception. It is salutary to note that in the space of 2–3 years the indications for endometrial ablation have changed from a procedure recommended only when a woman had severe menorrhagia but was unfit for major surgery, to an alternative to almost all elective hysterectomies except those associated with severe uterine prolapse. The complications of endometrial ablation (immediate and remote) and their documentation and publication is a matter of importance for hospital Boards of Management when accrediting practitioners to perform this most modern endoscopic surgery. The authors present data suggesting that better educated and higher occupational status women are less likely to have a hysterectomy, indicating the need to investigate aspects of the decision making process leading to hysterectomy. The editorial committee agrees that these findings require further research to confirm these trends. We also wish to draw readers' attention to perhaps the most important unresolved aspect of ‘elective’ hysterectomy, namely whether removal of the cervix and/or uterus influences coital satisfaction (orgasm, lubrication) by the woman. Why is it that the better educated, presumably more vocal woman, is more likely to protest at the suggestion that her reproductive parts be partially amputated? The introduction of endometrial ablation provides the opportunity to perform trials of this method of treatment of premenopausal women with menorrhagia with vaginal hysterectomy or abdominal hysterectomy without oophorectomy. We hope to be offered the results of such studies for publication in this journal. Summary: : A community survey of 8,896 households was undertaken in the Hunter region of New South Wales to assess women's health status. Consent was gained from 5,781 of the 6,361 eligible women between 18 and 69 years of age. The prevalance of hysterectomy in this sample was 16.9%, with 34.2% of women in their fifties having had a hysterectomy. Most hysterectomies (75%) were performed on women between the ages of 30 and 49 years. The demographic variables of parent's country of birth, educational level and employment status predicted recent hysterectomies after controlling for the effect of age.