A hysterectomy is the surgical removal of the uterus. This can range from a small part of the uterus up through the entire thing, along with the ovaries and fallopian tubes. Perhaps unsurprisingly, this is a major decision and is generally used only wen less-drastic treatments have bee tried without success. A patient who has had a hysterectomy will be unable to bear children and as a result the operation is not generally performed unless that is not an issue. Nonetheless, one in three American women will have ha a hysterectomy by age 60.

The operation can be performed either vaginally or, more commonly, through a small incision in the abdomen similar to that made for a caesarian section. An abdominal hysterectomy is ordinarily performed when the uterus is enlarged or inflamed, or when the entire uterus needs to be removed together with the ovaries and fallopian tubes. The abdominal incision offers better access in these cases. Vaginal hysterectomy is fewer complications and a shorter recovery time, but doesn’t afford surgeons the same opportunity to see the condition of the organs, and can only be used if they know exactly what needs to be done.

There are a number of reasons a hysterectomy might be performed. When cervical, uterine, endometrial, or ovarian cancer is localized, removing the affected organ could be a complete treatment. Heavy menstrual flow, such as that caused by fibroids, can lead to anemia as well as severe pain, and hysterectomy may be performed in such cases as a last resort. It is also used for endometriosis or for uterine prolapse. Sometimes a pregnancy so damages the uterus—typically, a case of the placenta growing in an unusual place—that it needs to be removed.

However, a recent study suggests that too many hysterectomies are being done, and as many a one in five are not necessary at all. According to the researchers, for conditions for which hysterectomy is recommended as a last resort, it was actually the only treatment offered to almost 40 percent of patients. Less than a third of the women whose cases were looked at got medical treatment for their conditions before the operation even though in many cases it would likely have been sufficient.

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