THE NUMBER of hysterectomies carried out on Irish women has dropped by almost one- third in a seven-year period, new research has found.
Dr Richard Horgan of the department of obstetrics and gynaecology at University College Cork and Dr Gerard Burke, consultant gynaecologist at the Mid Western Regional Hospital, Limerick, examined Hospital In Patient Enquiry (HIPE) data to calculate the number of women having surgery to remove their womb for diseases other than cancer.
They found a marked reduction of 36 per cent in the number having their wombs removed by means of abdominal surgery in 1999-2006.
Hysterectomy, defined as the surgical removal of the uterus, was traditionally the definitive treatment for heavy menstrual bleeding. The condition affects up to 30 per cent of women in the later stages of menstrual life. However, hysterectomy is a major operation involving a prolonged recovery time. It also carries a significant risk of complications.
More recently, less invasive methods of womb removal such as vaginal hysterectomy carried out using a laparoscope have been developed. And a range of effective pharmaceutical treatments for excessive menstrual bleeding are now available.
The authors found the total number of hysterectomies performed in the Republic dropped from 3,088 in 1999 to 2,251 in 2006, a reduction of 27 per cent.
“This change in medical practice is probably attributable to concerns about morbidity, the availability of reliable alternatives and the emergence of minimal access and short-stay procedures minimise personal disruption for patients and reduce costs,” they say in the current issue of the Irish Medical Journal (IMJ). They note that declining hysterectomy rates cannot be explained by population change, as the female population has increased according to the 2006 census.
Previous research has found a large increase in the use of progestogen-loaded intrauterine devices in Ireland to treat heavy menstrual bleeding. This treatment has been shown to be more cost-effective than hysterectomy. There has also been an increased use of minimally invasive techniques to remove the lining of the womb (endometrial ablation).
“The decline in hysterectomy rates observed in Ireland over the past decade is clearly advantageous to women. It is another example of rapid but evidence-based uptake of new technologies that are having a profound effect on improving clinical outcome, on medical training and on the cost of medical care, and patients can be reassured that there are safe effective alternatives to hysterectomy,” the authors conclude.
Meanwhile, a separate paper in the IMJ has found the average age at which girls start menstruating has dropped from 13.5 years to 12.5 years in 1986-2006.
Using data from the Irish health behaviours in school- aged children survey, researchers from the Department of Health Promotion at the National University of Ireland Galway also found that girls living in cities have the earliest menarche (age of first period). There was no significant difference between Irish-born and immigrant girls.
“Ongoing observation of this biological milestone is warranted to identify whether this secular trend will stabilise in Ireland and at what age. Consequences of earlier biological maturation on adolescent health behaviours and outcomes should also be monitored,” the authors said.