The professional organization that sets the standards of care followed by gynecologists has just released a new patient education booklet on hysterectomy. While this new version from the American College of Obstetricians and Gynecologists is something of an improvement (I'll get to that later), it leaves out completely the most serious risk facing women who are hysterectomized and/or lose their ovaries: heart attack.
I brought that very subject up with my cardiologist recently (yes, I have heart problems), and this is what he said:
"If they're taking out their ovaries, they're giving these women heart attacks. And you can quote me." Dr. Pavel Romano, Huntington, New York.
The "they," of course, is gynecologists. It's brave of Dr. Romano to put his name on a quote like this, but he's really not going out on a limb on the science. As I blogged about recently, solid research has now established that losing your ovaries greatly increases a woman's risk of heart attack; losing your uterus alone also increases that risk, but not by as much.
So I carefully read ACOG's new patient education booklet, expecting to find mention of this risk. Remember, heart attack is the leading cause of death of American women.
And is that risk mentioned? No, it is not.
I asked the spokesperson for ACOG just who is responsible for the contents of the pamphlet, and she ascribed it to "ACOG Fellows" who base the content on the College's Practice Bulletins and Committee opinions.
I've asked to interview one or more of these Fellows, but in the meantime I've now had the pleasure of reading ACOGs "Guidelines for Women's Health Care," published in 2007. Nowhere in that very long description of how doctors should respond to women's various gynecological problems is any mention of the increased heart attack risk brought about by hysterectomy and oopherectomy.
Absent any other explanation, this seems to be a case of a medical truth that's inconvenient for business. Acknowledging the heart attack risk might force the gynos to confront their tendency to just yank out a woman's organs, and that would leave many of them unable to earn their usual fees. It takes a lot more skill than many gynecologists have, and a lot more time, for apparently no bigger reimbursement from Medicaid, for example, to remove only a woman's fibroids instead of her entire uterus. Fibroids are the most common reason for hysterctomizing a woman, and they are never a good reason for a hysterectomy, much less removal of ovaries. Apparently, learning to do the more difficulty surgery is a problem for many gynecologists, who prefer instead the quicker, more lucrative and simpler job of just cutting out entire organs.
As I said earlier, there is some new information in the pamphlet that is helpful to women deciding whether to consent to a hysterectomy. The pamphlet now admits that the menopausal symptoms caused by ovary removal "may be more intense" (oh, yeah, make that will be horrendous) than if a woman went through menopause naturally. And that there is an increased risk of bone fracture due to osteoporosis.
But most of the pamphlet is still devoted to explaining the different ways surgeons can cut out a woman's organs and the details of how a woman is prepped for surgery.
A woman reading this pamphlet would still come away with only a partial understanding of the functions of her organs and of the consequences of surgery that may very well shorten her life.
It's an outrage that complete information is still absent from this booklet, and no woman agreeing to the surgery based on it is giving truly informed consent.