Wednesday, September 21, 2011

Doctors' Group Ignores Hysterectomy as a Cause of Incontinence; Urinary Problems Cost U.S. Women $13 Billion/Year

They call themselves Urogynecologists, women's doctors who do not deal with pregnancies or infertility or  hysterectomies, only what they refer to as "pelvic floor disorders" including urinary incontinence. So you'd like to think they'd be upfront about the fact that hysterectomy is one of the major reasons why 40% of all U.S. women find themselves leaking urine by the time they hit the age of 60. (Interesting coincidence: that's the same percentage of women who undergo a hysterectomy by the time they are 60.)

In fact,  a very large and long study of Swedish women found that a woman's chance of incontinence at least doubled after a hysterectomy.

This group of doctors has even put a price tag on what it costs women to deal with incontinence: an average of $15 a week for pads, laundry and dry cleaning. If you multiply that by the 17 million women--a low estimate--who have this embarrassing problem, and then by 52 weeks, you find out that incontinence is costing American women at least $13 billion a year. This calculation does not include the cost of the various prescription medications now being promoted by drug companies to relieve incontinence.

Yet, you can search the website of the American Urogynecologic Society (AUG) or their new information website, Voices for PFD, and you won't find a mention of hysterectomy. The closest you get is this statement with its vague reference to surgery: "Sometimes, very clear-cut events such as pregnancy, vaginal delivery, surgery, radiation or accidental injury can lead to these kinds of problems..." Notice that all of these causes of incontinence are essentially unavoidable--except surgery for hysterectomy, which is avoidable with other treatments in 70 to 90% of cases.

But wait, these doctors have a solution to incontinence, once you've got it:  More surgery! Last year, the AUG released results of a study showing that two years after women had surgery to try to cure stress urinary incontinence, their cost per week had dropped to $4 from $15 while their episodes of incontinence dropped from 23 per week to 3. Hooray.

The final irony is that just a few days ago, the AUG released its own study of information about incontinence on various web sites and found them "inadequate." Two physician reviewers evaluated more than 50 websites and found them "not comprehensive, relevant or accurate."

I tried to reach Dr. Steven Minaglia, a Hawaii-based physician whose team reviewed the websites, but he had left for a trip to China. Perhaps when he gets back he can ask them to review why AUG's own website doesn't bother to tell women about the connection between hysterectomy and incontinence.

Perhaps he could start by having them review the Swedish study.

Tuesday, September 13, 2011

Hysterectomy is a Feminist Issue: 1 in 3

The Ms. Magazine Blog now features an article I wrote that gives some of the shocking information about the epidemic of hysterectomy. I have been amazed for a long time that this most feminist of issues is not on the radar of feminist organizations despite the huge impact of these surgeries on women's health, well-being and relationships.  I've struggled to understand why. Partly, I think, it's because the surgery is simply so common. Breast cancer advocates have made women very aware that their life-time risk is 1 in 8. But consider: 1 in 3 women 60 and older no longer has a uterus!

That's right, 1 in 3. It's just about a right of passage for older women.

But as I say in the Ms. blog, we who are the 1 in 3 have got to speak up. We can't let this continue. Keeping our condition a secret because we're embarrassed, afraid of being regarded as less of a woman, or as being too unaware to prevent our doctors from doing this to us--well, we've just got to get over that the same way women who've lost a breast have done so bravely.

Tuesday, September 6, 2011

Summarizing the Risks of Hysterectomy

When a women has surgery to remove her uterus, and way too often her healthy ovaries at the same time, she increases her risk of dying prematurely, diminishing her sex life, and suffering from a host of other health problems.

Here's a quick summary of the Risk Increase shown by some of the research, with sources:

Hysterectomy Alone
  • Incontinence: 60% greater risk by age 60 than an intact woman ("Vital Signs: Consequences; Hysterectomy and Risk of Incontinence." The New York Times, Aug. 22, 2000. By Eric Nagourney
  • Coronary Heart Disease: 3 times grater risk if hysterectomy done before menopause (American Journal of Obstetrics & Gynecology, Jan. 1981; 139 (1):58-61)
Oophorectomy (removal of ovaries)
  • Early Death: twice the risk if ovaries removed before age 45 and no estrogen replacement given ("Survival patterns after oophorectomy in premenopausal women: a population-based cohort study." Lancet Oncology Volume 7, Issue 10, 2006, pp.821-828; by W.A. Rocca, MD, and others.)
  • Dementia: 33% higher over all than women who keep their ovaries through menopause; 74% higher if her ovaries are removed on or before age 43 ("Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause." Neurology 2007; 69:1074-1083; by W.A. Rocca, MD, and others)
  • Heart Attack: double the risk if a woman loses her ovaries between the ages of 40 and 44; 40% higher if ovaries removed after age 50 ("Ovarian Conservation at the Time of Hysterectomy for Benign Disease." Obstetrics & Gynecology, Vol. 106, No.2, Aug. 2005
  • Bone fractures from osteoporosis: 54% more fractures when ovaries removed after menopause (same study, Ovarian Conservation, etc., cited above)
This is not a list you will find in any of the literature given out by gynecologists. Nor, when they try to talk women into letting them take out their ovaries while doing the hysterectomy, will they reveal that the average woman's risk of ovarian cancer is 1 in 72 (or 1.39% over her lifetime). By comparison, the lifetime risk of breast cancer is 1 in 8 (or 12.15% over her lifetime).

Of course, some women have genetic and family risk factors for ovarian cancer that make their decision much more difficult. I feel for them. But for other women, a gynecologist who uses the fear of ovarian cancer to convince her to consent to ovary removal is nothing less than unethical. Such a doctor should do women the favor of finding some other line of work.