Why Are Hysterectomy Rates Declining?

Abstract

To explore reasons for a 16% decline in hysterectomy rates in Ontario from 1982 to 1990, hysterectomy rates were examined by indications for the procedure, across different age groups, by type of hospital (community vs teaching), and by use of bilateral salpingo-oophorectomy (BSO) with hysterectomy. Menstrual hemorrhage, fibroids, genital prolapse, endometriosis, and cancer were the main indications for hysterectomy. Over time, hysterectomy for fibroids and genital prolapse rates decreased slightly for women <45 years but increased for older women. For cancer, a slight decline in rates was demonstrated for women <45, but rates were stable for older women. For endometriosis, there was no change in rates for any age group. However, for menstrual hemorrhage, large declines were seen for women <54 years especially women aged 35–44 (24% decline). The proportion of women undergoing BSO with hysterectomy increased from 29% in 1982 to 34% in 1990, with women <35 experiencing a significant increase in the rate of this combination procedure. Teaching hospitals showed a greater decline in hysterectomy for noncancerous conditions, whereas community hospitals performed fewer hysterectomies for cancer with time. Most of the fall in hysterectomy rates in Ontario in the 1980s is accounted for by women under 45 years of age undergoing fewer procedures, especially for menstrual hemorrhage. The declines for these groups were substantial and offset a general increase in hysterectomy rates for women over 55. These changes may result from various factors, including wider treatment options (alternative medical treatments or more conservative surgery), more awareness among women and providers of options including nonsurgical alternatives, and delayed childbearing influencing the need to conserve reproductive capacity.