A hysterectomy is the surgical removal of the uterus. It is often performed as a life-saving operation, to remove any reproductive cancers or to stop severe hemorrhaging or infections. Controversy, however, surrounds its use in treating certain non-life-threatening problems, such as precancerous conditions, fibroid tumors, or endometriosis, where other treatment alternatives are available. In the early 1980s about 800,000 women in the United States were undergoing hysterectomy each year, but the Centers for Disease Control and Prevention in Atlanta estimated that at least 15% of these operations were not necessary. By the mid-1990s about 550,000 women were operated on annually.
Several hysterectomy techniques exist. A total abdominal hysterectomy removes the uterus and cervix through an incision in the lower abdomen. Sometimes surgery to remove the ovaries and fallopian tubes is done at this time. A vaginal hysterectomy removes the uterus and cervix through an incision inside the vagina. Removal of the ovaries during a hysterectomy is usually not recommended for a woman younger than age 40 unless they are cancerous or infected. The hormones produced by the ovaries in a premenopausal woman protect against heart disease and osteoporosis, and artificial replacement of these hormones cannot fully duplicate their role. Some doctors believe that women over 40 undergoing a hysterectomy should have their ovaries removed as a precaution against ovarian cancer, although recent research indicates this may not be as large a risk as thought.