Our Summary

This study looked at how hysterectomies (surgery to remove a woman’s uterus) have changed in France from 2009 to 2019, using data from the Medical Information Systems Program. Hysterectomies are common, with about 60,000 performed in France in 2019. The report found that laparoscopy (a less invasive surgery using small incisions) is now the most common method, used in 30% of procedures. However, other methods, like laparotomy (making a large cut in the abdomen), vaginal approaches, and combined abdominal-vaginal approaches are still used often. The study also found that more laparoscopic procedures are done in public hospitals than private ones. A little over 40% of hysterectomies were done alongside adnexectomy (removal of the ovaries and fallopian tubes). Interestingly, the number of hysterectomies has decreased since 2008, possibly because new treatments and guidelines have been introduced. This suggests that the number of hysterectomies being done may be related to the availability of other treatment options for the conditions that typically require a hysterectomy.

FAQs

  1. What are the different methods of performing hysterectomies, as per the study conducted in France?
  2. Has the number of hysterectomies performed in France increased or decreased from 2009 to 2019?
  3. Are laparoscopic hysterectomies more commonly done in public or private hospitals in France, according to the study?

Doctor’s Tip

  • A doctor might advise a patient undergoing a hysterectomy to discuss with their healthcare provider the different surgical methods available, such as laparoscopy, to determine the best option for their individual case.
  • They may also recommend discussing the possibility of combining the hysterectomy with adnexectomy (removal of the ovaries and fallopian tubes) if necessary.
  • It’s important for patients to understand that the number of hysterectomies being performed has decreased over time due to advancements in treatment options, so they should feel confident in exploring all available options before proceeding with surgery.

Suitable For

Patients who may be recommended for a hysterectomy include those with:

  • Uterine fibroids that are causing symptoms such as heavy menstrual bleeding, pelvic pain, or pressure
  • Endometriosis that has not responded to other treatments
  • Uterine prolapse, where the uterus has descended into the vaginal canal
  • Gynecologic cancers such as uterine, cervical, or ovarian cancer
  • Abnormal uterine bleeding that has not responded to other treatments
  • Chronic pelvic pain that is not relieved by other means

It is important for patients to discuss the risks and benefits of a hysterectomy with their healthcare provider to determine if it is the best treatment option for their specific condition.

Timeline

Before a hysterectomy, a patient may experience symptoms such as pelvic pain, heavy menstrual bleeding, fibroids, endometriosis, or cancer. They may undergo various tests and consultations with their healthcare provider to determine if a hysterectomy is the best course of action. After the decision is made to proceed with the surgery, the patient will typically undergo pre-operative evaluations and preparations.

During the hysterectomy procedure, the patient will be under general anesthesia and the surgeon will remove the uterus through the chosen method (laparoscopy, laparotomy, vaginal approach, etc.). The duration of the surgery and recovery time can vary depending on the method used and the individual patient.

After the hysterectomy, the patient may experience some pain, discomfort, and fatigue. They will need to follow post-operative instructions provided by their healthcare team, including taking prescribed medications, avoiding heavy lifting, and attending follow-up appointments. Recovery time can vary, but most patients can return to normal activities within 4-6 weeks.

In the long term, many patients report relief from their pre-existing symptoms, such as pelvic pain and heavy bleeding. Some patients may experience changes in hormonal levels or sexual function, depending on whether the ovaries were removed during the hysterectomy. It is important for patients to continue with regular gynecological screenings and follow-up care after a hysterectomy.

What to Ask Your Doctor

  1. What are the different types of hysterectomy procedures available, and which one do you recommend for me?
  2. What are the potential risks and complications associated with a hysterectomy?
  3. How will a hysterectomy affect my hormonal balance and menopausal symptoms?
  4. Will I still be able to have children after a hysterectomy?
  5. What is the recovery process like, and how long can I expect to be out of work or restricted in my activities?
  6. Are there alternative treatments or therapies that I could try before considering a hysterectomy?
  7. How will a hysterectomy affect my sexual function and libido?
  8. Will I need hormone replacement therapy after the procedure?
  9. How often do you perform hysterectomies, and what is your experience with this procedure?
  10. Are there any long-term effects or considerations I should be aware of after having a hysterectomy?

Reference

Authors: Chevrot A, Margueritte F, Fritel X, Serfaty A, Huchon C, Fauconnier A. Journal: Gynecol Obstet Fertil Senol. 2021 Nov;49(11):816-822. doi: 10.1016/j.gofs.2021.07.002. Epub 2021 Jul 7. PMID: 34245923