Whilst considered safe and low risk, a hysterectomy is still a major operation for a woman and should generally only be recommended when other treatment options have been unsuccessful.
Hysterectomy is the surgical removal of the uterus (womb). It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. The most common reasons for having a hysterectomy include uncontrollable vaginal bleeding, which can be caused by fibroids (benign tumours); chronic pelvic pain, which may be due to endometriosis, pelvic inflammatory disease (infection) or again to fibroids; prolapse of the womb; or cancer of the womb, ovaries or cervix.
Leaving cancer aside, there has been controversy that hysterectomies are being performed for unwarranted and unnecessary reasons, in that too often surgery is the only option offered to women with certain gynaecological issues and it shouldn't be. Although many gynaecological conditions are painful, distressing and unpleasant, they may not pose a significant risk to a women’s health, so as to justify a hysterectomy. Studies have revealed that women with benign gynaecological symptoms may be recommended a hysterectomy, without other treatment options being explained to them or tried out. They may not have even had pathological findings to support the recommendation for a hysterectomy.
A woman who has undergone a hysterectomy can’t have children, so it is a hugely important decision to take. If a patient is not consented properly, or does not have the chance to try other types of treatment, she may be deprived of the chance of having children.
There are a number of treatment options that can avoid the need for a hysterectomy. For example, fibroids can be treated surgically in a way that saves the woman’s womb (a myomectomy) while endometriosis can sometimes be reduced with hormone therapy. Uterine artery embolisation (UAE) is a surgical procedure to cut off the blood supply to the arteries in the womb and can help control vaginal bleeding or treat fibroids.
In 2015 a woman received £30,000 in damages after she underwent a hysterectomy and oophorectomy (removal of her ovaries) for gynaecological symptoms including abdominal pain, bladder infections and pain during intercourse. She had sterilisation treatment some years earlier and ultimately it was established that a complication of this, a dislodgement of one of the sterilisation clips, had been the cause of her gynaecological symptoms. Her condition could have been discovered and resolved without the radical surgery. A claim was brought on the basis that there had been a negligent failure to carry out sufficient investigation, to consider her medical history fully, to refer for definitive imaging such as a CT or MRI scan, and to exclude the possibility of a sterilisation clip being the cause of the symptoms. Liability was admitted and the claim settled. Sadly for this patient, she suffered a premature menopause after having undergone the unnecessary hysterectomy.
Alison Johnson, partner in Penningtons Manches Cooper’s clinical negligence team, represents patients with gynaecological claims. She is currently working with a number of women whose gynaecological symptoms, including abnormal uterine bleeding, have been misdiagnosed. They have in some cases received the wrong treatment, impacting on their fertility. One of these women was recommended a hysterectomy, but thankfully decided to obtain a second opinion before going ahead, as she wanted further children. The private gynaecologist she saw was able to make the correct diagnosis for her, recommend different treatment and confirm that she didn’t need a hysterectomy.
Alison says: “Women should not immediately assume that a hysterectomy is their only option. It may be needed, but they should discuss alternatives to surgery with their gynaecologist. A patient should not agree to undergo a hysterectomy unless she is sure that she has understood all of her options and if she has any doubts, seeing a specialist for a second opinion is worthwhile.”