Dr Katsnelson, Founder and CEO of USA Clinics Group, a parent company for several healthcare centres including USA Fibroid Centers, sheds light on the alarming prevalence of hysterectomies in the US. Uterine fibroids, affecting 26 million American women, are the leading cause behind the overprescription and overperformance of hysterectomies, particularly among women of colour. This trend highlights the urgent need for alternative approaches and a more thoughtful approach to women’s healthcare. Dr Katsnelson tells us more.
Why have hysterectomies become such a common procedure in the US?
The hysterectomy is one of the most major self-inflicted disasters in our healthcare system. It has become the most frequently non-pregnancy-related major surgery performed on women because it’s faster and easier. Many physicians consider it a quick fix—and one in three women undergo a hysterectomy by age 60. We are witnessing around 600,000 hysterectomies are done every year.
Uterine fibroids, a common benign tumour that grows in the muscle of the uterus, affect 26 million American women and are the leading cause of hysterectomies being overperformed and over-prescribed, especially for women of colour.
You have previously stated that the majority of these hysterectomies never have to happen, why is this the case and does this failure rest in technology or human error?
Hysterectomies, the removal of the uterus for a benign condition, does not and should not have to happen. The reason hysterectomies are performed is women needing fibroid treatment are not aware of seldom offered less drastic, nonsurgical treatments, such as uterine fibroid embolisation (UFE).
Every gynaecologist learns how to perform a hysterectomy in residency training and there is a high comfort level in offering this treatment. Since hysterectomies are the main treatment that gynaecologists perform, there is some resistance to providing patient referrals to other specialties, such as interventional radiologists that offer a non-surgical and less invasive fibroid treatment option.
What are the implications of unnecessary surgeries?
There is an unnecessary risk to life that comes with surgery. Surgical risks also include a longer recovery time and addiction to drugs such as opioid pain relivers. Unnecessary surgeries such as hysterectomies can lead to vaginal prolapse, regardless of the reason for the hysterectomy.
Hysterectomy is the permanent removal of one’s reproductive organ, which plays a critical role in menstruation, fertility and pregnancy. Another implication is the cost. Hysterectomies are the most common non-obstetric surgical procedure for women in the U.S. and account for more than $5 billion in healthcare spending.
Other concerns include an increased risk for infection, heart disease, uterine cancer and infertility. Only 10 percent of hysterectomies are done for a cancer diagnosis; the remaining 90 percent are considered elective.
In your opinion, have western societies ‘normalised’ invasive surgeries?
There has been tremendous progress in achieving better results by doing minimally invasive procedures through a tiny pinhole. For example, most heart treatments are done through a catheter that can be inserted through an artery using guided imagery. There are many surgical specialties such as colon and rectal, gynaecology, urology and neurological, to name a few, that have led to surgeons specialising in specific surgeries.
Advances in minimally invasive procedures, where catheters that are as thin as a hair deliver treatment directly to the diseased area through a puncture the size of a pinhole, have translated into tremendous benefits for the patient. These types of non-invasive techniques are done by an interventional radiologist. This is really the future of medicine to deliver medicine and treatment, such as uterine fibroid embolisation, through tiny pinholes, removing the need for major surgery.
What are the benefits of nonsurgical fibroid treatment?
Uterine fibroid embolisation (UFE) a nonsurgical fibroid treatment maintains a woman’s fertility and gives back the quality of her life. During UFE, a thin catheter is inserted through an artery in the wrist or groin and tiny particles are injected to stop blood flow to the fibroids. UFE involves less pain, fewer risks than surgery and a higher success rate than hysterectomies or myomectomies.
Other benefits include:
- Painful fibroid symptoms, including heavy periods, are relieved
- Successful pregnancy is possible after UFE because the uterus is left intact
- The uterus is not cut away any uterine tissue
- Multiple fibroids can be treated at the same time
- There is no hospital stay—patients go home the same day as the procedure
- Patients resume everyday activities quickly and feel better within one to two weeks
Why is there a lack of awareness about nonsurgical fibroid treatment?
Women do not know about fibroid symptoms and treatment because no one educates them. There is a stigma around discussing menstrual cycles and many women cannot recognise abnormalities.
Minimal invasive options to treat this very common condition. It is disappointing that these options are rarely discussed in length, and many women are unaware of the risks that hysterectomies and myomectomies pose. The healthcare system needs to consider the experience and preferences of the most important person, the patient. Until these things change, the status quo will remain the same.
Some physicians remain untrained in newer, less invasive approaches and perform hysterectomies because that is all they offer. Clinicians need to learn about updated, evidence-based treatments, such as UFE to treat patients with uterine fibroids, and better understand the benefits of nonsurgical fibroid treatments.
What technologies are supporting healthcare professionals in recognising symptoms and preventing future neglect of Uterine Fibroids?
Even with technological advances, it still starts with asking the patient the right questions and looking at their chief complaints and symptoms. The advance of ultrasound has made it extremely accurate to look at the uterus. Certain patients can benefit from an MRI to better identify the size and location of fibroids.
At USA Fibroid Centres, a comprehensive, evidence-based consultation is performed. Once the diagnosis is made, a treatment plan can be tailored to the patient’s symptoms, medical history and desire for fertility. UFE has improved so that all patients who undergo UFE experience relief from their symptoms.
What does the future of hysterectomies and fibroid treatments look like for US women?
I hope the future of hysterectomies will be rare and only an elective choice instead of the first option. UFE or other new developments will become the proven way for women to regain their lives from painful symptoms of fibroid disease and maintain their fertility. Despite minimally invasive UFE being approved for over 25 years, many physicians still remove a women’s organ, which is equal to a castration. We need to educate women and healthcare providers to put an end to this. There is no reason an organ should be removed to treat a benign tumour.
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