Medical science has improved human health markedly in modern times. However, the history of medical practice in the U.S. has a dark side.

Following are a few examples: 1) A few decades ago patients were placed at bedrest for several days or weeks for illnesses, and after procedures such giving birth; eventually, it became apparent that active recovery was better. 2)  At one time the treatment for a torn knee meniscus was to remove the whole meniscus, which changed the mechanics of the joint, resulting in severe arthritis. 3) For a long time, the treatment for breast cancer was radical mastectomy, a disfiguring operation that eventually was found to be unnecessary.

These harmful practices were based on tradition, rather than good science. It should also be noted that the time lag between when medical science tells us we should change the way we practice and when practice actually changes is 17 years.

In the Dec. 3 science section of the New York Times there was an eye-opening, 2-page article detailing new information about hysterectomy (removal of the uterus) and oophorectomy (removal of ovaries). The uterus is a pear-shaped female organ with 2 upper openings to the fallopian tubes, which surround the ovaries. A larger, lower opening called the cervix) connects to the vagina. The main function of the uterus is to allow implantation of a fertilized egg and to carry a developing fetus for 9 months. The ovaries are responsible for releasing eggs once a month; and they also produce estrogen, progesterone, testosterone, and other hormones.

For years, doctors have recommended hysterectomies for women for conditions such as heavy or irregular bleeding, and fibroid tumors (which are benign and are common). The thinking was that if woman didn’t want to have more children, there was no reason for her to keep her uterus. Hysterectomy is the second most common surgery in women, next to c-section; in 2020, 500,000 of them were done in the U.S.

It turns out that there are downsides to removing the uterus:  1) First of all, it involves surgery, which can result in complications such as infection, bleeding, and injury to the bowel. 2) The procedure involves some vaginal shortening. 3) It can adversely affect a woman’s sexual response. 4) It can also cause some of the same health problems mentioned below that oophorectomy causes, thought to be due to damage to the arteries to the ovaries when the uterus is removed.

By the 1990s, doctors were trained to take the ovaries out when a hysterectomy was done, the rational being that this would prevent cancer of the ovaries, which is relatively rare but difficult to diagnose and often fatal. However, it turns out that even after menopause the ovaries produce needed hormones. Recently, Dr. William Parker, an OB-GYN professor at the University of California, Los Angeles, reviewed data from the 30,000 women in the national Nurses’ Health Study and found that women who had their ovaries removed were at significantly higher risk for heart disease, strokes, osteoporosis, lung cancer, Parkinson’s disease, dementia, loss of skin elasticity, and early menopause. Those who lost their ovaries before menopause lived shorter lives. The American College of Obstetricians and Gynecologists now recommends against oophorectomy, which, and the procedure is now less common. When a hysterectomy is done these days, the fallopian tubes are often removed—thought to be where ovarian cancer usually starts.

Interestingly, around half of patients who have had gynecologic surgery don’t know exactly what was done. Partly this is due to confusing nomenclature. A partial hysterectomy means removal of the uterus, leaving the cervix in place (in which case a Pap smear is still necessary). A total hysterectomy means removal of the uterus and cervix. Oophorectomy means removal of the ovaries, and salpingectomy refers to removal of the fallopian tubes.

Part of the problem, though, is that gyn doctors (often male in the old days) fail to adequately explain what surgery is planned, the possible downsides, and other available options (e.g. for fibroids there are options other than hysterectomy).

Of course, there are some cases, such as cancer of the uterus, where hysterectomy is necessary. And if a woman is at extremely high risk for ovarian cancer, oophorectomy might be the best choice. But ask questions and consider second opinions if you are advised to have a one of these operations.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfeinsinger@comcast.net or 970-379-5718.