New Zealand Listener – March 02, 2018

36 LISTENER MARCH 10 2018

by Ruth Nichol

HEALTH

ThisLife

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A

uckland gynaecologist Cindy Far-

quhar can remember a time when

she would perform four hysterecto-

mies in a morning. But these days,

Farquhar, postgraduate professor of

obstetrics and gynaecol-

ogy at the University of

Auckland, says a falling hysterectomy

rate is making it hard to find enough

uncomplicated cases to train young

gynaecologists in the procedure, which

involves removing a woman’s uterus and

in some cases the cervix.

“We’re finding that the only hysterec-

tomies we’re doing are the difficult ones.

We used to do a lot of hysterectomies

for women who had normal-appearing

uteruses, whereas now most of the women have

underlying conditions such as endometriosis,

fibroids or adhesions, so they’re more difficult to

do.”

Hysterectomies were once commonly performed

on otherwise healthy women who were experienc-

ing heavy menstrual bleeding or had fibroids or a

prolapsed uterus. According to a study published in

the New Zealand Medical Journal in 1984, an average

of 4.1 women in every 1000 had a hysterectomy,

and they had a 39%

chance of having the

operation by the age of

85. Now, hysterectomies
    are used largely as a
    final resort, rather than
    as a first-line treatment.
    We don’t have
    up-to-date national figures – partly
    because private hospitals, which in
    1984 performed 42% of all hyster-
    ectomies, no longer have to provide
    them. However, a report published
    last year by the Australian Commis-
    sion on Safety and Quality in Health
    Care suggests our rate could be as low
    as 1.5 for every 1000 women. That
    compares with 2.3 in Australia.

I

t’s part of an international trend

that Farquhar describes as one of

the great gynaecological success

stories of the past 30 years. And she

says it’s come about because a range

of alternatives to hysterectomy are

now available.

“We don’t really talk about it a lot,

but it is a success story, as we have

several options for women now.”

One of the most successful of these

options is using a hormone-releasing

intrauterine device (IUD), such as a

Mirena, that provides contraception

and also reduces heavy menstrual

bleeding. These IUDs stop periods

altogether in about a fifth of women.

A study published in the Medical

Avoiding

the knife

Hysterectomies used to

be common, but women

now have less-invasive

options available.

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Gynaecologist Cindy

Farquhar: “It is a success

story.”