The question of whether hysterectomy (surgical removal of the uterus) is overused or appropriately performed for benign conditions such as fibroids or abnormal uterine bleeding is controversial and hotly debated. What is clear is that, regardless of treatment choice, women should be informed about the availability and appropriateness of the many available, safe, and effective alternatives to hysterectomy. Furthermore, it should always be the case that women are actively making the treatment decisions along with their doctor. How bothered a woman is by her symptoms, how she feels about the risks and recovery involved in the different treatments, her desire for future childbearing, among others, should all factor into the decision-making process.
This story does a nice job of describing the controversy over the potential overuse of hysterectomy for uterine fibroids. It appropriately describes how fibroids do not need to be treated unless they are causing a lot of bothersome symptoms. It also describes the available alternatives to hysterectomy, although it could have done more to discuss the availability of some of the newer options such as myolysis and uterine artery embolization.
The story fails to discuss costs of hysterectomy and the alternatives. Other than to describe hysterectomy as "invasive" and requiring a hospital stay and recovery time, the story does not discuss the harms of hysterectomy or the alternatives. Finally, although the story mentions a "90 percent success" rate of the alternative procedures, this is not sufficient quantification of benefits. Not only is it not clear how "success" is defined, but also for which procedure and compared to what.
The story does not mention costs of hysterectomy or of the available alternatives.
Although the story mentions a "90 percent success" rate of the alternative procedures, this is not sufficient quantification of benefits. Not only is it not clear how "success" is defined, but also for which procedure and compared to what.
Other than to describe hysterectomy as "invasive" and requiring a hospital stay and recovery time, the story does not discuss the drawbacks of hysterectomy. Nor does the story describe the drawbacks of the newer procedures.
The story does not adequately address the strength of the available evidence. One particular problem is that the article presents arguments against hysterectomies, but does not give details on the "failure rates" of some of the newer procedures. For example, if a women has an embolization procedure, how likely is she to have total relief of symptoms, versus a need for repeat procedure or eventual hysterectomy?
The story accurately represents the seriousness and prevalence of fibroids. The story does a great job of explaining that fibroids do not need to be treated unless the woman is bothered by the symptoms.
Several physician/experts are quoted in the story.
The story does a good job of laying out the alternatives to hysterectomy as well as the different types of hysterectomy that are available.
The story clearly states that hysterectomy is available. What is not clear, however, is how widely available are some of the new alternatives, such as myolysis and uterine artery embolization.
The story clearly states that hysterectomy is not a new idea. However, the story could have provided more information about the novelty of some of the newer alternatives, such as myolysis, which is very new and has not been extensively evaluated.
Because the story quotes multiple experts, the reader can assume the story did not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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