Each year, more than 600,000 women in the United States undergo hysterectomy to treat uterine fibroids, unaware that many less invasive alternatives exist. Beverly Johnson, the first Black woman to appear on the cover of Vogue, an entrepreneur and actress, became one of these hundreds of thousands of women in 1999.
Johnson was diagnosed with uterine fibroids at age 35. By 46, she suffered from unbearable heavy menstrual bleeding and severe menstrual cramps. In 1997, she had a myomectomy to remove the fibroids, but they gradually regrew. Two years later, her abdomen became severely distended, causing increasing discomfort. Her menstrual cycles became irregular, eventually leading to persistent, uncontrolled bleeding. Her doctor recommended a hysterectomy. When she woke up after surgery, she not only felt severe pain but was also shocked to find herself completely menopausal.
Although Johnson heard there were options other than total hysterectomy, she did not explore them. She felt it was too late to question whether alternative treatments would work and chose not to think about it further. She comforted herself that hysterectomy was her best option.
Johnson now recognizes how uninformed she was when deciding on fibroid treatment. While hysterectomy may be the best choice in some cases, minimally invasive treatments are often appropriate and effective. Many uterine preservation advocates and an increasing number of physicians agree that after a fibroid diagnosis, women should first review all available options: watchful waiting, myomectomy, uterine artery embolization (UAE) to cut off blood supply to fibroids, or estrogen-suppressing medications to shrink fibroids.
Dr. Linda Bradley, a surgeon and Director of the Hysteroscopy Service at the Cleveland Clinic Foundation, states: “I always tell women: unless they have been diagnosed with cancer, they should never agree to a hysterectomy after just one consultation with their doctor.”
Dr. Charles Miller, a reproductive endocrinologist, gynecologic surgeon, and fibroid specialist in Chicago, explains: “For many women, hysterectomy can be a satisfying solution for fibroids, especially those who have had a myomectomy with recurrence or who have completed childbearing but are still far from menopause. However, as women approach menopause, declining estrogen levels naturally shrink fibroids, often making aggressive treatment unnecessary.”
Authorities are launching new initiatives to promote research in fibroid treatment and improve patient education, expanding women’s treatment options. These efforts will bring more funding for fibroid research and support a challenging educational campaign for both physicians and patients.