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Hysterectomy, one of the most common inpatient surgeries in Canada, is increasingly being performed on women at younger ages and more frequently among those with lower educational levels, according to a recent study. The research, which analyzed data from Alberta’s Tomorrow Project—a large-scale, long-term study—highlights a significant disparity in hysterectomy rates linked to education, and raises important questions about the broader social determinants of women’s health.
Currently, nearly one in three Canadian women aged 60 and older have undergone a hysterectomy. While this rate has been declining, primarily due to the increased use of non-surgical treatments for conditions like abnormal uterine bleeding, fibroid growths, and pelvic organ prolapse, the procedure remains normalized in Canadian culture. Many women, along with some healthcare providers, view it as a routine part of aging or a natural progression after childbearing.
However, this cultural acceptance has concerning long-term implications. Research indicates that undergoing a hysterectomy, particularly before natural menopause, can significantly increase the risk of cardiovascular disease, osteoporosis, and early onset menopause symptoms. Despite these risks, nearly 35,000 hysterectomies are performed annually in Canada, with Alberta having a hysterectomy rate more than 20% higher than the national average.
The study, led by a team of medical professionals and health researchers, focused on whether education levels were a factor in the likelihood of women undergoing the procedure. The results were stark: women with only a high school diploma or less were 1.7 times more likely to have a hysterectomy compared to those with a university degree. Even women with a college diploma were 1.6 times more likely to undergo the surgery.
These findings suggest that less educated women not only have a higher likelihood of surgery but also tend to have the procedure at a younger age, often before menopause. This timing exacerbates the associated long-term health risks.
Social Disparities in Access to Care
The study’s results underscore the broader social disparities in healthcare access. Women with lower educational attainment often face economic barriers that limit their access to alternative treatments. For many, surgery becomes the only viable option, particularly as it is fully covered by Canada’s universal healthcare system, unlike some non-surgical treatments that may require out-of-pocket expenses or extended health benefits.
Additionally, women in precarious employment situations, juggling multiple roles at work and home, may not have the flexibility to manage unpredictable symptoms like heavy uterine bleeding, leading them to opt for the “quick fix” of surgery. These women are also less likely to have access to healthcare providers who are familiar with newer, non-invasive treatments.
The research further suggests that healthcare providers may unintentionally recommend surgery more frequently to women with lower education, potentially due to biases or assumptions about their ability to afford or manage non-surgical alternatives. Lower health literacy could also play a role, making it harder for these women to make informed decisions about their healthcare, ask questions, or seek second opinions.
A Call for Comprehensive Change
The findings from this study call for a multi-faceted approach to address these disparities. To reduce the overuse of hysterectomy and mitigate its long-term health risks, experts recommend several key interventions:
- Improved Access to Non-Surgical Treatments: Non-invasive options, such as pelvic floor physiotherapy and medications to manage conditions like heavy uterine bleeding, should be more widely available, especially for women with lower educational levels. Canada’s recent move to federally fund birth control could serve as a model for expanding access to these alternatives.
- Increasing Health Literacy: It is essential to improve health literacy, particularly among women with lower education, to ensure they are active participants in their healthcare decisions. Empowering women to question medical recommendations and seek second opinions can help reduce the likelihood of unnecessary surgeries.
- Addressing Unconscious Bias in Healthcare: There is an urgent need for healthcare providers to engage in training to recognize and address unconscious biases that may lead to the over-recommendation of surgery for women with less education.
- Shared Decision-Making: Promoting shared decision-making between healthcare providers and patients is crucial. Women should be fully informed of all available options, including non-surgical treatments, and have the opportunity to participate actively in their healthcare decisions.
As the study highlights, while hysterectomy remains a common procedure in Canada, its overuse in certain populations—especially among women with lower education—suggests that more must be done to ensure that women of all backgrounds have access to the most appropriate and effective care. Addressing these social and economic disparities in healthcare is essential for improving the long-term health outcomes of women across the country.
