BOOK REVIEW
The UNhysterectomy: Solving Your Painful, Heavy Bleeding Without Major Surgery by Holly Bridges, Self-published 2012, UNhysterectomy website [1]
By Zelda Abramson
In the 1990s, the Toronto Women’s Health Network, together with the Ontario government and a group of physicians wrote a report to address the variable rates of hysterectomy within Ontario (see the updated report by the Ontario Women’s Health Council [2]. Overall, hysterectomy rates were high across Canada with women living in Newfoundland having the highest rate of hysterectomy. The likelihood of a woman having a hysterectomy in northern Ontario was 2.5 times greater than for a woman in Toronto. Even in Toronto there was variability between women whose physicians practised in teaching hospitals and those in non-teaching hospitals. The report addressed some of the factors explaining the variation such as: physician practice style, ongoing training of gynaecologists living in remote areas, fee structures and education levels of consumers (e.g., an inverse relationship between hysterectomy rates and a woman’s education level). Based on these findings, the recommendations of the report focused on increased training in and availability of equipment for alternative and less invasive procedures as well as information and support programmes for women, especially targeting women in remote regions and those less educated.
More than 15 years later, Holly Bridges writes in her book The UNhysterectomy: Solving Your Painful, Heavy Bleeding Without Major Surgery [1]: “[a]nywhere from 60% to 80% of hysterectomies are elective and medically unnecessary” [emphasis in original]. Although hysterectomy rates today are lower than those in the 1990s, they continue to be unnecessarily high and hence the reason for this book. Bridges is on a campaign to reduce the numbers of unnecessary hysterectomies in Canada. This is both good and necessary.
Bridges passionately argues for a serious rethinking of gynecologists’ aggressive approaches to treating women’s gynaecological problems, in particular heavy menstrual bleeding. Using her personal story as well as other case studies, Bridges shows that heavy menstrual bleeding can be successfully treated through minimally invasive surgery. Compared to hysterectomy, the recovery time is much quicker and there are many fewer short and long-term side effects.
The book presents various ailments related to heavy menstrual bleeding. The most common is fibroids, which are benign uterine tumours. Other conditions discussed include adenomyosis, Von Willebrand disease, endometrial polyps, ovarian cysts, and a full chapter is set aside for endometriosis. Here Bridges describes in detail what these conditions are, and includes background information, symptoms and causes.
The preferred solution presented for all these conditions is minimally invasive surgery. Each of these procedures—First and Second Generation Ablations (more invasive), and Focused ultrasounds, Uterine Artery Embolization and Volumetric Embolization (the least invasive procedure)—are discussed in great detail in UNhysterectomy, paying attention to their respective advantages and disadvantages. This part of the book is informative, comprehensive and the diagrams are excellent.
In addition to the various gynaecological ailments, Bridges addresses the problematic politics that surround hysterectomy. Namely lack of financial incentive for physicians, insufficient physician training, lack of resources particularly in non-urban areas and lack of consumer awareness. Her arguments contextualize hysterectomy as a social and political phenomenon. Bridges lays fault for the many unnecessary hysterectomies performed in Canada largely at the hands of healthcare systems and some physicians. In the end, she concludes, the onus is on women to advocate for themselves.
The writing of UNHysterectomy is one strategy Holly Bridges uses to communicate that change is needed. Although the author’s motivation is excellent, the book has its shortcomings. Her organization of information is somewhat choppy and uneven. The chapter, “About Hysterectomy” appears in the middle of the book and not at the beginning which would introduce readers to the topic. The politics of hysterectomy appear and reappear throughout the book, at times interrupting the flow of the discussion at hand. There were numerous very long quotes from the physicians she interviewed, which could have been summarized and written in more accessible language. The book is written for an audience with a high level of education. Yet, it is women with lower levels of education who are more likely to have hysterectomies.
Although Bridges addresses alternatives (non-surgical) to hysterectomy such as “watchful waiting,” the reader is given a distinct impression that such approaches are not optimal as “menopause will come on its own sweet time” or “you may develop iron-deficiency anemia.” Her information is mostly medically sourced (through physician interviews and clinical research studies). Bridges seldom draws on the expertise of grassroots women’s health groups who would forewarn that even the least invasive surgeries carry risks. According to the Hysterectomy Education Resources and Services [3] (HERS) in the United States, it is best to “[stay] out of an operating room whenever possible.” I believe this book would benefit from more consideration of the risks of any surgery.
Holly Bridges calls for collective action to address the problem of unnecessary hysterectomies. One of her solutions is for a “new pink ribbon campaign” in the form of “a green daisy on the lapel of every man, woman and child in this country to raise awareness and funds to help these initiatives become a reality.” I for one do not wear pink ribbons nor will I wear a green daisy. Such campaigns take a life of their own and take resources and energy away from the issue at hand.
Health activist, breast cancer survivor and blogger Barbara Brenner’s critique of the pink ribbon campaign [4] makes this point (posted September 18 2011):
"Billions of dollars have been raised in the name of breast cancer research. We don’t know how much of that money actually goes to research. We don’t know what kinds of research are funded with that money. And the research funders often tout how much they have spent without every reporting whether the research has benefited women’s lives. What we do know is that the epidemic rages on, the incidence of breast cancer continues to increase, and the death rate does not decline."
Also, at CWHN we have joined with other organizations to focus on breast cancer PREVENTION. See our Get the Word Out postcard project [5].
All that said, if women are looking for information on surgical alternatives to hysterectomy, this is a book to read. The information is wide-ranging and offers women the knowledge and strategies to make informed choices. Throughout the book Bridges urges the reader to refer to her website [1] for further in-depth information. Bridges explains that she has self-financed all of her work on the book and website and, in order to "maintain her neutrality", she no longer accepts ads or sponsorship from the pharmaceutical industry.
For decades, women health activists have been frustrated by the large numbers of unnecessary hysterectomies performed in Canada and the challenges women face seeking alternative treatments. Although underfunding of the healthcare system certainly is a contributing factor, the question that begs to be answered is: why haven’t medical schools not integrated into their gynecological training an ideology that views hysterectomy as a treatment of last resort? Holly Bridges boasts the skill set of Dr. Singh in performing non-invasive surgery and his commitment to preventing hysterectomies. Why is Dr. Singh’s practice style the exception and not the norm? In so questioning, Holly Bridges’ passionate writing reminds us, “there’s much work to do.”
Zelda Abramson is a sociologist at Acadia University whose research and teaching interests are in the areas of health and methodology.