About 90 percent of hysterectomies are elective and performed before menopause, usually for abnormal uterine bleeding. The initial approach to treating abnormal bleeding is with medicines such as medroxyprogesterone. When this medication fails to relieve symptoms or causes adverse effects, hysterectomy is superior to use of additional medications for alleviating clinical symptoms and improving women's quality of life, according to a recent study. The study was conducted by the Medicine or Surgery Research Group, based at the University of California, San Francisco, with support from the Agency for Healthcare Research and Quality (HS09478).
For this multicenter study, the researchers randomly assigned 63 premenopausal women (aged 30 to 50 years) with abnormal uterine bleeding that had not responded to cyclic medroxyprogesterone acetate treatment to receive either a hysterectomy or expanded medical treatment with estrogen and/or progesterone and/or a prostaglandin synthetase inhibitor. The researchers followed the women for 2 years. Two reports from this study are described here.
Kuppermann, M., Varner, R.E., Summitt, R.L., and others (2004, March). "Effect of hysterectomy vs. medical treatment on health-related quality of life and sexual functioning." Journal of the American Medical Association 291(12), pp. 1447-1455.
This report describes significant improvements in quality of life among women in the hysterectomy group (31 women) compared with women in the medication group (32 women). At 6 months, more women in the hysterectomy group boosted their mental health scores than women in the medicine group. They also had better symptom resolution, fewer pelvic problems that interfered with sex, more sexual desire, less health distress, fewer sleep problems, better overall health, and greater satisfaction with health.
By the end of the study, 53 percent of women in the medicine group had requested and received a hysterectomy. These women reported improvement in quality of life outcomes during the 2 years similar to those reported by women randomized to the hysterectomy group. Those who continued medical treatment also reported some improvements.
Learman, L.A., Summitt, R.L., Varner, E., and others (2004, May). "Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: Clinical outcomes in the medicine or surgery trial." Obstetrics & Gynecology 103, pp. 824-833.
This report discusses greater improvement in clinical symptoms among women in the hysterectomy group compared with women in the medicine group for cessation of vaginal bleeding (87 vs. 11 percent), pelvic pain, urinary urgency, incomplete bladder emptying, and breast pain. Compared with those who remained on medication through year 2, women who crossed over to hysterectomy experienced greater improvement in bleeding, pelvic pain, low back pain, breast pain, and urinary frequency and urgency. However, they also experienced more days off from work or usual activities and more days spent in bed than those who remained on medicine.
Quality of life and sexual functioning improved to a clinically significant degree among all women in the 2 years of followup, regardless of whether or not they had a hysterectomy. The researchers conclude that hysterectomy may be an optimal choice for women who give high priority to resolving bothersome symptoms, but they note that many women who are treated medically also experience some improvement.
Editor's Note: A related study shows that use of medical care resources over a 2-year period is comparable for total and supracervical hysterectomy. For more details, see Showstack, J., Kuppermann, M., Lin, F., and others (2004, May). "Resource use for total and supracervical hysterectomies: Results of a randomized trial." (AHRQ grant HS11657). Obstetrics & Gynecology 103, pp. 834-841.
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