Studies Find Hysterectomy Viable Yet Avoidable

Women can turn to surgery, but other options are available

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HealthDay Reporter

TUESDAY, March 23, 2004 (HealthDayNews) -- Two new studies on hysterectomy and quality of life conclude that, while there may be a place for surgery in easing abnormal bleeding, it often depends on the individual woman.

"It's kind of a judgment call," says Dr. James R. Scott, co-author of an editorial accompanying the two studies in the March 24/31 issue of the Journal of the American Medical Association. "It depends a lot on the woman. A lot of women don't want surgery. Others say they're just tired and want to get it done."

According to the first study, hysterectomy, which is the surgical removal of the uterus, is the most common major surgical procedure performed in the United States for non-obstetric reasons.

There has been a great deal of debate about whether the operation is performed too often. It is, after all, major surgery and involves significant recovery time, discomfort, and, like all surgery, a small risk of death.

It has also developed a negative reputation that these studies may help ease. "Hysterectomy has had a bad name, and it probably isn't as bad as has been implied -- by some, anyway," says Scott, who is also editor of Obstetrics & Gynecology.

The first study randomly assigned 63 premenopausal women with abnormal uterine bleeding to receive either a hysterectomy or "expanded medical treatment," including hormone therapy. The women, all of whom had tried and stopped the hormone therapy medroxyprogesterone, were followed for about two years to assess their mental health and quality of life.

After six months, women in the hysterectomy group showed greater improvements in overall mental health than women in the other group. They also had greater improvement in symptom resolution, symptom satisfaction, interference with sex, sexual desire, health desire, sleep problems, overall health and satisfaction with health.

Interestingly, at the end of two years, more than half (53 percent) of the women in the medicine group had requested and received a hysterectomy and reported improvements.

Women who continued with the medical treatment also reported improvements, indicating this course of action may eventually lead to improved quality of life.

In sum, though, hysterectomy seemed to come out ahead. "Women who have abnormal bleeding that have tried medicine and hasn't worked well, that hysterectomy is a very good option for them -- not that every woman should have a hysterectomy," says study author Miriam Kuppermann, an associate professor of obstetrics, gynecology and reproductive science at the University of California San Francisco. "For women who have not been adequately treated by medicine, hysterectomy is a worthwhile option to consider."

On the other hand, if a woman really does not want the operation, she can expect to get some benefit from medicine, Kuppermann adds.

The second study, taking place in Finland, compared levonorgestrel-releasing intrauterine system (LNG-IUS) with hysterectomy in women with menorrhagia, the medical term for unusually heavy menstrual bleeding. Levonorgestrel is a hormone. In Finland, the LNG-IUS is approved for contraception and treatment of menorrhagia while, in the United States, it is approved only for contraception. Leiras Co. (now Schering) provided the LNG-IUS free of charge.

Here, the researchers randomly assigned 236 women at five university hospitals in Finland to be treated with the LNG-IUS or hysterectomy. All women were monitored for five years.

The two groups were similar in terms of health-related quality of life and psychosocial well-being. As with the first study, however, a sizable proportion (42 percent) of the women in the nonsurgical group eventually opted for a hysterectomy.

Still, the LNG-IUS was clearly the less expensive route, at $2,817 per woman vs. $4,660 in the surgery group.

As the editorial writers point out, it comes down to deciding if the glass is half-empty or half-full. "You can interpret this two different ways," Scott says. "Does that mean that it's not worth it to try these other things or does it mean, well, look, it's worth it because half the time you can avoid surgery."

The findings are unlikely to change much in clinical practice, Scott adds.

But this might vary by region. "I can speak more to the [San Francisco] Bay Area. Here there really has been an emphasis on trying every last thing before resorting to hysterectomy," Kuppermann says. "This may have an impact. It may introduce hysterectomy as an option earlier on."

The sheer number of choices may indicate that this is a glass-half-full scenario. "There are a lot of choices," Kuppermann goes on to say. "Hysterectomy is a viable option. There has been so much press about overuse, but realize that for that situation, it is a very effective option."

More information

The National Women's Health Information Center and the U.S. Centers for Disease Control and Prevention have more on hysterectomies.

SOURCES: Miriam Kuppermann, Ph.D., M.P.H., associate professor, obstetrics, gynecology, and reproductive science, University of California, San Francisco; James R. Scott, M.D., professor, obstetrics and gynecology, University of Utah School of Medicine, Salt Lake City, and editor, Obstetrics & Gynecology; March 24/31, 2004, Journal of the American Medical Association

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