Vidyya Medical News Service
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Volume 6 Issue 84 Published - 14:00 UTC 08:00 EST 24-Mar-2004 Next Update - 14:00 UTC 08:00 EST 25-Mar-2004
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Study of hysterectomy vs. other medical treatments for abnormal uterine bleeding

Two studies published in the March 24/31 issue of The Journal of the American Medical Association (JAMA) look at the effect of medical treatment compared with hysterectomy on health-related quality of life for women with abnormal uterine bleeding.

According to background information in one of the articles, the Medicine or Surgery (Ms) randomized trial: "Hysterectomy [removal of the uterus] is the most common major surgical procedure performed in the United States for nonobstetric reasons. In 2000, approximately 633,000 hysterectomies were performed, and U.S. women have an estimated 25 percent risk of having their uterus removed." The authors note that most hysterectomies are elective and performed before menopause for abnormal uterine bleeding and other non-life-threatening reasons.

Miriam Kuppermann, Ph.D., M.P.H., from the University of California, San Francisco and colleagues from the Ms Research Group, studied 63 premenopausal women, aged 30 to 50 years, who had abnormal uterine bleeding for a median (mid-point) of four years despite a variety of medical treatments, including hormone therapy (such as medroxyprogesterone acetate). The women were randomly assigned to undergo hysterectomy (n=31) or expanded medical treatment (n=32). The authors assessed overall mental health as the primary outcome, using the Mental Component Summary (MCS) of the 36-Item Short-Form Health Survey (SF-36). Secondary outcomes included physical health, symptom resolution and satisfaction, body image and sexual functioning. The participants were followed-up for two years.

"At 6 months, women in the hysterectomy group had greater improvement in MCS scores than women in the medicine group (8 vs. 2)," the authors report. "They also had greater improvement in symptom resolution (72 vs. 29), symptom satisfaction (44 vs. 7), interference with sex (41 vs. 22), sexual desire (21 vs. 3), health distress (33 vs. 13), sleep problems (13. vs. 1), overall health (12 vs. 2), and satisfaction with health (31 vs. 14). By the end of the two-year follow-up, 17 (53 percent) of the women in the medicine group had requested and received hysterectomy, and these women reported improvements in quality-of-life outcomes during the two years that were similar to those reported by women randomized to the hysterectomy group. Women who continued in the medical treatment also reported some improvements, with the result that most differences between randomized groups at the end of the study were no longer statistically significant in the intention-to-treat analysis."

"We have shown that hysterectomy results in substantial improvement in health-related quality of life within six months for women who have not responded to medroxyprogesterone. Persisting efforts at medical treatment can also produce benefits for many of these women throughout the ensuing two years although others who prolong medical treatment at this stage will decide within a year to have a hysterectomy," the authors conclude.

(JAMA 2004; 291:1447-1455.)



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