Hysterectomy
Leads To Improved Symptoms And Satisfaction
Studies Compare
Medication Therapy To Surgical Procedure
Two new studies on hysterectomy and
quality of life conclude that, while there is a place for surgery in
easing abnormal bleeding, making this choice usually depends on the
individual woman.
The reports, presented
in the Journal of the American Medical Association (JAMA), show
that about 50 percent of the women taking medication to control bleeding
eventually had a hysterectomy because of dissatisfaction with the more
conservative therapy.
Hysterectomy, which is the
surgical removal of the uterus, is the most common major surgical procedure
performed in the US for non-obstetric reasons, according to one
of the study reports.
In 2000, about 633,000
hysterectomies were performed. Women in the US have an estimated 25
percent risk of having their uterus removed.
The authors note that usually
a hysterectomy is elective and performed before menopause for abnormal
uterine bleeding and other non-life-threatening reasons.
"It's kind of a judgment
call," says Dr. James R. Scott, co-author of an editorial accompanying
the two studies in JAMA. "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."
Research
Delves Into Satisfaction, Outcomes
There has been a great deal
of debate about whether this type of surgery is performed
too often. It is, after all, major surgery. It involves significant
recovery time, discomfort, and, like all surgery, a small risk of death.
The studies may provide new
information that will lessen the negative reputation that is sometimes
associated with hysterectomy.
"Hysterectomy has had a bad
name, and it probably isn't as bad as has been implied - by some, anyway,"
says Dr. 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 medication treatment 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 medication
group had requested and received a hysterectomy and reported improvements.
Women who continued with
the medications 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
Must Weigh Information, Choices
Dr. Miriam Kuppermann, author
of the first study, says, "Women who have abnormal bleeding that have
tried medicine and hasn't worked well, [then] hysterectomy is a very
good option for them - not that every woman should have a hysterectomy."
Kuppermann is 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," she says.
On the other hand, if a woman
really does not want the operation, she can expect to get some benefit
from medications, Dr. Kuppermann adds.
Dr. Kuppermann points out
that the study was small and reflected the difficulty of finding women
to participate who were willing to be placed in either group. She says
it is "unclear" whether these women represent the entire population
of women choosing between medication and surgery.
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 US, 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.
Dr. Kuppermann says, "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.
This [study] may have an impact. It may introduce hysterectomy as an
option earlier on.
"There are a lot of choices,"
Dr. Kuppermann says. "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."
Always consult your physician
for more information.
|
May 2004
Hysterectomy
Leads To Improved Symptoms And Satisfaction
Research
Delves Into Satisfaction, Outcomes
Women
Must Weigh Information, Choices
Why
Is Hysterectomy Performed?
Types
of Hysterectomy Procedures
Online
Resources
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Resources:
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a St. John's Mercy Physician
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John's Mercy Classes and Programs
Why
Is Hysterectomy Performed?
According to the
American College of Surgeons, hysterectomy may be performed
to treat a variety of gynecological (female reproductive
system) problems.
It is an elective
procedure 90 percent of the time. Today most hysterectomies are done
to treat
benign (non-cancerous) fibroid tumors of the uterus. While not life-threatening,
these growths cause pelvic pain, excessive bleeding, or pain during
sexual intercourse.
Fibroid tumors are
common
and usually do not require surgery. Other forms of treatment which preserve
the uterus and
childbearing capacity are also available.
A woman should discuss
these options with her surgeon.
Endometriosis is
a condition in which the tissue lining the uterus becomes displaced
and grows in
other parts of the abdomen, where it can cause pain. Endometriosis is
the second most common
reason for a woman to have a hysterectomy.
However, the practice
of treating endometriosis by performing hysterectomy has been declining
in the last decade because other treatments have evolved. The American
College of Surgeons recommends that a woman discuss other options
with her surgeon first to see if another treatment for endometriosis
may be effective for her.
Prolapse of the
uterus is another reason why some women decide to undergo a hysterectomy.
In this condition, the uterus descends or sags into the vagina due to
stretching of the ligaments and
fibrous tissue that usually hold it in place.
Women with cancer
of the uterus or cancer of the cervix require special types of treatment
which
may include a simple or radical hysterectomy. These women should seek
the counsel of a gynecologic oncologist, states the surgeon group.
Types
of Hysterectomy Procedures
The American College
of Surgeons explains that a woman may hear different names used to refer
to this type of operation. That is because there are different types
of hysterectomies.
A total hysterectomy(panhysterectomy)
applies only
to the removal of the uterus and cervix.
When the ovaries
and fallopian tubes on both sides of the
uterus are also removed, the procedure is called a hysterectomy and
bilateral salpingo-oophorectomy.
A radical hysterectomy
is a much more extensive procedure and is only performed in special
situations such as cancer of the uterus or cervix. It includes removal
of the uterus, cervix, and surrounding tissue, the upper vagina, and
usually the pelvic lymph nodes. A surgeon with special training in gynecologic
oncology performs this type of procedure.
Always consult your
physician for more information.
Online
Resources
Centers
for Disease Control and Prevention (CDC)
HealthierUS.Gov
National
Institutes of Health (NIH)
National
Library of Medicine
National
Women's Health Information Center
Office
of Research on Women's Health
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