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Updated: Feb 8th, 2012 - 06:46:21 |
Hysterectomy and Other Treatments for Uterine Conditions
More than 500,000 hysterectomies are performed in the United States each year at an annual cost of more than $5 billion. More than one-third of women in the United States have had a hysterectomy by age 60.
The most common reason for hysterectomy for women of any age continues to be fibroid tumors, which in the mid-1990s accounted for about one-third of all hysterectomies (nearly two-thirds for black women). Other reasons for hysterectomy include endometriosis (about 18 percent), uterine prolapse (16 percent), excessive bleeding (5 percent), and other causes (10 percent).
- Type of hysterectomy does not affect sexual functioning and quality of life 2 years later.
Women who undergo supracervical hysterectomy (cervix is left in place) or total abdominal hysterectomy (cervix is removed) achieve similar sexual functioning and quality of life 2 years after the procedure, according to this study of 135 premenopausal women who underwent hysterectomy in one of four U.S. clinical centers. At 6 months postsurgery, sexual problems had improved dramatically in both groups, and at 2 years the women reported few problems in this area. Both groups also had substantial improvement in most other quality of life measures.
Kuppermann, Summit, Varner, et al., Obstet Gynecol 105(6):1309-1318, 2005; see also Learman, Summitt, Varner, et al., Obstet Gynecol 102:453-462, 2003 (AHRQ grant HS09478).
- Hysterectomy offers better outcomes than medicine for women with abnormal uterine bleeding.
This randomized controlled trial of women aged 30 to 50 who had abnormal uterine bleeding for an average of 4 years found that those in the hysterectomy group had greater improvement in their symptoms and expressed higher satisfaction with their overall health 6 months after treatment than women in the oral medication group.
Kuppermann, Varner, Summitt, et al., JAMA 291(12):1447-1455, 2004 (AHRQ grant HS07373).
- Long-term outcomes are similar for women who either have a hysterectomy or go through natural menopause.
This is the first study to examine the long-term impact of hysterectomy on quality of life. The researchers found no difference in quality of life between women who had a hysterectomy (with or without ovary removal) an average of 27 years earlier and women who had a natural menopause 25 years earlier. The study involved 801 women aged 50-96 who were interviewed between 1992 and 1996.
Kritz-Silverstein, Von Muhlen, Ganiats, and Barrett-Connor, Qual Life Res 13:55-62, 2004 (AHRQ grant HS06726).
- Several factors influence women's satisfaction with use of medication to treat abnormal uterine bleeding.
Factors such as age, fertility status, attitudes about uterine conservation, and intensity of symptoms affect premenopausal women's satisfaction with use of oral medroxyprogesterone acetate to control bleeding.
Richter, Learman, Lin, et al., Am J Obstet Gynecol 189:37-42, 2003 (AHRQ grant HS9478).
- Study finds racial differences in treatment and outcomes of women undergoing surgery for uterine fibroids.
The researchers examined the medical charts of 225 women (53 percent black, 47 percent white) who underwent abdominal myomectomy for fibroid tumors at one medical center between 1992 and 1998. Black women were more than twice as likely as white women to have in-hospital complications or a blood transfusion. These increased complications were largely due to differences in uterine size and number of fibroids.
Roth, Gustilo-Ashby, Barber, and Myers, Obstet Gynecol 101:881-884, 2003 (AHRQ grant HS09874).
- Endometrial ablation does not substitute for hysterectomy.
Using the State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project, investigators accessed data on women with benign uterine conditions who underwent hysterectomy or endometrial ablation. In the six States studied, from 1990 to 1997, increases in endometrial ablation rates did not mirror decreases in hysterectomy rates. Results show endometrial ablation was used as an additive medical technology rather than as a substitute for hysterectomy.
Farquhar, Naoom, and Steiner, Int J Technol Assess Health Care 18(3):625-634, 2002. (Reprints, AHRQ Publication No. 03-R004).*
- Study shows life satisfaction improves after hysterectomy.
In a 1992 survey, women were asked to rate their life satisfaction as better, the same, or worse after menopause or hysterectomy. Women who were 20 or more years posthysterectomy or postmenopause were significantly more likely to reply "better" than women 5 or fewer years after these events. Among women with a hysterectomy, 53 percent with oophorectomy and 60 percent with ovarian conservation rated life better after the surgery. Only 42 percent of women who had not had a hysterectomy rated life satisfaction as better after menopause.
Kritz-Silverstein, Wingard, and Barrett-Connor J Womens Health and Gender-Based Med 11(2):181-190, 2002 (AHRQ grant HS06726).
- U.S. hysterectomy rates stayed constant but the type of surgery changed.
An analysis of 1990-1997 hospital discharge data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project revealed that over the study period, rates of hysterectomy for benign uterine conditions remained about the same, abdominal hysterectomy remained the most common procedure, and laparoscopic hysterectomies increased 30-fold.
Farquhar and Steiner, Obstet Gynecol 99(2):229-234, 2002. (Reprints, AHRQ Publication No. 02-R049)* (Intramural).
- Study reveals effects of hysterectomy on UI.
Using the Urinary Symptom Scale for Women, researchers interviewed 1,299 women to assess incontinence before and after hysterectomy. Responses indicate that UI improves for the first 2 years after surgery for most women who have moderate or severe incontinence. According to researchers, women who had mild or no incontinence before hysterectomy had a 10 percent risk of worse or new-onset incontinence after surgery.
Kjerulff, Langenberg, Greenaway, et al., J Urol 167:2088-2092, 2002 (AHRQ grant HS06865).
- Report describes evidence on management of uterine fibroids.
Researchers at the Duke EPC reviewed the available evidence on the commonly used medical and invasive therapies for uterine fibroids and found the overall quality of the literature to be poor and inconsistent. They did, however, find good evidence that use of gonadotropin-releasing hormone agonists prior to surgery reduces blood loss and may facilitate certain surgical approaches (e.g., use of laparoscopic or vaginal approaches or use of transverse abdominal instead of vertical incisions). They also found that 2-year outcomes are favorable for most women who undergo hysterectomy.
Copies of Evidence Report/Technology Assessment No. 34, Management of Uterine Fibroids (AHRQ Publication No. 01-E051 summary and 01-E052, full report), are available from AHRQ (contract 290-97-0014).*
