Hysterectomy Versus Medical Treatments For Abnormal Menstrual Bleeding
]]>Hysterectomy]]> is the surgical removal of the uterus, resulting in sterility, or the inability to become pregnant. It is the second most common major surgery among women in the United States. (The most common being ]]>cesarean section]]> delivery.) In the year 2000 alone, 633,000 hysterectomies were performed, more than 90% of which were in premenopausal women, as a way of treating abnormal menstrual bleeding and other non-life-threatening conditions.
Traditionally, the standard of care for treating abnormal menstrual bleeding (a collective term that includes such conditions as amenorrhea (the absence of menstrual periods), dysmenorrhea (painful menstruation), ]]>menorrhagia]]> (frequent, heavy menstrual bleeding) and irregular bleeding caused by hormonal imbalance) is treatment with hormonal therapy or non-steroidal anti-inflammatory drugs. However, for many women, these treatments either fail to relieve their symptoms, or cause intolerable adverse effects. This leads many premenopausal women to elect to have a hysterectomy. Unfortunately, early hysterectomy comes with its own set of risks and complications.
So, which of these two treatments actually works best for women suffering from abnormal menstrual bleeding? To answer this question, a group of researchers conducted a study designed to compare the effect of hysterectomy versus medical treatment on health-related quality of life in these women. The results of their study were published in the March 24/31 issue of The Journal of the American Medical Association. The study found that within the first six months, hysterectomy provides the greatest relief from symptoms and improvement in quality of life for women suffering from abnormal menstrual bleeding. However, the study also found that medical therapy, if continued for a period of two years or more, was just as effective.
About the Study
The study included 63 premenopausal women between the ages of 30 and 50, all of whom had suffered from abnormal menstrual bleeding for approximately four years and who were dissatisfied with their current medical treatments.
For the purposes of this study, abnormal menstrual blood flow was defined as any one of the following:
- More than seven days of flow per month
- ]]>Anemia]]> caused by heavy menstrual flow
- Previous unsuccessful treatment with a commonly prescribed hormonal treatment for abnormal menstrual bleeding
Each of the participants was randomly assigned to receive either a hysterectomy or expanded medical treatment with the hormones estrogen and/or progesterone, and/or another kind of medication called prostaglandin synthetase inhibitor. After two years, the researchers measured several aspects of each woman’s health-related quality of life, including mental health, physical health, symptom resolution and satisfaction, body image, and sexual functioning.
The study found that after six months, the women who had received hysterectomies reported greater overall improvement in all aspects of health-related quality of life than those who received expanded medical treatment. Additionally, by the study’s end, 17 (53%) of the women in the medication group had requested and received hysterectomies. By the end of the two-year follow-up period, these women reported improvements similar to those seen among the women who had received hysterectomies at the beginning of the trial.
Women who remained on medical treatment for the duration of the trial also reported some symptom improvements, enough so that by the end of study, the differences between the women who had received hysterectomies and those who received medical treatment were no longer statistically significant.
How Does This Affect You?
The researchers concluded that for women suffering from abnormal menstrual bleeding who were dissatisfied with the results of their current medical treatment, hysterectomy offered greater and faster symptom relief (within six months) than expanded medical treatment. Moreover, half of the women who continued to receive an expanded version of their medical treatment opted for hysterectomies.
Interestingly, a second study published in the same issue of the Journal , drew a different conclusion. In this study, researchers compared health-related quality of life issues in women suffering from menorrhagia who were treated with either an intrauterine hormone releasing device (a device placed in the uterus that releases small amounts of a hormone) or hysterectomy. The study found that the intrauterine device provided equal relief to hysterectomy, but at a fraction of the cost.
An editorial published in the same issue of the Journal, attempts to place these two studies in context. According to the author, both studies are important because they bring the issue of the use or overuse of hysterectomy to the fore, but larger studies with longer follow ups are needed before the question of whether, in the long run, medical treatments are as cost-effective as hysterectomies in the treatment of abnormal menstrual bleeding are answered.
National Institutes of Health (NIH)
Hurskainen R, Teperi J, Rissanen P. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia. JAMA. 2004;291:1456-1463.
Kuppermann M, Varner RE, Summitt RL, et al. Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning. JAMA. 2004;291:1447-1455.
Pitkin RM, Scott JR. Evaluating gynecological surgical procedures: trials and tribulations. JAMA. 2004;291:1503-1504.
Last reviewed March 26, 2004 by ]]>Richard Glickman-Simon, MD]]>
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