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Hysterectomy substantially improves symptoms, physical functioning, and quality of life for some women

Hysterectomy can lead to substantial improvements for women suffering multiple and severe symptoms associated with gynecologic disorders, such as uterine fibroids (benign tumors), abnormal uterine bleeding, and endometriosis. However, for some women, hysterectomy does not relieve specific symptoms, and some even develop new symptoms or other problems after surgery, according to a study supported by the Agency for Healthcare Research and Quality (HS06865).

The study found that 8 percent of women who had hysterectomies had just as many symptoms or more severe symptoms 2 years after hysterectomy as they had before the surgery. However, these women were more likely to be in therapy for emotional problems at the time of surgery or to have a low household income (less than $35,000). These findings underscore the relevance of factors in patients' private lives that affect treatment effectiveness but of which gynecologists might not be aware, notes Kristen H. Kjerulff, M.S., Ph.D.

Dr. Kjerulff and colleagues at the University of Maryland School of Medicine prospectively studied 1,299 women who had hysterectomies for benign conditions at 28 Maryland hospitals. They documented symptoms, psychological functioning, and quality of life before surgery and at 3, 6, 12, 18, and 24 months after surgery.

Most of the women in this study reported substantial improvement in symptoms, quality of life, and psychologic function following hysterectomy, with no evidence of regression of improvement over 2 years. Whether the hysterectomy was done abdominally or vaginally or whether the women were on hormone replacement therapy following the operation had no impact on symptom relief. Trend analysis from 6 to 24 months after surgery showed significant reduction in pelvic pain, activity limitation, abdominal bloating, anxiety, and depression; substantial improvement in physical function; and borderline improvement in social function. In addition, about three-fourths of women who scored as depressed before hysterectomy were no longer depressed, and two-thirds of those who scored as anxious before the operation were no longer anxious 1 and 2 years later.

More details are in "Effectiveness of hysterectomy," by Dr. Kjerulff, Patricia W. Langenberg, Ph.D., Julia C. Rhodes, M.S., and others, in the March 2000 Obstetrics & Gynecology 95(3), pp. 319-326.

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