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Hysterectomy results in better outcomes than medicine for patients with abnormal uterine bleeding

After unsuccessful treatment with a common hormonal medication, women with abnormal uterine bleeding who underwent hysterectomies experienced greater improvement in their symptoms and expressed higher satisfaction with their overall health 6 months after treatment than women who were prescribed an alternate regimen of oral medication for the same condition, according to a recent study. The study, which was funded by the Agency for Healthcare Research and Quality (HS07373), was led by Miriam Kuppermann, Ph.D., M.P.H., of the Departments of Obstetrics, Gynecology, & Reproductive Sciences and Epidemiology & Biostatistics at the University of California, San Francisco.

Hysterectomy, or surgical removal of the uterus, is the most common major surgical procedure performed in the United States for nonobstetric reasons. In 2000, approximately 633,000 women had hysterectomies, 90 percent of which were performed prior to menopause for abnormal uterine bleeding and other non-life-threatening reasons. In the United States, about 5.6 per 1,000 women have hysterectomies, a rate that is three to four times higher than that of Australia, New Zealand, and most European countries. This difference, as well as regional variations within the United States, has raised questions about whether so many hysterectomies are necessary.

This study was the first randomized controlled trial to compare hysterectomy with oral medical treatment for abnormal uterine bleeding. Dr. Kuppermann and her collaborators from UCSF and four clinical centers across the United States examined differences in outcomes and satisfaction for 63 women ages 30 to 50 years who had experienced abnormal uterine bleeding for an average of 4 years and were dissatisfied with treatment by medroxyprogesterone, a hormone that is commonly prescribed for this condition. Half of the women in the study were randomly selected to have hysterectomies, and the other half were treated with an alternate regimen of oral medication selected by the women's gynecologists. All of the women were followed for 2 years.

The women who had hysterectomies experienced greater improvements in mental health, sexual desire and functioning, sleep, and overall satisfaction with health. Most of the improvement was evident within 6 months. By the end of the study, half of the women originally assigned to medical treatment had elected to undergo hysterectomies, and their improvement was similar to that of women who were assigned to have hysterectomies at the outset.

Women who were assigned to take the alternate medical regimen and who continued on medication for the entire 2-year study period also showed improvements, according to Dr. Kuppermann. She notes, however, that their improvements were smaller in magnitude than those of women who underwent hysterectomy.

The researchers had difficulty recruiting women for this trial due to the reluctance of many women to agree to be assigned randomly either to have a hysterectomy or not. However, the researchers note that there were enough participants to reveal significant differences in quality-of-life outcomes.

For more information, see "Effect of hysterectomy vs. medical treatment on health-related quality of life and sexual functioning: The Medicine or Surgery (MS) Randomized Trial," by Dr. Kuppermann, R. Edward Varner, M.D., Robert L. Summitt, Jr., M.D., and others, in the March 24/31, 2004, Journal of the American Medical Association 291(12), pp. 1447-1455.

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