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Three clinical characteristics double the likelihood of hysterectomy for women with common noncancerous pelvic conditions

Over 600,000 hysterectomies are performed on U.S. women each year, mostly for noncancerous conditions. A new study recently identified three clinical characteristics that predict the likelihood of subsequent hysterectomy. It found that women who suffered from both abnormal uterine bleeding and chronic pelvic pain or symptomatic uterine fibroids (with abnormal bleeding or pressure), who previously used gonadotropin-releasing hormone (GnRH) agonists, or who reported no resolution of their symptoms, were at least twice as likely to have a hysterectomy as other women.

Researchers examined the hysterectomy status of 734 women within 4 years of their seeking care at several California clinics and practices. The women had sought care for abnormal uterine bleeding, chronic pelvic pain, or symptomatic uterine fibroids. Nearly half (45 percent) of the women had suffered from symptoms for more than 5 years. Some of the women had already endured surgical removal of fibroids (myomectomy, 11 percent), removal of the uterine lining (endometrial ablation, 7 percent), and GnRH agonist treatment (10 percent).

A total of 99 women (13.5 percent) underwent hysterectomies during the 4-year study period. Study results following the 4-year study period showed that women with multiple pelvic symptoms or symptomatic fibroids had nearly twice the likelihood of undergoing hysterectomy. Women who had previously used a GnRH agonist were 2.5 times more likely to undergo the surgical procedure and those who had no symptom resolution were 2.2 times more likely to undergo hysterectomy. Women also had an escalating risk of hysterectomy with each additional risk factor. For example, predicted hysterectomy rates ranged from 20 percent, if all three clinical factors were absent, to 95 percent, if all three were present.

The study was supported in part by the Agency for Healthcare Research and Quality (HS09478, HS11657, and HS07373).

See "Predictors of hysterectomy in women with common pelvic problems: A uterine survival analysis," by Lee A. Learman, M.D., Ph.D., Miriam Kuppermann, Ph.D., M.P.H., Elena Gates, M.D., and others, in the April 2007 Journal of the American College of Surgeons 204, pp. 633-641.

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