Hysterectomy
Leads To Improved Symptoms And Satisfaction
Studies Compare
Medication Therapy To Surgical Procedure
Two new studies on
hysterectomy and quality of life conclude that, while there
is a place for surgery in easing abnormal bleeding, making this
choice usually depends on the individual woman.
The reports,
presented in the Journal of the American Medical Association
(JAMA), show that about 50 percent of the women
taking medication to control bleeding eventually had a hysterectomy
because of dissatisfaction with the more conservative therapy.
Hysterectomy, which
is the surgical removal of the uterus, is the most common major
surgical procedure performed in the US for non-obstetric
reasons, according to one of the study reports.
In 2000, about
633,000 hysterectomies were performed. Women in the US have
an estimated 25 percent risk of having their uterus removed.
The authors note that
usually a hysterectomy is elective and performed before
menopause for abnormal uterine bleeding and other non-life-threatening
reasons.
"It's kind of a judgment
call," says Dr. James R. Scott, co-author of an editorial accompanying
the two studies in JAMA. "It depends a lot
on the woman. A lot of women don't want surgery. Others say
they're just tired and want to get it done."
Research
Delves Into Satisfaction, Outcomes
There has been a great
deal of debate about whether this type of surgery is
performed too often. It is, after all, major surgery. It involves
significant recovery time, discomfort, and, like all surgery,
a small risk of death.
The studies may provide
new information that will lessen the negative reputation that
is sometimes associated with hysterectomy.
"Hysterectomy has
had a bad name, and it probably isn't as bad as has been implied
- by some, anyway," says Dr. Scott, who is also editor of Obstetrics
& Gynecology.
The first study randomly
assigned 63 premenopausal women with abnormal uterine bleeding
to receive either a hysterectomy or "expanded medical treatment,"
including hormone therapy.
The women, all of
whom had tried and stopped the hormone therapy medroxyprogesterone,
were followed for about two years to assess their mental health
and quality of life.
After six months,
women in the hysterectomy group showed greater improvements
in overall mental health than women in the medication treatment
group.
They also had greater
improvement in symptom resolution, symptom satisfaction, interference
with sex, sexual desire, health desire, sleep problems, overall
health, and satisfaction with health.
Interestingly, at
the end of two years, more than half (53 percent) of the women
in the medication group had requested and received a hysterectomy
and reported improvements.
Women who continued
with the medications also reported improvements, indicating
this course of action may eventually lead to improved quality
of life.
In sum, though, hysterectomy
seemed to come out ahead.
Women
Must Weigh Information, Choices
Dr. Miriam Kuppermann,
author of the first study, says, "Women who have abnormal bleeding
that have tried medicine and hasn't worked well, [then] hysterectomy
is a very good option for them - not that every woman should
have a hysterectomy." Kuppermann is an associate professor
of obstetrics, gynecology, and reproductive science at the University
of California San Francisco.
"For women who have
not been adequately treated by medicine, hysterectomy is a worthwhile
option to consider," she says.
On the other hand,
if a woman really does not want the operation, she can expect
to get some benefit from medications, Dr. Kuppermann adds.
Dr. Kuppermann points
out that the study was small and reflected the difficulty of
finding women to participate who were willing to be placed in
either group. She says it is "unclear" whether these women represent
the entire population of women choosing between medication and
surgery.
The second study,
taking place in Finland, compared levonorgestrel-releasing intrauterine
system (LNG-IUS) with hysterectomy in women with menorrhagia,
the medical term for unusually heavy menstrual bleeding.
Levonorgestrel is
a hormone. Leiras Co. (now Schering) provided the LNG-IUS free
of charge.
Here, the researchers
randomly assigned 236 women at five university hospitals in
Finland to be treated with the LNG-IUS or hysterectomy. All
women were monitored for five years.
The two groups were
similar in terms of health-related quality of life and psychosocial
well-being. As with the first study, however, a sizable proportion
(42 percent) of the women in the nonsurgical group eventually
opted for a hysterectomy.
Dr. Kuppermann says,
"I can speak more to the [San Francisco] Bay Area. Here, there
really has been an emphasis on trying every last thing before
resorting to hysterectomy. This [study] may have an impact.
It may introduce hysterectomy as an option earlier on.
"There are a lot of
choices," Dr. Kuppermann says. "Hysterectomy is a viable option.
There has been so much press about overuse, but realize that
for that situation, it is a very effective option."
Always consult your
physician for more information. |
May
2004
Hysterectomy
Leads To Improved Symptoms And Satisfaction
Research
Delves Into Satisfaction, Outcomes
Women
Must Weigh Information, Choices
Why
Is Hysterectomy Performed?
Types
of Hysterectomy Procedures
Online
Resources
Why
Is Hysterectomy Performed?
According to the American
College of Surgeons, hysterectomy may be performed
to treat a variety of gynecological (female reproductive
system) problems.
It is an elective
procedure 90 percent of the time. Today most hysterectomies
are done to treat
benign (non-cancerous) fibroid tumors of the uterus. While not
life-threatening, these growths cause pelvic pain, excessive
bleeding, or pain during sexual intercourse.
Fibroid tumors are
common
and usually do not require surgery. Other forms of treatment
which preserve the uterus and
childbearing capacity are also available.
A woman should discuss
these options with her surgeon.
Endometriosis is a
condition in which the tissue lining the uterus becomes displaced
and grows in
other parts of the abdomen, where it can cause pain. Endometriosis
is the second most common
reason for a woman to have a hysterectomy.
However, the practice
of treating endometriosis by performing hysterectomy has been
declining
in the last decade because other treatments have evolved. The
American College of Surgeons recommends that a woman discuss
other options with her surgeon first to see if another
treatment for endometriosis may be effective for her.
Prolapse of the uterus
is another reason why some women decide to undergo a hysterectomy.
In this condition, the uterus descends or sags into the vagina
due to stretching of the ligaments and
fibrous tissue that usually hold it in place.
Women with cancer
of the uterus or cancer of the cervix require special types
of treatment which
may include a simple or radical hysterectomy. These women should
seek the counsel of a gynecologic oncologist, states the surgeon
group.
Types
of Hysterectomy Procedures
The American College
of Surgeons explains that a woman may hear different names used
to refer
to this type of operation. That is because there are different
types of hysterectomies.
A total hsterectomy
(panhysterectomy) applies only
to the removal of the uterus and cervix.
When the ovaries and
fallopian tubes on both sides of the
uterus are also removed, the procedure is called a hysterectomy
and bilateral salpingo-oophorectomy.
A radical hysterectomy
is a much more extensive procedure and is only performed in
special situations such as cancer of the uterus or cervix. It
includes removal of the uterus, cervix, and surrounding tissue,
the upper vagina, and usually the pelvic lymph nodes. A surgeon
with special training in gynecologic oncology performs this
type of procedure.
Always consult your
physician for more information.
Online
Resources
(Our Organization
is not responsible for the content of Internet sites.)
Centers
for Disease Control and Prevention (CDC)
HealthierUS.Gov
National
Institutes of Health (NIH)
National
Library of Medicine
National
Women's Health Information Center
Office
of Research on Women's Health |
