In the largest study ever undertaken to determine the effectiveness of hysterectomy, researchers at the University of Maryland School of Medicine have concluded that for the vast majority of women, the surgery offers significant relief of painful and debilitating gynecological symptoms that do not respond well to other treatments.
Of the 1300 Maryland women interviewed for the study, 92 percent reported a decrease in the severity of their symptoms after hysterectomy. In addition, these women reported less depression and anxiety, and an overall improvement in their quality of life. The study is published in the March issue of Obstetrics and Gynecology.
"This study should offer a great deal of reassurance to women who are considering a hysterectomy," says Dr. Kristen H. Kjerulff, Ph.D., associate professor of epidemiology at the University of Maryland School of Medicine, and principal investigator for the two-year study. "The findings indicate that for most women with chronic and severe gynecologic problems, hysterectomy does provide long term symptom relief."
Researchers assessed how the surgery affected a variety of symptoms, including vaginal bleeding, pelvic and back pain, urinary incontinence, and fatigue. The study also measured depression and anxiety before and after hysterectomy.
"Women reported substantial relief from all of these symptoms following surgery," says Dr. Kjerulff. "Two years later, most of the women were still feeling better, both physically and psychologically. Their quality of life had definitely improved."
Participants in the study reported dramatic improvements in every symptom category. Two years after hysterectomy, 97 percent of the women experienced no limitations on their day to day activities. Eighty-nine percent reported no significant pelvic pain, and 76 percent reported relief from urinary incontinence two years later.
Researchers also found a substantial decrease in depression and anxiety levels after hysterectomy. Nearly three-quarters of the women who were found to be depressed before surgery were no longer depressed two years later. In addition, 67 percent of the patients found to be anxious before hysterectomy had experienced relief from their anxiety two years after surgery.
A hysterectomy is the surgical removal of the uterus, and may also be accompanied by removal of the fallopian tubes and ovaries. Approximately 600,000 hysterectomies are performed in the United States every year, making it the most common major surgical procedure for women unrelated to pregnancy.
The leading cause of hysterectomies is uterine fibroids, benign tumors that can develop within the uterus. Hysterectomy is also used to treat malignant tumors. However, all of the women in the University of Maryland study were being treated for non-cancerous conditions.
A hysterectomy may also be recommended for the treatment of chronic menstrual disorders, or endometriosis, a condition in which the tissue that normally lines the uterus grows in other areas of the body, causing pain, bleeding or infertility.
Although 92 percent of the women in the study experienced relief from their symptoms, eight percent did not benefit from hysterectomy. Some of those women developed new symptoms or other problems after surgery. "It is important to recognize that hysterectomy is not an effective treatment for all women and some women may not be good candidates for the surgery," says Dr. Kjerulff.
By analyzing the demographic background of the study participants, researchers found two factors associated with poor patient outcomes. Women were less likely to benefit from hysterectomy if their household income was less than $35,000 or if they were being treated for emotional problems at the time of surgery. "We suspect that these women were under additional stress, which may have contributed to the severity of their symptoms," says Dr. Kjerulff.
An earlier study involving the same group of women found that sexual functioning improved dramatically following hysterectomy. Along with an increased desire for sex, women had sex more often, had better orgasms, and experienced less pain during intercourse. Results of that study were published in the November 24th issue of the Journal of the American Medical Association (JAMA).
Journal
Obstetrics and Gynecology