Hysterectomy is more for the use o...

Hysterectomy is more for the use of all in the United States than in other unfolded countries, with considerable regional variation. Observational studies have reported improvement in sexual function and quality of life after hysterectomy, however this procedure also can originate in early ovarian failure, incontinence in later life, and death. In this randomized trial, Kuppermann and colleagues compared a medical and a surgical approach to the treatment of uncontroll abnormal uterine bleeding in women whose symptoms persisted despite medical treatment for a median of four years.

Premenopausal women 30 to 50 years of age with abnormal uterine bleeding who were treated previously with cyclic medroxyprogesterone were randomized to further medical treatment or hysterectomy and followed for couple years. Outcome measures included health-related quality of life, symptom resolution, dead body image and sexual function, and psychologic distress and well-being.

Sixty-three women who failed to improve with medroxyprogesterone treatment were assigned randomly to receive expanded medical treatment or hysterectomy. The former clump received a variety of treatment regimens; in the latter assign places to some women had abdominal hysterectomy, and an had vaginal hysterectomy. At four weeks, the patients who had hysterectomy experienced a decrease in physical health further had a somewhat higher mental health score than those in the medical groups

At six month the surgery dispose reported significantly greater improvement in quality of life, symptom resolution, satisfaction with stage of symptom resolution, sexual function and desire, and other parameters. These improvements were maintained after sum of two units years, at which time the medical collection also experienced improvements. The barely remaining difference between groups was an increase in sexual desire that favored the surgery clump However, by the end of brace years, 53 percent of the women had afflictioned over to the hysterectomy assemblage with significant improvements in quality of life and in 11 of the 13 other measured results compared with no significant improvements in quality of life if it be not that improvements in seven of 13 other issue measures in women who stayed with medical management.

The authors determine that, with respect to issues such as quality of life and mental health, women who have hysterectomies for refractory abnormal uterine bleeding do better than women who are treated medically. This difference is substantial, particularly at six month before the mass of medical group crossover to hysterectomy occurr in this close attention This improvement was attenuated at brace years, and the difference between disposes was nonsignificant in quality-of-life measures by the agency of the end of the studious mood However, many women in the medical arrange eventually opted for hysterectomy. equable so, many of the women who did not cros through to surgery experienced significant improvement in a variety of issue measures.

CAROLINE WELLBERY, MD

Kuppermann M et al., for the M Research form into groups Effect of hysterectomy vs medical treatment forward health-related quality of life and sexual functioning. The medicine or surgery (Ms) randomized trial. JAMA March 24/31 2004;291:1447-55

COPYRIGHT 2005 American Academy of Family Physicians

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