Hysterectomy for dysfunctional uterine bleeding

Medical experts generally recommend that hysterectomy should not be used to treat dysfunctional uterine bleeding until medical therapy has failed.^{1, 2} The cause of the bleeding should be thoroughly evaluated with tests such as an endometrial biopsy before hysterectomy is considered. Hysterectomy is used as surgical treatment for dysfunctional uterine bleeding when:

• Dysfunctional uterine bleeding does not respond to medicine or other treatment. These options include taking a nonsteroidal anti-inflammatory drug (NSAID) or progestin, using a progestin IUD (Mirena), or endometrial ablation.
• Childbearing is completed and you do not wish to try treatment with medicine.
• Symptoms of dysfunctional uterine bleeding outweigh the risks and discomforts of surgery.

The size, location, and involvement of other abdominal organs determines which type of hysterectomy is most appropriate.

Removal of the ovaries (oophorectomy) may be required; for example, when ovarian hormones are making other conditions worse, such as endometriosis or ovarian cysts. When the ovaries are removed, estrogen replacement therapy (ERT) is usually prescribed to take the place of the hormone cycle and protect against osteoporosis risk, at least until menopausal age.

How effective is it?

Hysterectomy is a successful technique for the treatment of dysfunctional uterine bleeding.³ But it is usually reserved for women who have tried other treatments first.

What else should I know?

An accurate diagnosis is essential to the successful outcome of a hysterectomy. If your symptoms are not accurately diagnosed, a hysterectomy may not relieve your symptoms.

Citations

1. Mishell DR Jr, et al. (2001). Abnormal uterine bleeding. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 1079–1097. St. Louis: Mosby.

2. Speroff L, Fritz MA (2005). Dysfunctional uterine bleeding. In L Speroff, MA Fritz, eds., Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 548–571. Philadelphia: Lippincott Williams and Wilkins.

3. Kuppermann M, et al. (2004). Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: The medicine or surgery (Ms) randomized trial. JAMA, 291(12): 1447–1455.