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Formula May Predict Hysterectomy Need

Study: Women With Multiple Uterine Symptoms at Higher Risk
By
WebMD Health News
Reviewed by Louise Chang, MD

April 11, 2007 -- More than 600,000 hysterectomies are performed in the U.S. each year, and now new research can help predict a woman’s chance of needing the surgery.

The study confirmed that women are more likely to have hysterectomies when they have more than one pelvic symptom causing discomfort or have symptoms that do not get better with other treatments.

University of California, San Francisco professor of gynecology Lee A. Learman, MD, PhD, one of the researchers, says the findings will help doctors better counsel women with pelvic problems.

“Asking just a few simple questions can determine a patient’s risk of having a hysterectomy over the next several years,” he tells WebMD.

3 Predictors = High Risk

Researchers followed 734 premenopausal women who had sought treatment for heavy menstrual bleeding, chronic pelvic pain, or symptomatic uterine fibroids. None of the symptoms were caused by cancer. The women were followed for four years, during which time 99 had hysterectomies.

Learman and colleagues identified three independent predictors of an increased likelihood of hysterectomy: having a combination of symptoms, such as pelvic pain and heavy bleeding; not responding to earlier treatments; and previous use of drugs called gonadotropin-releasing hormone agonists (GnRH agonists) such as Lupron.

Women in the study with all three predictors had a 95% chance of having a hysterectomy during the four years of follow up, compared with a 20% chance among women with no predictors.

The more predictors a woman had, the greater her chances of having her uterus surgically removed. Socioeconomic status and duration of symptoms were not predictors of hysterectomy, nor was a history of having had other surgical procedures, such as myomectomy or endometrial ablation.

The study is published in the April issue of the Journal of the American College of Surgeons.

Learman says the findings should reassure women with just a few risk factors, and they could help those with a high likelihood of hysterectomy avoid years of pain and discomfort.

Hysterectomy Works

The newly reported research is part of a larger UCSF study of treatments for gynecologic pelvic problems, in which 1,500 premenopausal women are being followed for four to eight years.

Despite the fact that surgical removal of the uterus has been among the most widely performed surgeries in women since the 1960s, it has only been within the last decade that studies have confirmed its usefulness, Learman says.

“There is a big story to tell about hysterectomy, and it has to do with educating patients about what we have learned within the last 10 years,” he says. “We now know that hysterectomy works extremely well for most women who have symptoms severe enough to need treatment.”

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