March 14, 2000 (New York) -- Women who have a hysterectomy in Maryland for a non-cancerous condition usually get relief from the symptoms that caused them to seek the procedure, according to a new study in the March issue of the journal Obstetrics & Gynecology. Hysterectomies for cancerous conditions were not studied.
Kristen H. Kjerulff, MS, PhD, the study's lead author, says that the study applies largely to women who have symptoms such as bleeding, bloating, and/or pelvic pain -- symptoms that a hysterectomy has the potential to help address. Kjerulff is associate professor of epidemiology and preventive medicine at the University of Maryland School of Medicine in Baltimore.
But don't make that appointment with your ob/gyn just yet. Kjerulff tells WebMD that this finding may not prove relevant in states where doctors overuse hysterectomy. Maryland has one of the lowest hysterectomy rates in the U.S.
"Women do feel better [and] report substantial improvements by and large that are maintained two years out," says Kjerulff. "We thought that there might be a honeymoon period, but these benefits held up two years after the surgery." However, she stopped short of saying the study recommends performing hysterectomy for all women because there is wide variation in how and when doctors perform hysterectomies. "I don't know if these results are replicable in places where hysterectomies are more common," she says.
In the study, researchers followed for two years nearly 1,300 women who were scheduled to have a hysterectomy for a non-cancerous condition at 28 hospitals across Maryland. The authors assessed symptoms of vaginal bleeding, pelvic pain, fatigue, back pain, abdominal bloating, sleep disturbance, urinary incontinence, and activity limitation before surgery at different intervals during the two years after surgery.
However, hysterectomy did not relieve symptoms for some women, most notably those women with lower incomes, women in psychological therapy, and women with children under age 18 living in their home. Speculating on why low-income women might do worse, Kjerulff says that "they are often in very chaotic life situations," with poverty being an enormous stress in their lives.
Based on her findings, Kjerulff says, "women who are clinically depressed may not be good candidates for hysterectomy. Symptoms might be caused by distress rather than gynecological problems." Yet the study showed that approximately 25% of women evaluated before having a hysterectomy showed evidence of clinical depression.
The study was not designed to determine whether the depression was long term or just in anticipation of the surgery. And the authors did not look at whether women were taking antidepressants. However, one variable that stood out was that women in psychological therapy tended to report less symptom relief.
Another key finding is that women who had their ovaries removed during the hysterectomy had worse outcomes two years later, a finding that Kjerulff says "could not be explained."
In an interview with WebMD, Judy Levison, MD, says that based on the study and her own clinical experience, patients with chronic pelvic pain are among the hardest patients to assess for a hysterectomy because there are so many possible causes for the pain. Levison, an obstetrician/gynecologist in Houston, says the study lumped very different types of pain into one category, and therefore didn't give a good answer about how best to manage each type of chronic pelvic pain.
Levison is especially concerned about depressed women who consider hysterectomy to relieve symptoms. "They should be counseled well because a hysterectomy may not cure them," she says.
Kjerulff says, "Women who have symptoms should try every potential therapy before they resort to hysterectomy. Hysterectomy is still major surgery and involves a long recovery. If they have tried everything and they still feel their symptoms impact on their quality of life," she says it is reasonable to consider hysterectomy.
- In a study in Maryland, women who underwent hysterectomy for noncancerous conditions reported substantial improvements in symptom relief and quality of life.
- The rate of hysterectomy in Maryland is relatively low, so researchers cannot say that the results can be applied to other regions where the procedure may be overused.
- Women who are symptomatic should try every potential therapy before considering hysterectomy, and those who are depressed may not be good candidates for the surgery.