Surgery vs. Medication for Heavy Periods?

Most Women Do Better With Hysterectomy, Studies Show

From the WebMD Archives

March 23, 2004 -- Women who have hysterectomies to stop heavy periods may do better than those who continue with medication, new research suggests. But the findings do not mean that surgery is the best choice for everyone.

In two newly published studies, roughly half of the women taking medication to control heavy periods ended up having hysterectomies because they were unhappy with treatment. But a substantial percentage of women who continued on drugs reported improvements, as well. The studies are published in the March 24/31 issue of TheJournal of the American Medical Association.

"No matter which option a woman chooses, treating this uterine condition can have a profound impact on all aspects of her health-related quality of life," researcher Miriam Kuppermann, PhD, tells WebMD. "Women who chose hysterectomy can expect a very positive outcome. But those who want to persist with expanded medical treatment may also improve."

The Studies

Hysterectomy is one of the most common major surgeries performed in the U.S., with more than 600,000 American women having the procedure each year. The vast majority of these women chose to have their uterus removed by surgery because of abnormally heavy periods or other non-life-threatening problems, before menopause.

Kuppermann and colleagues from the University of California, San Francisco, studied 63 women with heavy periods who already had been treated with a variety of medications prior to the study. Each woman either took more aggressive medical treatment or had a hysterectomy. The women were followed for a period of two years. Each woman was assigned a score based on mental well-being, symptom resolution, sexual interest and satisfaction, ability to sleep, and overall satisfaction with health.

Six months into the study, the women in the hysterectomy group scored better than those in the drug-treatment group. By the end of the two-year follow-up period, 53% of the women in the drug treatment group had requested and received hysterectomies. They reported improved symptom scores after undergoing hysterectomies.

Women who opted to continue on medication also reported improvements at the end of the two-year period. The researchers report that differences among the groups were minimal by the end of the two-year trial.

In the second study, researchers from Finland's Helsinki University Hospital looked at 232 women treated for heavy periods. Half the women had hysterectomies while the other half were treated with a hormonal contraceptive inserted into the uterus.

After five years of follow up, the two groups did not differ substantially in terms of quality of life or mental well-being, but 42% of the women originally assigned to the contraceptive group had decided to have hysterectomies. The researchers report that treatment satisfaction in both groups was similar.

Half Empty or Half Full?

In an editorial accompanying the two studies, ob-gyns Roy M. Pitkin, MD, and James R. Scott, MD, write that the findings could be viewed as a case of the glass being half empty or half full.

"Does it mean that surgery will likely be necessary eventually anyway, so perhaps better sooner than later?" they write. "Or does it mean that there is a 50% chance of avoiding hysterectomy and these odds are worth taking to avoid a major operation? Inevitably, different patients and different physicians will give different answers to this question."

Pitkin, professor emeritus at UCLA, tells WebMD that the two new studies will help doctors better inform women about their treatment options.

"How a woman views these results is very likely to be affected by what she already thinks about surgery vs. other treatments," he says. "Many patients are very open to the idea of surgery and others are not."

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SOURCES: Kuppermann, M.; Hurskainen, R. The Journal of the American Medical Association, March 24/31, 2004; vol 291: pp 1456-1464. Miriam Kuppermann, PhD, MPH, associate professor of obstetrics, gynecology and reproductive sciences, University of California, San Francisco. Roy Pitkin, MD, professor emeritus, UCLA.
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