Self-reported long-term outcomes of hysterectomy

Article Abstract:

Hysterectomy (removal of the uterus) is a common major operation that is carried out on 17 percent of women in the US, mainly for abnormal menstrual bleeding, fibroids (benign tumors), and genital prolapse (collapse of the uterus into the vagina). As many as half the women who undergo hysterectomy will develop complications, such as urinary tract infection, pain during intercourse, and increased rates of coronary artery disease. To learn more concerning the attitudes toward hysterectomy of women who have had one, a study of a sample of 236 former patients was carried out. The study, performed in Australia, consisted of two parts: a 20-minute telephone interview concerning the respondent's demographic characteristics, reasons for hysterectomy, and perceived benefits and problems; and a 28-item questionnaire of the format 'Agree-Disagree'. Ninety-one percent of the subjects were married or living as married. The most commonly perceived medical reason for hysterectomy was bleeding or pain; the most common personal reasons included 'fed up with symptoms' or doctor's recommendation. The benefit of the procedure most often cited was relief from heavy menstrual periods; pain relief, relief from painful periods, and better emotional well-being were also mentioned. Most symptoms (66 percent), including pain, incontinence, pain during sex were improved by the operation, but 59 percent of the women reported worse or new symptoms after hysterectomy. Ninety percent of the women were satisfied with various aspects of the doctor-patient relationship, but less satisfaction was reported for some items, such as the pain of the procedure and the difficulty of recovery. Ninety-five percent of the respondents said they would undergo the procedure again if circumstances were the same. Satisfaction with treatment and recovery was higher among women with fewer than three children; women under 50 at the time of surgery; and when symptoms were seen as serious. These results suggest that more careful examination of patients' reasons for hysterectomy is warranted before the procedure is undertaken. (Consumer Summary produced by Reliance Medical Information, Inc.)

Women, Complications and side effects, Surgery, Beliefs, opinions and attitudes, Uterus

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The place of oophorectomy at vaginal hysterectomy

Article Abstract:

Removal of the ovaries (oophorectomy) in women undergoing hysterectomy (removal of the uterus) may be performed to prevent the development of ovarian cancer. This surgery is routinely performed in the UK, according to one study, in 85 percent of the cases that involve postmenopausal women. However, oophorectomy is carried out less often during vaginal hysterectomy (removal of the uterus through the vagina) than during hysterectomy accomplished by abdominal incision. The author reports results from studying 740 women who underwent vaginal hysterectomy with attempted vaginal oophorectomy, and 700 women who underwent vaginal hysterectomy only. Technical details of the vaginal oophorectomy procedure are presented. The women were offered prophylactic oophorectomy if they were postmenopausal, more than 45 years old but still menstruating, or more than 40 years old with a family history of ovarian cancer or certain other ovarian abnormalities. Results showed that the procedure was successful in 702 of the 740 cases; in 38 cases, removal of both ovaries was not possible. The most important factor that influenced the success of vaginal oophorectomy was the presence of disease of the fallopian tubes or ovaries. Other significant factors were obesity, whether the woman had borne children (a more difficult procedure in those who had not had children), the size of the pelvic space, the position of the uterus, and the ease of access through the vagina. These are discussed in some detail. Vaginal oophorectomy is safe and appropriate at the time of vaginal hysterectomy when carried out by an experienced surgeon. When women undergo vaginal hysterectomy, the decision concerning prophylactic removal of the ovaries should be based on whether the ovaries would be removed if the hysterectomy were carried out via the abdominal route. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Ovariectomy

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