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Obstet Gynecol. 2013 Jul;122(1):15-25. doi: //10.1097/AOG.0b013e318292aea4.

Contributions of hysterectomy and uterus-preserving surgery to health-related quality of life.

Author information

1
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143-856, USA. kuppermannm@obgyn.ucsf.edu

Abstract

OBJECTIVE:

To document the long-term effect of surgical interventions for noncancerous uterine conditions on health-related quality of life.

METHODS:

The Study of Pelvic Problems, Hysterectomy and Intervention Alternatives, conducted between 1998 and 2008, was a longitudinal study of 1,503 women with intact uteri experiencing abnormal uterine bleeding with or without leiomyomas, chronic pelvic pain, or pressure resulting from leiomyomas. Baseline and follow-up questionnaires included three condition-specific measures (Pelvic Problem Resolution, Pelvic Problem Impact Overall, and Pelvic Problem Impact on Sex) and five generic measures (Short Form-12 Mental and Physical Component Summaries, Current Health Utility, Feelings about Heath, and Satisfaction with Sex). We modeled changes over time in these patient-reported outcomes stratified by the most invasive treatment undergone (hysterectomy [13.7%], uterus-preserving surgery [9.0%], or nonsurgical therapy [77.3%]).

RESULTS:

Participants in all three groups reported significant improvement on all condition-specific measures and two of the five generic measures (Current Health Utility and Feelings about Health) from enrollment to final interview (all P values <.01). In general, greater improvements were experienced by women who had surgery. Trajectories modeled around the dates of surgery showed dramatic improvements after hysterectomy and, to a lesser degree, after uterus-preserving surgery. Although women who underwent uterus-preserving surgery tended to show immediate improvement, women who underwent hysterectomy experienced a 6-month delay in improvement in some outcomes with trajectories converging by 4 years postsurgery.

CONCLUSION:

Women seeking care for noncancerous uterine conditions can expect to experience improvement over time. Those who opt for surgery may experience most improvement. Understanding health-related quality-of-life trajectories may enhance counseling for women deciding between hysterectomy and alternative interventions.

LEVEL OF EVIDENCE:

II.

PMID:
23787923
DOI:
//10.1097/AOG.0b013e318292aea4
[Indexed for MEDLINE]

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