Well-being similar after total or partial hysterectomy

Women who have a hysterectomy for non-cancerous conditions seem to fare similarly well in terms of psychological well-being whether they have all or part of the uterus removed, a new study finds.

Studies have shown that rates of partial hysterectomies have been on the rise since the 1990s, in the U.S. and other countries. A total hysterectomy removes the entire uterus, while the partial procedure leaves the lower part of the uterus - the cervix - intact. Uterine fibroids benign - growths that, in some women, cause troublesome symptoms like persistent bleeding and chronic pelvic pain - are the most frequent reason for the procedure.

Some have speculated that one reason for the increase in partial hysterectomies is the belief that women tend to have a better quality of life after a partial, rather than total, hysterectomy.

A pair of influential Scandinavian studies from the 1980s suggested that because partial hysterectomy is less invasive, women may have better psychological and sexual outcomes in the long run, explained Dr. Par Persson of Uppsala University Hospital in Sweden, the lead researcher on the current study.

Still, partial hysterectomies have potential downsides, such as continued bleeding related to fibroids.

In their study, Persson and his colleagues found that among 179 hysterectomy patients they followed for one year, psychological well-being improved over time regardless of whether the women had undergone a partial or total hysterectomy.

And there was no evidence that one group fared better, on average, than the other, the researchers report in the British medical journal BJOG.

Most of the women in the study had undergone hysterectomy to treat fibroids: 94 women who underwent a partial hysterectomy and 85 who had the whole uterus removed. All patients underwent an abdominal hysterectomy, in which the uterus is removed through small cuts in the belly. Women were randomly assigned to receive one type of operation or the other, but they were told before the procedure which one they would have.

Before surgery, and again six months and one year afterward, the women completed four standard tests of psychological well-being, including measures of anxiety and depression symptoms.

On average, the researchers found, women in the two hysterectomy groups had similar scores on each test before surgery, and those scores improved to a similar degree over the year following surgery.

All of the average scores were within normal range, according to Persson.

There was one significant difference between the two groups in the study: 20 percent of partial hysterectomy patients complained of regular bleeding one year after surgery, versus one patient who’d had a total hysterectomy. One to three patients in each group complained of sexual dysfunction or pelvic pain at the one-year mark.

For women like these, Persson told Reuters Health in an email, the bottom line is that both partial and total hysterectomy are generally safe procedures that improve quality of life for the “vast majority of patients.”

Women considering a hysterectomy need to talk with their own doctors about whether a total or partial hysterectomy is right for them, said Persson.

SOURCE: BJOG, online January 14, 2010.

Provided by ArmMed Media