Multiple symptoms predict need for hysterectomy

hree factors - numerous symptoms; a lack of symptom resolution; and the previous use of hormone treatment - can be used in a simple strategy to predict whether women with pelvic health problems will eventually require a hysterectomy, gynecologists report.

Dr. Lee A. Learman of the University of California, San Francisco, and colleagues found that 95 percent of women with all three factors required a hysterectomy within 4 years.

In contrast, women with none of these symptoms had only a 20 percent chance of requiring a hysterectomy, the researchers report in the Journal of the American College of Surgeons.

Based on these findings, women who are likely to need the procedure can decide to have it earlier rather than later, while those at little risk can be told that they are likely not to require hysterectomy, Learman and his team conclude.

There are a growing number of alternative treatments for pelvic problems, including strategies to remove the lining of the uterus, surgical removal of fibroids, and hormone-releasing uterine implants, the researchers note. But these therapies aren't effective for every woman, and many may require hysterectomy anyway after years of trying other approaches.

To investigate predictors of hysterectomy, the researchers followed 762 women with abnormal uterine bleeding, chronic pelvic pain, or uterine fibroids (or two or three of these symptoms) for four years.

Women with multiple symptoms were nearly 2 times as likely to require hysterectomy. Those who were treated with gonadotropin-releasing hormone (GnRH) blockers were 2.5 times as likely to have their uterus removed. And women with unresolved symptoms were more than 2 times as likely to undergo hysterectomy.

While women generally put off hysterectomy as long as possible, Learman notes in a press release accompanying the study, they usually will experience a great improvement in quality of life after having the surgery.

"Ten years ago, we had to say we didn't know whether women were better off or not, but now we do know. When women have a hysterectomy because of bleeding, pain or bulky fibroids, we now know that they do extremely well."

SOURCE: Journal of the American College of Surgeons, April 2007.