Women who opt for drug treatment rather than hysterectomy because of abnormal uterine bleeding have about an even chance of having the surgery anyway later on, according to studies.
If the findings can be applied to the general population, then even if women who suffer from uterine bleeding stay on conservative therapy with drugs, half of them end up getting a hysterectomy, said two experts who reviewed the studies.
“Does it mean that surgery will likely be necessary eventually anyway, so perhaps better sooner than later, sparing the woman continued symptoms? Or does it mean that there is a 50 percent chance of avoiding the hysterectomy and these odds are worth taking to avoid a major operation?” asked physicians Roy Pitkin of the University of California, Los Angeles, and James Scott of the University of Utah in Salt Lake City.
Quality of life improvement
Their comments, in an editorial in the Journal of the American Medical Association, where the studies were published, concluded with a suggestion that more clinical trials are needed “to determine whether these (or other) more conservative treatments are more efficacious and cost-effective in the long run than hysterectomy.”
One study published in the journal, from the University of California, San Francisco, involved 63 premenopausal women with abnormal uterine bleeding that either underwent hysterectomies or were treated with hormone therapy.
The study found that hysterectomy “results in substantial improvement in health-related quality of life within six months for women who have not responded to (drug therapy).”
But it said persisting with drug treatment “can also produce benefits for many of these women throughout the ensuing two years (they were studied) although others who prolong (drug) treatment at this stage will decide within a year to have a hysterectomy.”
Most common surgery
The second study from Finland’s Helsinki University Hospital looked at 236 women being treated for heavy bleeding over a period of five years, to compare hysterectomy with a treatment that involves an intrauterine system releasing small doses of the drug levonorgesterel.
After five years, the two groups did not differ substantially in terms of quality of life or psychosocial well-being, the authors said. Forty-two percent of the women in the drug treatment group, however, eventually underwent hysterectomy.
Hysterectomy, in which the uterus is removed, is the most common major surgical procedure performed in the United States for reasons other than childbirth, according to the study from California. U.S. women run about a 25 percent risk of having their uterus removed, it added.
