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The benefits of hysterectomy THE BENEFITS OF HYSTERECTOMY
The research team was surprised to find how strikingly beneficial hysterectomy was for symptom relief, and concluded that 'hysterectomy was associated with more marked improvement in symptoms and quality of life than nonsurgical therapy'. The women who had hysterectomies reported significant relief from bleeding problems, pelvic and back pain, pain during intercourse, abdominal swelling and urinary problems. Those who felt they benefited most from the surgery were those who had been most impaired by their symptoms. This impairment took the form of persistent discomfort or limitations on activity.
The study also found much lower rates of adverse effects of hysterectomy than expected. Earlier studies had reported problems with passing urine in 20-30% of women after hysterectomy, but the Maine study found this occurred in only 4%. Other studies have reported diminished sexual function in 15-30%, but although 7% of the Maine women reported being bothered by less interest in sex after their hysterectomy, only 1% reported less enjoyment of sexual activity, and the majority reported increased interest in, and enjoyment of, sex. Persistence of pelvic pain after hysterectomy has been reported to occur in 22% of women, but in Maine the figure was 5%. Importantly, 82% of women in the Maine study felt they had a choice about having the hysterectomy and, for most, six or more months elapsed between the decision to have surgery and the actual operation.
As a check on possible biases that might explain these sorts of findings, the Maine study authors looked at eligible patients who were not referred by their doctors to participate in the trial. They found that patients not in the study were more likely to feel that they had no choice about having a hysterectomy, and their mental health assessments were less positive than those of the women who had participated. It is possible that doctors selectively referred patients to the trial who were more involved in the treatment strategy and in a better state of mental health. It is also possible that improvements in surgical techniques and post-operative care are responsible for the more positive results that seem to be occurring. In the light of these uncertainties, the authors recommended that their study be repeated in other parts of the US.
Recent Australian research on the outcomes of hysterectomy has also found high levels of satisfaction among women having the operation, although this was tempered by the belief that some new symptoms had arisen which were caused by the surgery itself. Research by an Australian team from the University of Newcastle and Macquarie University, published in the British Journal of Obstetrics and Gynaecology in 1991, asked women who had had a hysterectomy between two and ten years earlier to describe the impact of their experience. Of 175 women interviewed, 97% said the hysterectomy was worth the trouble and 88% said they would recommend a hysterectomy to others with similar problems, given their experience of it. The single most important benefit for 32% of the women was relief from heavy periods; for 25% it was relief from pain or painful periods; and for 4% it was improved emotional well-being.
An earlier Australian study, in which over 800 women who had had a hysterectomy (abdominal or vaginal) in New South Wales in 1976 or 1977 responded to a questionnaire, found that only about half were enthusiastic or very pleased that they had undergone the procedure. About 11% were not satisfied with the outcome of the operation and almost 12% complained of poor doctor or nurse communication. Post-operative recovery was frequently longer than expected, with 70% requiring up to three months for a return to normal activities and 16% more than six months. One impact that favourably impressed many women was sexual function, one-third indicating that this had improved after hysterectomy, while 3% reported a deterioration.
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