Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects.
OBJECTIVE
To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding.


METHODS
Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital.


METHODS
204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women).


METHODS
Mental state, martial relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later.


RESULTS
Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome.


CONCLUSIONS
Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness.
Alexander
D A
DA
Department of Mental Health, Medical School, University of Aberdeen.
Naji
A A
AA
Pinion
S B
SB
Mollison
J
J
Kitchener
H C
HC
Parkin
D E
DE
Abramovich
D R
DR
Russell
I T
IT
D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D015907:Hysteroscopy / Q000523:psychology; D007398:Interpersonal Relations; D053685:Laser Therapy / Q000523:psychology*; D017060:Patient Satisfaction; D011182:Postoperative Care; D011446:Prospective Studies; D012725:Sexual Behavior; D014592:Uterine Hemorrhage / Q000523:psychology / Q000601:surgery*