Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial.
BACKGROUND
Although a quarter of US women undergo elective hysterectomy before menopause, controlled trials that evaluate the benefits and harms are lacking.


OBJECTIVE
To compare the effect of hysterectomy vs expanded medical treatment on health-related quality of life.


METHODS
A multicenter, randomized controlled trial (August 1997-December 2000) of 63 premenopausal women, aged 30 to 50 years, with abnormal uterine bleeding for a median of 4 years who were dissatisfied with medical treatments, including medroxyprogesterone acetate. The participants, who were patients at gynecology clinics and affiliated practices of 4 US academic medical centers, were followed up for 2 years.


METHODS
Participants were randomly assigned to undergo hysterectomy or expanded medical treatment with estrogen and/or progesterone and/or a prostaglandin synthetase inhibitor. The hysterectomy route and medical regimen were determined by the participating gynecologist.


METHODS
The primary outcome was mental health measured by the Mental Component Summary (MCS) of the 36-Item Short-Form Health Survey (SF-36). Secondary outcomes included physical health measured by the Physical Component Summary (PCS), symptom resolution and satisfaction, body image, and sexual functioning, as well as other aspects of mental health and general health perceptions.


RESULTS
At 6 months, women in the hysterectomy group had greater improvement in MCS scores than women in the medicine group (8 vs 2, P =.04). They also had greater improvement in symptom resolution (75 vs 29, P<.001), symptom satisfaction (44 vs 7, P<.001), interference with sex (41 vs 22, P =.003), sexual desire (21 vs 3, P =.01), health distress (33 vs 13, P =.009), sleep problems (13 vs 1, P =.03), overall health (12 vs 2, P =.006), and satisfaction with health (31 vs 14, P =.01). By the end of the study, 17 (53%) of the women in the medicine group had requested and received hysterectomy, and these women reported improvements in quality-of-life outcomes during the 2 years that were similar to those reported by women randomized to the hysterectomy group. Women who continued medical treatment also reported some improvements (P<.001 for within-group change in many outcomes), with the result that most differences between randomized groups at the end of the study were no longer statistically significant in the intention-to-treat analysis.


CONCLUSIONS
Among women with abnormal uterine bleeding and dissatisfaction with medroxyprogesterone, hysterectomy was superior to expanded medical treatment for improving health-related quality-of-life after 6 months. With longer follow-up, half the women randomized to medicine elected to undergo hysterectomy, with similar and lasting quality-of-life improvements; those who continued medical treatment also reported some improvements.
Kuppermann
Miriam
M
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143-0856, USA. kuppermannm@obgyn.ucsf.edu
Varner
R Edward
RE
Summitt
Robert L
RL
Learman
Lee A
LA
Ireland
Christine
C
Vittinghoff
Eric
E
Stewart
Anita L
AL
Lin
Feng
F
Richter
Holly E
HE
Showstack
Jonathan
J
Hulley
Stephen B
SB
Washington
A Eugene
AE
D000328:Adult; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007044:Hysterectomy; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D008875:Middle Aged; D017060:Patient Satisfaction; D017697:Premenopause; D011374:Progesterone / Q000627:therapeutic use; D011788:Quality of Life; D012725:Sexual Behavior; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000188:drug therapy* / Q000601:surgery*
D016861:Cyclooxygenase Inhibitors; D004967:Estrogens; D006728:Hormones; D011374:Progesterone; D017258:Medroxyprogesterone Acetate