title: Hysterectomy status, estrogen use and quality of life in older women: the Rancho Bernardo study.
abstract: OBJECTIVE
  To examine the long-term effects of hysterectomy and use of estrogen replacement therapy on health related quality of life and symptom subscales in community dwelling postmenopausal women.
  
  
  METHODS
  Information on menopausal history including hysterectomy and oophorectomy status, and history of estrogen use was obtained from a sample of 801 women aged 50-96 years at a clinic visit between 1992 and 1996. Within 1 week of the clinic visit, a standardized, validated quality of well-being (QWB) scale was administered over the telephone by a trained interviewer.
  
  
  RESULTS
  Among these women, 25.2% reported hysterectomy with bilateral oophorectomy an average of 28 years earlier, and 11.0% reported hysterectomy with ovarian conservation an average of 26.5 years earlier. Age-adjusted comparisons indicated that women with natural menopause had slightly higher total QWB scores and lower symptom subscale scores than women in either of the hysterectomy groups (p's = 0.06). However, after additional adjustment for estrogen use and other potentially confounding covariates, there was no significant difference in total QWB score or on any subscale scores by hysterectomy and oophorectomy status. After adjustment for age, women who never used estrogen had significantly higher total QWB scores (p = 0.03) and significantly lower symptom subscale scores, indicating fewer symptoms, than those who were past or current users (p = 0.01). These differences persisted after adjustment for age, type of menopause, and behavioral and lifestyle covariates (p's = 0.008).
  
  
  CONCLUSIONS
  There are no long-term adverse effects of hysterectomy or bilateral oophorectomy on health related quality of life. Lower total QWB and greater symptom subscale scores by women currently using estrogen may reflect an adverse effect of hormone use on health related quality of life in older postmenopausal women.
authors.affiliation: Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, CA, USA. dsilverstein@ucsd.edu
authors.forename: Donna
authors.initials: D
authors.lastname: Kritz-Silverstein
authors.forename: Denise G
authors.initials: DG
authors.lastname: Von Muhlen
authors.forename: Theodore G
authors.initials: TG
authors.lastname: Ganiats
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008875:Middle Aged; D010052:Ovariectomy / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data; D017698:Postmenopause / Q000523:psychology*; D011788:Quality of Life; D018434:Sickness Impact Profile; D016387:Women's Health