The impact of alternative treatment for abnormal uterine bleeding on hysterectomy rates in a tertiary referral center.
OBJECTIVE
The purpose of this study was to estimate the influence of alternatives to hysterectomy for abnormal uterine bleeding (AUB) on hysterectomy rates.


METHODS
Retrospective cohort study. Canadian Task Force II-2.


METHODS
University hospital.


METHODS
Premenopausal patients with AUB.


METHODS
Medical records of all premenopausal patients treated for AUB in our university clinic between January 1, 1995, and December 31, 2004, were reviewed. Patients were identified based on (specific) diagnostic and therapy codes used in the registry system of the hospital. The total number of placements of levonorgestrel-releasing intrauterine device (LNG-IUD), hysteroscopic surgery, and hysterectomies performed/year was estimated. In addition, the course of treatment of each patient was assessed.


RESULTS
A total of 640 patients received surgery and 246 LNG-IUDs were placed. The proportion of endometrial ablations decreased significantly over time (p <.001), whereas hysteroscopic polyp or myoma removal (p =.030) and insertion of LNG-IUD (p <.001) both increased. The proportion of patients receiving hysterectomy for AUB as their first therapy decreased significantly (p =.005) from 40.6% to 31.4%, although the total number of patients receiving hysterectomy remained similar (p =.449). The 5-year intervention-free percentage for LNG-IUD was 70.6% (SD = 3.3%), for hysteroscopic polyp or myoma removal 75.5% (SD = 3.3%), and for endometrial ablation 78.0% (SD = 4.3%; p =.067).


CONCLUSIONS
Despite the introduction of alternative therapies, the total hysterectomy rate in the management of AUB did not decrease in our clinic.
van Dongen
Heleen
H
Department of Gynecology, Leiden University Medical Center, The Netherlands. H.van_Dongen@lumc.nl
van de Merwe
Amy G
AG
de Kroon
Cornelis D
CD
Jansen
Frank Willem
FW
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data* / Q000639:trends; D015907:Hysteroscopy / Q000706:statistics & numerical data* / Q000639:trends; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data* / Q000639:trends; D016912:Levonorgestrel / Q000008:administration & dosage*; D008796:Metrorrhagia / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies
D016912:Levonorgestrel