title: Contributions of hysterectomy and uterus-preserving surgery to health-related quality of life.
abstract: To document the long-term effect of surgical interventions for noncancerous uterine conditions on health-related quality of life.
  
  
  
  The Study of Pelvic Problems, Hysterectomy and Intervention Alternatives, conducted between 1998 and 2008, was a longitudinal study of 1,503 women with intact uteri experiencing abnormal uterine bleeding with or without leiomyomas, chronic pelvic pain, or pressure resulting from leiomyomas. Baseline and follow-up questionnaires included three condition-specific measures (Pelvic Problem Resolution, Pelvic Problem Impact Overall, and Pelvic Problem Impact on Sex) and five generic measures (Short Form-12 Mental and Physical Component Summaries, Current Health Utility, Feelings about Heath, and Satisfaction with Sex). We modeled changes over time in these patient-reported outcomes stratified by the most invasive treatment undergone (hysterectomy [13.7%], uterus-preserving surgery [9.0%], or nonsurgical therapy [77.3%]).
  
  
  
  Participants in all three groups reported significant improvement on all condition-specific measures and two of the five generic measures (Current Health Utility and Feelings about Health) from enrollment to final interview (all P values <.01). In general, greater improvements were experienced by women who had surgery. Trajectories modeled around the dates of surgery showed dramatic improvements after hysterectomy and, to a lesser degree, after uterus-preserving surgery. Although women who underwent uterus-preserving surgery tended to show immediate improvement, women who underwent hysterectomy experienced a 6-month delay in improvement in some outcomes with trajectories converging by 4 years postsurgery.
  
  
  
  Women seeking care for noncancerous uterine conditions can expect to experience improvement over time. Those who opt for surgery may experience most improvement. Understanding health-related quality-of-life trajectories may enhance counseling for women deciding between hysterectomy and alternative interventions.
  
  
  
  II.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143-856, USA. kuppermannm@obgyn.ucsf.edu
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
authors.forename: Lee A
authors.initials: LA
authors.lastname: Learman
authors.forename: Michael
authors.initials: M
authors.lastname: Schembri
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Jackson
authors.forename: Alison
authors.initials: A
authors.lastname: Jacoby
authors.forename: James
authors.initials: J
authors.lastname: Lewis
authors.forename: A Eugene
authors.initials: AE
authors.lastname: Washington
mesh_terms: D000328:Adult; D002140:California; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000523:psychology; D008137:Longitudinal Studies; D008875:Middle Aged; D059351:Organ Sparing Treatments; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*