Predictors of need for hysterectomy

Three factors - numerous symptoms; a lack of symptom resolution; and the previous use of hormone treatment - can be used in a simple strategy to predict whether women with pelvic health problems will eventually require a hysterectomy. There are a growing number of alternative treatments for pelvic problems, including strategies to remove the lining of the uterus, surgical removal of fibroids, and hormone-releasing uterine implants. But these therapies aren't effective for every woman, and many may require hysterectomy anyway, after years of trying other approaches. While women generally avoid hysterectomy for as long as possible, they usually experience a great improvement in quality of life after the surgery. To investigate predictors of hysterectomy, the researchers from the University of California, San Francisco, USA, followed 762 women with abnormal uterine bleeding, chronic pelvic pain, or uterine fibroids (or two of these symptoms) for four years. It was found that 95 percent of women with all three factors required a hysterectomy within 4 years. In contrast, women with none of these symptoms had only a 20 percent chance of requiring a hysterectomy. Women with multiple symptoms were nearly 2 times as likely to require hysterectomy. Those who were treated with gonadotropin-releasing hormone (GnRH) blockers were 3 times as likely to have their uterus removed. And women with unresolved symptoms were more than 2 times as likely to undergo hysterectomy. Based on these findings, women who are likely to need the procedure can decide to have it earlier rather than later, while those at little risk can be told that they are likely not to require hysterectomy.