Contributions of Hysterectomy and Uterus-Preserving Surgery to Health-Related Quality of Life

Kuppermann, Miriam PhD, MPH; Learman, Lee A. MD, PhD; Schembri, Michael BS; Gregorich, Steven E. PhD; Jackson, Rebecca A. MD; Jacoby, Alison MD; Lewis, James MD; Washington, A. Eugene MD, MSC

Obstetrics & Gynecology:
doi: //10.1097/AOG.0b013e318292aea4
Original Research
Abstract

OBJECTIVE: To document the long-term effect of surgical interventions for noncancerous uterine conditions on health-related quality of life.

METHODS: 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%]).

RESULTS: 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.

CONCLUSION: 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.

LEVEL OF EVIDENCE: II

In Brief

Hysterectomy and, to a lesser extent, uterus-preserving surgery for leiomyomas, bleeding, or pain is followed by large and sustained improvements in health-related quality of life.

Author Information

Departments of Obstetrics, Gynecology & Reproductive Sciences, Epidemiology & Biostatistics, Medicine, and the Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, San Francisco, California; and the Departments of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, Kaiser Permanente, San Francisco, California, and University of California, Los Angeles, Los Angeles, California.

Corresponding author: Miriam Kuppermann, PhD, MPH, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, 3333 California Street, Suite 335, San Francisco, CA, 94143-0856; e-mail: kuppermannm@obgyn.ucsf.edu.

Funded by grants from the Agency for Healthcare Research and Quality (U01 HS09478, R01 HS011657, U01 HS07373) and the National Institute on Aging and Office of Research in Women's Health, National Institutes of Health (U01 HS09478). The funding sources had no role or involvement in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.

Financial Disclosure Dr. Washington serves as director, Johnson and Johnson Board of Directors. The other authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists.