A woman's chance of undergoing a hysterectomy can now be accurately predicted, according to new UCSF study findings.
Results from a four-year study of 762 women with various symptoms of uterine distress, such as chronic pelvic pain, abnormal bleeding or fibroids, are reported in the April 2007 issue of the "Journal of the American College of Surgeons." Study findings also are available online at www.journalacs.org.
The findings confirm a widely held, but untested, belief in gynecology that the more symptoms of discomfort a woman has, as well as the longer she has tried alternative therapies unsuccessfully, the more likely she is to have a hysterectomy, said lead investigator Lee Learman, MD, a professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.
"In the past, we were never entirely sure which symptoms were most likely to lead to a hysterectomy and which were most likely to be controlled with conservative treatments, so women received differing advice from individual doctors across the country," he added. "Now, for the first time, we have easily-measured, clinical characteristics that we can assess and use to accurately counsel patients on their options."
That, in turn, means women with a high likelihood of hysterectomy can avoid years of pain and discomfort while trying other options first and women with a low likelihood of hysterectomy can explore other options with more confidence of their success, Learman said.
The study found three independent predictors of a patient's chance of having a hysterectomy: a combination of symptoms, such as pelvic pain and bleeding, or fibroids with bleeding or pressure; a lack of symptom resolution despite prior treatments; and previous use of gonadotropin-releasing hormone agonist, known as GNRH agonist and the so-called "medical menopause" that doctors sometimes prescribe to alleviate severe symptoms.
One symptom alone, such as pelvic pain or bleeding, results in only a 20 percent chance of undergoing a hysterectomy within four years, the study found. Yet a combination of symptoms as well as the two other predictors , a lack of symptom resolution and previous use of GNRH agonist , led to a 95 percent chance.
Subgroups with a combination of these predictors showed an escalating risk of hysterectomy with each additional risk factor.
This study was the first part of an ongoing UCSF research project on hysterectomies, called the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives, or SOPHIA. The project is tracking nearly 1,500 premenopausal women, including those in this study, for four to eight years to understand not only their rate of hysterectomy, but also predictions of their quality of life over time.