Gynecologists have long been concerned at the lack of data on whether or not women with pelvic pain and or depression before hysterectomy improve in these symptoms after surgery.
"Our worst fear was that we might be making the situation worse by doing a hysterectomy," said Dr. Katherine Hartmann, assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine. She also is assistant professor of epidemiology in UNC's School of Public Health.
Results from a new study by Hartmann may have answered this concern convincingly, showing for the first time significant improvements in self-reported pelvic pain and depression after hysterectomy.
The study, which enrolled nearly 1,300 women, involved interviews with women before and after surgery. Participants were asked to quantify their pain and depression, using well-validated methods, before surgery and also at six, 12 and 24 months after surgery. For the data analysis, women with symptoms were separated into three groups based on their preoperative interviews: those with pelvic pain only, depression only or both pelvic pain and depression.
Each group showed clear improvement in all measures of pain and depression two years after hysterectomy, Hartmann said. "This is strong evidence that we haven't made women worse, and, in fact, relative to their own baseline, women are doing much better."
Hartmann, also director of UNC's Center for Women's Health Research, said she was particularly pleased to see that the group with the most serious preoperative symptoms - that is, those with both pelvic pain and depression - improved most overall. Prior to hysterectomy, 96 percent of women in this group reported pelvic pain, which dropped to only 19 percent after hysterectomy. A similar improvement was seen in their depression: Ninety-three percent reported impaired mental health before hysterectomy, but only 38 percent after the operation.
"Proportionally, after surgery, they were still the group which were most affected by pain and depression," said Hartmann. "But relative to where they started, they had a dramatic improvement."
Interestingly, women with depression but without pain also reported significant improvement in their mental health measures two years postoperatively.
"It may be that their depression was being better managed postoperatively," said Hartmann. "But at the very least, it would suggest that if women are getting adequate treatment for their depression, the decision to have a hysterectomy need not be postponed."
The participants were enrolled from major hospitals across Maryland.
Hartmann's collaborators and co-authors were, from the University of Maryland, Drs. Kristen Kjerulff, associate professor of epidemiology and preventive medicine, and Patricia Langenberg, professor of epidemiology and preventive medicine and vice chair of the department of epidemiology and preventive medicine; and, from UNC, Drs. John Steege, professor of obstetrics and gynecology, and Georgine Lamvu, assistant professor of obstetrics and gynecology.
As participants of this study did not come from large academic medical centers, they more accurately represent the population of women undergoing hysterectomy for benign reasons, such as fibroids, Hartmann said.
Nearly 600,000 hysterectomies are performed in the United States annually. Of these, 10 percent of women have pelvic pain as the primary medical indication for the surgery, Hartmann and the co-authors said.
The study provides some initial data to use in counseling patients with pain and-or depression and who are considering hysterectomy, the authors said.