RANDOMIZED TRIAL COMPARING HYSTERECTOMY WITH ENDOMETRIAL ABLATION FORDYSFUNCTIONAL UTERINE BLEEDING - PSYCHIATRIC AND PSYCHOSOCIAL-ASPECTS

Objective-To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunc tional uterine bleeding. Design-Prospective randomised controlled tria l. Setting-Obstetrics and gynaecology department of a large teaching h ospital. Subjects-204 women with dysfunctional bleeding for whom hyste rectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hyster oscopic surgery (transcervical resection (52 women) or laser ablation (53 women)). Main outcome measures-Mental state, marital relationship, psychosocial and sexual adjustment in assessments conducted before th e operation and one month, six months, and 12 months later. Results-Bo th treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoper ative psychiatric illness, Sexual interest after the operation did not vary with treatment, Overall, 46 out of 185 (25%) women reported a lo ss of sexual interest and 50 out of 185 (27%) reported increased sexua l interest. Marital relationships were unaffected by surgery. Personal ity and duration of dysfunctional uterine bleeding played no significa nt part in determining outcome. Conclusions-Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial out comes, There is no evidence that hysterectomy leads to postoperative p sychiatric illness.