THE MAINE-WOMENS-HEALTH-STUDY .2. OUTCOMES OF NONSURGICAL MANAGEMENT OF LEIOMYOMAS, ABNORMAL BLEEDING, AND CHRONIC PELVIC PAIN

Objective: To assess the effect of nonsurgical management of leiomyoma s, abnormal uterine bleeding, and chronic pelvic pain on symptoms and quality of life.Methods: We performed a prospective cohort study of wo men receiving nonsurgical management (n = 380) or hysterectomy (n = 31 1) for leiomyomas, abnormal uterine bleeding, or chronic pelvic pain. Patients recruited from the practices of 63 physicians throughout Main e were interviewed at the outset of treatment and 3, 6, and 12 months later. The principal outcome measures were frequency and severity of p hysical and psychological symptoms, and quality of life as measured by validated indices of mental and general health and physical activity. Results: Medical therapy for abnormal bleeding and chronic pelvic pai n produced significant improvements in symptoms and quality of life. H owever, almost one-quarter of patients initially treated nonsurgically subsequently underwent hysterectomy; of patients continuing nonsurgic al therapy, 25% with abnormal bleeding and 50% with chronic pelvic pai n reported substantial levels of symptoms after 1 year. There were no significant changes in symptoms and quality of life in patients treate d nonsurgically for leiomyomas. New problems including tiredness, hot flashes, weight gain, and depression developed in 10% or less of women who did not report these symptoms preoperatively. A logistic regressi on analysis controlling for age, reproductive history, and severity of symptoms showed that hysterectomy was the factor most highly correlat ed with a positive outcome at 1 year for all three conditions. Conclus ions: Many women with leiomyomas, abnormal bleeding, and chronic pelvi c pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treat ment fails.