HYSTERECTOMY TRENDS IN FINLAND IN 1987-1995 - A REGISTER-BASED ANALYSIS

Background. The study objective was to identify trends in the use of h ysterectomy by nationwide register based analysis in Finland. Methods. All women (n=89,069) undergoing hysterectomy in 1987-1995 according t o the Finnish Hospital Discharge Register were the numerator. The annu al denominator data were obtained from the population database of Stat istics Finland. Results. From 1987 to 1992 the hysterectomy rate incre ased by 22%, from 340 to 414 per 100,000 females, almost half of this being attributable to the changing age structure. From 1993 on, ambigu ity in coding laparoscopically assisted vaginal hysterectomies prohibi ted detailed analyses. However, the overall trend continued at least a mong women 50 years and over until 1995. The age-adjusted 12% increase from 1987 to 1992 coincided with a rapid increase in operation rates in postmenopausal groups (60% or more among women aged 55-59 and 70-79 years). Among women aged 55-64 years, operations for fibroids and ute rine bleeding more than doubled, suggesting an influence of increased use of estrogen replacement therapy. Among all women, operations due t o bleeding disorders and genital prolapse showed the largest increase (41% and 42% respectively). Bilateral oophorectomy became more common in all age groups over 46 years. Conclusions. There was a modest incre ase in the overall hysterectomy rate. However, the operation became fa r more common in postmenopausal women, possibly due to the growing use of estrogen replacement therapy. Register data can be used for descri bing changes in clinical practice, but other methods are needed to con firm the causal relationships underlying the changes.