Effectiveness of hysterectomy

Objective: To measure the effectiveness of hysterectomy in relieving advers e symptoms and to identify factors associated with lack of symptom relief. Methods: In a 2-year prospective study, data were collected before and at 3 , 6, 12, 18, and 24 months after hysterectomy in 1299 women who had hystere ctomies for benign conditions at 28 hospitals across Maryland. Effectivenes s was measured in terms of relief of symptoms such as problematic vaginal b leeding, pelvic pain, and urinary incontinence. Psychologic function and qu ality of life before and after surgery also were assessed. Results: Symptom severity, depression, and anxiety levels decreased signifi cantly after hysterectomy and quality of life improved, :particularly in th e area of social function. However, 8% of women had at least as many sympto ms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristi cs predicted lack of symptom relief, including therapy for emotional or psy chologic problems, depression, and household income of $35,000 or less. Bil ateral oophorectomy predicted lack of symptom relief at 24 months but not a t 12 months after hysterectomy. Conclusion: Significant improvements were seen after hysterectomy for all t hree aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hy sterectomy. (Obstet Gynecol 2000; 95:319-26. (C) 2000 by The American Colle ge of Obstetricians and Gynecologists.).