Hysterectomy alternative effective for bleeding

NEW YORK (Reuters Health) - For women who need surgery for abnormal vaginal bleeding, both hysterectomy and a less-extensive alternative seem to be similarly effective, new research suggests.

The study, published in the journal Obstetrics & Gynecology, included 237 women who had surgery for dysfunctional uterine bleeding -- a disorder marked by vaginal bleeding between menstrual periods, abnormal periods, pelvic pain and other symptoms.

The women either had a hysterectomy, in which a surgeon removes the uterus, or a less-extensive procedure called endometrial ablation, which removes only the lining of the uterus.

Ablation does not require an abdominal incision, as a hysterectomy often does; instead, a thin scope is passed into the uterus, and heat is used to destroy the uterine lining.

In this study, researchers found that while hysterectomy tended to be more successful in eliminating the women’s abnormal bleeding, endometrial ablation was nearly as effective in easing their overall symptoms in the long term.

Endometrial ablation successfully eased the problems that prompted surgery in 85 percent of patients. That figure was 94 percent in the hysterectomy group, according to the researchers, led by Dr. Kay Dickersin of Johns Hopkins University in Baltimore.

A “substantial number” of women who had ablation ended up needing a repeat procedure, the researchers report. Nearly one-third had one within four years.

On the other hand, women in the hysterectomy group had more treatment side effects. They were six times as likely, for instance, to have a post-surgery infection. In all, about 40 percent of hysterectomy patients had some adverse effect in the six weeks following treatment -- which, besides infections, included nerve damage, blood clots and fluid buildup. That compared with 11 percent of ablation patients.

“Both endometrial ablation and hysterectomy are effective in solving the problem that led women to seek surgery and in relieving pain, fatigue, and bleeding,” write Dickersin and her colleagues -- though, they add, hysterectomy tends to control bleeding better.

Based on these findings, they conclude, it seems “reasonable” for women to choose the treatment option that best fits their “individual preferences and situations.”

SOURCE: Obstetrics & Gynecology, December 2007.