Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects

BMJ 1996;312:280-284 (3 February)

Papers

Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects

David A Alexander, senior lecturer in mental health,^a Audrey Atherton Naji, research assistant,^a Sheena B Pinion, research fellow in obstetrics and gynaecology,^b Jill Mollison, research assistant,^c Henry C Kitchener, consultant in obstetrics and gynaecology,^b David E Parkin, consultant in obstetrics and gynaecology,^b David R Abramovich, reader in obstetrics and gynaecology,^b Ian T Russell, director ^c

^a Department of Mental Health, Medical School, University of Aberdeen, Aberdeen AB9 2ZD, ^b Aberdeen Royal Infirmary, Aberdeen AB9 2ZD, ^c Health Services Research Unit, Medical School, University of Aberdeen, Aberdeen AB9 2ZD

Correspondence to: Professor Alexander.

Abstract

Objective: To compare in psychiatric and psychosocial termsthe outcome of hysterectomy and endometrial ablation for thetreatment of dysfunctional uterine bleeding.
Design: Prospective randomised controlled trial.
Setting: Obstetrics and gynaecology department of a large teachinghospital.
Subjects: 204 women with dysfunctional bleeding for whom hysterectomywould have been the preferred treatment were recruited over24 months and randomly allocated to hysterectomy (99 women)or to hysteroscopic surgery (transcervical resection (52 women)or laser ablation (53 women)).
Main outcome measures: Mental state, marital relationship, psychosocialand sexual adjustment in assessments conducted before the operationand one month, six months, and 12 months later.
Results: Both treatments significantly reduced the anxiety anddepression present before the operation, and there were no differencesin mental health between the groups at 12 months. Hysterectomydid not lead to postoperative psychiatric illness. Sexual interestafter the operation did not vary with treatment. Overall, 46out of 185 (25%) women reported a loss of sexual interest and50 out of 185 (27%) reported increased sexual interest. Maritalrelationships were unaffected by surgery. Personality and durationof dysfunctional uterine bleeding played no significant partin determining outcome.
Conclusions: Hysteroscopic surgery and hysterectomy have a similareffect on psychiatric and psychosocial outcomes. There is noevidence that hysterectomy leads to postoperative psychiatricillness.

Key messages

Key messages
Hitherto hysterectomy has been the preferred procedure, though women may be ill postoperatively
The introduction of hysteroscopic procedures demands an evaluation of different surgical methods according not only to gynaecological criteria but also in terms of their psychiatric and psychosocial outcome
This randomised trial of hysterectomy and hysteroscopic surgery found that both methods had satisfactory outcomes in terms of anxiety, depression, and psychosocial adjustment

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