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Excessive uterine blleding, hysterectomy: chance of surgery 50% after conservative tx.(Gynecology)
Women with an unsatisfactory response to first-line medical therapy for excessive uterine bleeding who undergo further conservative therapy stand about a 50% chance of ultimately needing a hysterectomy, results of two randomized trials suggest.
The clinical implications of this finding will vary among patients and their physicians. Dr. Roy M. Pitkin of the University of California. Los Angeles, and Dr. James R. Scott of the University of Utah. Salt Lake City, said in an editorial accompanying the studies (JAMA 291[12]:1503-04, 2004).
"Does it mean that surgery will likely be necessary eventually anyway, so perhaps better sooner than later, sparing the woman continued symptoms? Or does it mean that there is a 50% chance of avoiding the hysterectomy and these odds are worth taking to avoid a major operation?" they wrote, noting that additional randomized trials with longer follow-up are still needed.
In the first study. Finnish investigators found that use of intrauterine hormonal therapy provided improved quality of life and was 40% less expensive than hysterectomy at a 5-year follow-up (JAMA 291[12]:1456-63, 2004).
In the second study, hysterectomy was superior in terms of health-related quality of life at 6 months, compared with a variety of oral or injectable hormone regimens. A total of 17 women in the medical treatment group later requested and received hysterectomy, however. By the end of the 2-year study, most differences between the hysterectomy and medical groups were no longer statistically significant in an intention-to-treat analysis, said Miriam Kuppermann, Ph.D., of the University of California, San Francisco, and her associates (JAMA 291[12] 1447-55, 2004).
Both trials found a relatively high proportion of women in the control groups who eventually underwent hysterectomy: 42% in the Finnish trial and 53% in the U.S. trial.
The Finnish study included 236 women aged 35-49 years with complaints of menorrhagia. They were randomly assigned to receive hysterectomy or insertion of an intrauterine device that gradually releases 20 [micro]g of levonorgestrel every 24 hours over 5 years. The levonorgestrel group had 115 women available for follow-up and the hysterectomy group had 114, said Dr. Ritva Hurskainen of the University of ...
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...than levonorgestrel (0.75 mg) alone..sup.3 The crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group and 3.2% (31/976) in the levonorgestrel/ethinyl estradiol group. The proportion of prevented pregnancy...
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- Magazine article from: Internal Medicine News Boschert, Sherry September 1, 2005 700+ words
...randomization, women in the supracervical hysterectomy group had higher scores on the 100-point...function, compared with the abdominal hysterectomy group (mean score of 55). Phone interviews...groups--82 in the supracervical hysterectomy group, and 80 in the abdominal ...
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...randomization, women in the supracervical hysterectomy group had higher scores on the 100-point...function, compared with the abdominal hysterectomy group (mean score of 55). Phone interviews...groups--82 in the supracervical hysterectomy group, and 80 in the abdominal ...
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...patients who did not. Two cases in the hysterectomy group were converted to laparotomy: In...cystoscopy in three patients in the hysterectomy group and one in the nonhysterectomy group...after surgery in one patient in the hysterectomy group. Dr. von Pechmann recommended ...
Source: HighBeam Research, Excessive uterine blleding, hysterectomy: chance of surgery 50% after...