Women's Health

Depending on a woman's age, hysterectomy may be the best option for resolving chronic pelvic pain and heavy bleeding

Women who suffer from heavy or frequent uterine bleeding or pelvic pain but do not want hysterectomies do have other treatment options. Common uterus-preserving treatments (UPTs) include myomectomy (a surgery to remove uterine fibroids), endometrial ablation (a procedure to destroy the uterine lining), and uterine fibroid embolization (a procedure that stops blood flow to uterine fibroids). A new study finds that these options usually provide relief for women who are 40 and older, but not for women younger than that.

Miriam Kuppermann, Ph.D., M.P.H., and colleagues used data from 557 women who had undergone a UPT. Sixteen percent of the women ended up having hysterectomies after their UPTs, and 37 percent embarked on menopause. Regardless of age, women who had hysterectomies after UPTs were more likely to have their symptoms resolved than women who entered into menopause or who only had UPTs (82.6 percent, 52.6 percent, and 41.2 percent, respectively). Further, women who were 40 or older when they underwent their first UPT were more likely to have their symptoms subside than younger women undergoing their first UPT. The authors recommend that clinicians consider a woman's age when they counsel women on treatment options for heavy or frequent bleeding or pelvic pain, because UPT ultimately may only delay, not replace, hysterectomy for women under 40. This study was funded in part by the Agency for Healthcare Research and Quality (HS11657 and HS07373).

See "Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: Age and bridges to menopause," by Lee A. Learman, M.D., Ph.D., Sanae Nakagawa, M.A., Steven E. Gregorich, Ph.D., and others in the American Journal of Obstetrics & Gynecology 204(3), pp. 272e1-272e7, 2011.

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