Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects
Abstract Objective: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. Design: Prospective randomised controlled trial. Setting: Obstetrics and gynaecology department of a large teaching hospital....
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| Veröffentlicht in: | BMJ 1996-02, Vol.312 (7026), p.280-284 |
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| creator | Alexander, David A Naji, Audrey Atherton Pinion, Sheena B Mollison, Jill Kitchener, Henry C Parkin, David E Abramovich, David R Russell, Ian T |
| description | Abstract Objective: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. Design: Prospective randomised controlled trial. Setting: Obstetrics and gynaecology department of a large teaching hospital. Subjects: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 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, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. Results: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss of sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. Conclusions: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness. 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 |
| doi_str_mv | 10.1136/bmj.312.7026.280 |
| format | Article |
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Design: Prospective randomised controlled trial. Setting: Obstetrics and gynaecology department of a large teaching hospital. Subjects: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 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, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. Results: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss of sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. Conclusions: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness. 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</description><edition>International edition</edition><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-8146</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.312.7026.280</identifier><identifier>PMID: 8611783</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>London: British Medical Journal Publishing Group</publisher><subject>Adaptation, Psychological ; Adjustment ; Adult ; Anxiety ; Anxiety - etiology ; Anxiety disorders ; Biological and medical sciences ; Clinical trials ; Depression - etiology ; Depressive disorders ; Diseases ; Endometrium - surgery ; Female ; Female genital diseases ; Gynecology ; Gynecology. Andrology. Obstetrics ; Hospitals ; Humans ; Hysterectomy ; Hysterectomy - psychology ; Hysteroscopy - psychology ; Illnesses ; Interpersonal Relations ; Inventory ; Laser Therapy - psychology ; Medical research ; Medical sciences ; Mental depression ; Mental health outcomes ; Non tumoral diseases ; Patient Satisfaction ; Patients ; Personality ; Postoperative Care ; Prospective Studies ; Psychiatry ; Psychometrics ; Questionnaires ; Sexual Behavior ; Surgery ; Surgical specialties ; Uterine Hemorrhage - psychology ; Uterine Hemorrhage - surgery ; Womens health</subject><ispartof>BMJ, 1996-02, Vol.312 (7026), p.280-284</ispartof><rights>1996 BMJ Publishing Group Ltd.</rights><rights>Copyright 1996 British Medical Journal</rights><rights>1996 INIST-CNRS</rights><rights>Copyright: 1996 (c) 1996 BMJ Publishing Group Ltd.</rights><rights>Copyright BMJ Publishing Group Feb 3, 1996</rights><rights>Copyright British Medical Association Feb 3, 1996</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b630t-6704b741a44732e6429184369925561847afde166a6568ab20a519521ef6895e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/29730518$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/29730518$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,776,780,799,881,27901,27902,30976,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2977808$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8611783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alexander, David A</creatorcontrib><creatorcontrib>Naji, Audrey Atherton</creatorcontrib><creatorcontrib>Pinion, Sheena B</creatorcontrib><creatorcontrib>Mollison, Jill</creatorcontrib><creatorcontrib>Kitchener, Henry C</creatorcontrib><creatorcontrib>Parkin, David E</creatorcontrib><creatorcontrib>Abramovich, David R</creatorcontrib><creatorcontrib>Russell, Ian T</creatorcontrib><title>Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Abstract Objective: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. Design: Prospective randomised controlled trial. Setting: Obstetrics and gynaecology department of a large teaching hospital. Subjects: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 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, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. Results: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss of sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. Conclusions: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness. 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</description><subject>Adaptation, Psychological</subject><subject>Adjustment</subject><subject>Adult</subject><subject>Anxiety</subject><subject>Anxiety - etiology</subject><subject>Anxiety disorders</subject><subject>Biological and medical sciences</subject><subject>Clinical trials</subject><subject>Depression - etiology</subject><subject>Depressive disorders</subject><subject>Diseases</subject><subject>Endometrium - surgery</subject><subject>Female</subject><subject>Female genital diseases</subject><subject>Gynecology</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Hysterectomy - psychology</subject><subject>Hysteroscopy - psychology</subject><subject>Illnesses</subject><subject>Interpersonal Relations</subject><subject>Inventory</subject><subject>Laser Therapy - psychology</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Mental depression</subject><subject>Mental health outcomes</subject><subject>Non tumoral diseases</subject><subject>Patient Satisfaction</subject><subject>Patients</subject><subject>Personality</subject><subject>Postoperative Care</subject><subject>Prospective Studies</subject><subject>Psychiatry</subject><subject>Psychometrics</subject><subject>Questionnaires</subject><subject>Sexual Behavior</subject><subject>Surgery</subject><subject>Surgical specialties</subject><subject>Uterine Hemorrhage - psychology</subject><subject>Uterine Hemorrhage - surgery</subject><subject>Womens health</subject><issn>0959-8138</issn><issn>0959-8146</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkl2L1DAUhoso67DuvTdCUdEL6XjyneyFIINfuPiF7m1I23QnY9uMSavOX_BXm9phXAXXqyS8z3lPzuHNstsIlggR_rjsNkuC8FIA5kss4Vq2QJTLgklCrmcLUEwVEhF5MzuJcQMAmAipODvKjiRHSEiyyH58MH3tOxdtnQ_BmTavfLc1wfUX-XoXBxtsNfhul39zwzq3E2tnzpStGZzv88aHvN7FZuyr6Z2kMZW53uZla22dnE7zbdxVa2dSZZWnhvPbR1_9corb1CTeym40po32ZH8eZ5-eP_u4elmcvX3xavX0rCg5gaHgAmgpKDKUCoItp1ghSQlXCjPG01WYpraIc8MZl6bEYBhSDCPbcKmYJcfZk9l3O5adrSvbD8G0ehtcZ8JOe-P0n0rv1vrCf9WYUKVAJIMHe4Pgv4w2Djrtr7Jta3rrx6iFUEogyRL48GqQEyUpoMny7l_kxo8h7TJqDBSAIoauhkiaX0mVoHv_gpAQghGQQBMFM1UFH2OwzWF8BHoKl07h0ilcegqXTuFKJXcur-1QsI9S0u_vdRMr0zbB9JWLBwwrISTI3zabOPhwWSbA0KQXs-5S-L4fdBM-ay6IYPrN-UrD-et3_D2lelrKo5mfPvzfIX4CLbr-MQ</recordid><startdate>19960203</startdate><enddate>19960203</enddate><creator>Alexander, David A</creator><creator>Naji, Audrey Atherton</creator><creator>Pinion, Sheena B</creator><creator>Mollison, Jill</creator><creator>Kitchener, Henry C</creator><creator>Parkin, David E</creator><creator>Abramovich, David R</creator><creator>Russell, Ian T</creator><general>British Medical Journal Publishing Group</general><general>British Medical Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><general>BMJ Group</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7QJ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19960203</creationdate><title>Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects</title><author>Alexander, David A ; Naji, Audrey Atherton ; Pinion, Sheena B ; Mollison, Jill ; Kitchener, Henry C ; Parkin, David E ; Abramovich, David R ; Russell, Ian T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b630t-6704b741a44732e6429184369925561847afde166a6568ab20a519521ef6895e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Adaptation, Psychological</topic><topic>Adjustment</topic><topic>Adult</topic><topic>Anxiety</topic><topic>Anxiety - etiology</topic><topic>Anxiety disorders</topic><topic>Biological and medical sciences</topic><topic>Clinical trials</topic><topic>Depression - etiology</topic><topic>Depressive disorders</topic><topic>Diseases</topic><topic>Endometrium - surgery</topic><topic>Female</topic><topic>Female genital diseases</topic><topic>Gynecology</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Hysterectomy - psychology</topic><topic>Hysteroscopy - psychology</topic><topic>Illnesses</topic><topic>Interpersonal Relations</topic><topic>Inventory</topic><topic>Laser Therapy - psychology</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Mental depression</topic><topic>Mental health outcomes</topic><topic>Non tumoral diseases</topic><topic>Patient Satisfaction</topic><topic>Patients</topic><topic>Personality</topic><topic>Postoperative Care</topic><topic>Prospective Studies</topic><topic>Psychiatry</topic><topic>Psychometrics</topic><topic>Questionnaires</topic><topic>Sexual Behavior</topic><topic>Surgery</topic><topic>Surgical specialties</topic><topic>Uterine Hemorrhage - psychology</topic><topic>Uterine Hemorrhage - surgery</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alexander, David A</creatorcontrib><creatorcontrib>Naji, Audrey Atherton</creatorcontrib><creatorcontrib>Pinion, Sheena B</creatorcontrib><creatorcontrib>Mollison, Jill</creatorcontrib><creatorcontrib>Kitchener, Henry C</creatorcontrib><creatorcontrib>Parkin, David E</creatorcontrib><creatorcontrib>Abramovich, David R</creatorcontrib><creatorcontrib>Russell, Ian T</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alexander, David A</au><au>Naji, Audrey Atherton</au><au>Pinion, Sheena B</au><au>Mollison, Jill</au><au>Kitchener, Henry C</au><au>Parkin, David E</au><au>Abramovich, David R</au><au>Russell, Ian T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects</atitle><jtitle>BMJ</jtitle><addtitle>BMJ</addtitle><date>1996-02-03</date><risdate>1996</risdate><volume>312</volume><issue>7026</issue><spage>280</spage><epage>284</epage><pages>280-284</pages><issn>0959-8138</issn><issn>0959-8146</issn><eissn>1468-5833</eissn><eissn>1756-1833</eissn><coden>BMJOAE</coden><abstract>Abstract Objective: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. Design: Prospective randomised controlled trial. Setting: Obstetrics and gynaecology department of a large teaching hospital. Subjects: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 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, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. Results: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss of sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. Conclusions: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness. 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</abstract><cop>London</cop><pub>British Medical Journal Publishing Group</pub><pmid>8611783</pmid><doi>10.1136/bmj.312.7026.280</doi><tpages>5</tpages><edition>International edition</edition><oa>free_for_read</oa></addata></record> |
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| ispartof | BMJ, 1996-02, Vol.312 (7026), p.280-284 |
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| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Jstor Complete Legacy; MEDLINE; Alma/SFX Local Collection |
| subjects | Adaptation, Psychological Adjustment Adult Anxiety Anxiety - etiology Anxiety disorders Biological and medical sciences Clinical trials Depression - etiology Depressive disorders Diseases Endometrium - surgery Female Female genital diseases Gynecology Gynecology. Andrology. Obstetrics Hospitals Humans Hysterectomy Hysterectomy - psychology Hysteroscopy - psychology Illnesses Interpersonal Relations Inventory Laser Therapy - psychology Medical research Medical sciences Mental depression Mental health outcomes Non tumoral diseases Patient Satisfaction Patients Personality Postoperative Care Prospective Studies Psychiatry Psychometrics Questionnaires Sexual Behavior Surgery Surgical specialties Uterine Hemorrhage - psychology Uterine Hemorrhage - surgery Womens health |
| title | Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects |
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