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

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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