Intermediate Outcomes of Hysterectomy and Alternatives

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DESCRIPTION (TAKEN FROM APPLICANT): The proposed application expands on our existing prospective longitudinal study of 811 women with non-cancerous uterine conditions for which hysterectomy is a reasonable treatment option: abnormal uterine bleeding, symptomatic uterine leiomyomata, and pelvic pain/endometriosis. The principal aims of the proposed study are to 1) determine whether and how intermediate-term (4-8 year) clinical and qualityof- life outcomes differ by treatment group (hysterectomy, uterus-preserving surgery, or non-surgical treatments) for their uterine conditions; and 2) develop predictive models of treatment choice and satisfaction from a broad array of domains. The proposed expansion of the existing study is motivated by two main factors. First, by increasing the size of our cohort by an additional 700 we will extend the mean duration of follow-up from 1.7 to 4.1 years, and we will obtain at least four years of follow-up data on over 976 women. The increased sample at four years will allow us to accrue an adequate number of women undergoing hysterectomy and non-surgical treatments to support a statistically meaningful comparison. Because symptoms for women with noncancerous uterine conditions typically extend from the early 40?s to menopause, including intermediate-term, face this decision, providing useful information will help equip women and their physicians to make informed, shared decisions. Second, we will enhance our measures of sexual functioning, depression, and incontinence, and include assessments of newly available alternative treatments. These additions reflect changes in the understanding of the role of these factors in the management of non-cancerous uterine conditions since the inception of the original study. The results of this study are central to our long-term goal of improving decision making in the management of non-cancerous uterine conditions. The findings that emerge from the proposed study will be relevant to the development of evidence-based guidelines and the creation of decision-assisting tools to help women with non-cancerous uterine conditions make informed choices regarding their treatment during their decade of risk for hysterectomy.