Hysterectomy: Impact on Quality of Life (Part 3)
Hysterectomy is one of the most commonly performed surgical procedures in the United States today. Approximately 70% of these cases are performed for benign cases including fibroids, pelvic masses, endometriosis, adenomyosis, abnormal uterine bleeding, chronic pelvic pain and prolapse. There are some studies that have been done looking at the long and short term effects of hysterectomy on a patient`s quality of life but more research is needed for further investigation.
What type of hysterectomy is most popular?
The laparoscopic and vaginal approaches have increasingly replaced the abdominal approach, with the laparoscopic route being most popular and having better quality of life scores.
Women with what conditions noted the greatest improvement post op?
Women with endometriosis, fibroids and abnormal bleeding who had failed other treatment options, and who had a hysterectomy, scored higher on quality of life surveys after 6mos and 10years. The symptoms with most improvement included discomfort, distress/pain and sexual activity.
Impact on physical functioning post hysterectomy.
There is no consensus overall, but patients who had a total laparoscopic hysterectomy (TLH) did better than those who had an abdominal hysterectomy in the immediate post op periods. There appeared to be no difference at 1 and 3mos post op between the two routes.
Post op pain is lower in patients who had a vaginal hysterectomy (VH) than after an abdominal or laparoscopic assisted hysterectomy.
Patients who had a TLH resumed normal activity and work sooner than those who had an abdominal hysterectomy.
Impact on social functioning.
Social functioning in the post op period was better after a TLH compared to TAH but some studies showed no difference.
Some studies report there may be a negative impact on self-image in women who underwent an abdominal hysterectomy compared to those who had a TLH.
There is no consensus on the effects of TLH on psychosocial functioning.
Impact of hysterectomy on sex.
For women with prolapse, who had a hysterectomy, the greatest improvement in QOL( quality of life ) scores was observed in the area of sexual activity.
This is a major area of concern and anxiety for patients. An average of 15% of women will experience a decrease in sexual function in the post op period notwithstanding the route of hysterectomy. Research shows conflicting results and more studies are needed to investigate this aspect.
For instance: some research studies showed that laparoscopic hysterectomy decreased the risk of negative effect on sex post operatively. However, other studies show no difference in sex post operatively, regardless of approach to hysterectomy.
Additionally, some studies show patients resume sexual intercourse sooner after a TLH compared to TAH. Contrastingly, other studies show no change in frequency of sexual activity, orgasm, libido, arousal, lubrication and sexual desire after any route of hysterectomy.
Impact on bone health.
There appears to be an increased risk of osteoporosis in patients who had a hysterectomy versus those without a hysterectomy. The risk of osteoporosis was highest in women in their early forties who had both a hysterectomy and oophorectomy.
References:
- Choi HG, Jung YJ, Lee SW. Increased risk of osteoporosis with hysterectomy: A longitudinal follow-up study using a national sample cohort. Am J Obstet Gynecol. 2019 Jun;220(6):573.e1-573.e13.
- Fortin C, Hur C, Falcone T. Impact of Laparoscopic Hysterectomy on Quality of Life. J Minim Invasive Gynecol. 2019 Feb;26(2):219-232.
- Rahkola-Soisalo P, Brummer T, Jalkanen J, Sjöberg J, Sintonen H, Roine RP, Härkki P. Hysterectomy provides benefit in health-related quality of life: A ten-year follow-up study. J Minim Invasive Gynecol. 2019 Aug 9. pii: S1553-4650(19)30367
