The Impact of Alternative Treatment for Abnormal Uterine Bleeding on Hysterectomy Rates in a Tertiary Referral Center

Study Objective: The purpose of this study was to estimate the influence of alternatives to hysterectomy for abnormal uterine bleeding (AUB) on hysterectomy rates. Design: Retrospective cohort study. Canadian Task Force II-2. Setting: University hospital. Patients: Premenopausal patients with AUB. Interventions: Medical records of all premenopausal patients treated for AUB in our university clinic between January 1. 1995, and December 31, 2004, were reviewed. Patients were identified based on (specific) diagnostic and therapy codes used in the registry system of the hospital. The total number of placements of levonorgestrel-releasing intrauterine device (LNG-IUD), hysteroscopic surgery, and hysterectomies performed/year was estimated. In addition, the course of treatment of each patient was assessed. Measurements and Main Results: A total of 640 patients received surgery and 246 LNG-IUDs were placed. The proportion of endometrial ablations decreased significantly over time (p <.001), whereas hysteroscopic polyp or myoma removal (p =.030) and insertion of LNG-IUD (p <.001) both increased. The proportion of patients receiving, hysterectomy for AUB as their first therapy decreased significantly (p =.005) from 40.6% to 31.4%, although the total number of patients receiving hysterectomy remained similar (p =.449). The 5-year intervention-free percentage for LNG-IUD was 70.6% (SD = 3.3%), for hysteroscopic polyp or myoma removal 75.5% (SD = 3.3%), and for endometrial ablation 78.0% (SD = 4.3% p =.067). Conclusion: Despite the introduction of alternative therapies, the total hysterectomy rate in the management of AUB did not decrease in our clinic. Journal of Minimally Invasive Gynecology (2009) 16, 47-51 (C) 2008 AAGL. All rights reserved.