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

D. A. Alexander, Ahmed Anouar Naji, S. B. Pinion, Jill Mollison, HC Kitchener, David E. Parkin, D. R. Abramovich, I T Russell
In: BMJ · 1996 · vol. 312(7026) , pp. 280–284 · doi:10.1136/bmj.312.7026.280 · PMID:8611783 · W2047513947
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This trial found that both hysterectomy and hysteroscopic surgery for dysfunctional uterine bleeding resulted in similar improvements in mental health, sexual adjustment, and marital relationships with no evidence of postoperative psychiatric illness from hysterectomy.

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This prospective randomized controlled trial compared the psychiatric and psychosocial outcomes of hysterectomy versus hysteroscopic surgery, including transcervical resection or laser ablation, in 204 women treated for dysfunctional uterine bleeding. Assessments conducted at baseline, one month, six months, and twelve months post-operation revealed that both interventions significantly reduced pre-existing anxiety and depression without causing postoperative psychiatric illness. The study found no significant differences in mental health, marital relationships, or sexual interest between the two treatment groups over the twelve-month follow-up period. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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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, martial 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 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.
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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, martial 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 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. Full text PDFSelected References These references are in PubMed. This may not be the complete list of references from this article. - Alexander D. A., Taylor R. J., Fordyce I. D. Attitudes of general practitioners towards premenstrual symptoms and those who suffer from them. J R Coll Gen Pract. 1986 Jan;36(282):10–12. [PMC free article] [PubMed] [Google Scholar] - Andersen T. 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