Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause

Lee A. Learman, Sanae Nakagawa, Steven E. Gregorich, Rebecca Jackson, Alison Jacoby, Miriam Kuppermann
In: American Journal of Obstetrics and Gynecology · 2011 · vol. 204(3) , pp. 272.e1–272.e7 · doi:10.1016/j.ajog.2010.12.052 · PMID:21376169 · W2049079690
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This study investigated the success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids, analyzing outcomes in relation to patient age and proximity to menopause.

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Abstract

ObjectiveThe purpose of this study was to determine whether age at first uterus-preserving treatment (UPT) predicts symptom resolution among women with common pelvic problems.Study designWe conducted an analysis of 557 participants in the Study of Pelvic Problems, Hysterectomy and Intervention Alternatives cohort who reported having undergone a UPT. We performed multivariable regression modeling age at first UPT, hysterectomy, menopause, and other covariates to predict symptom resolution.ResultsMean ± SD age at enrollment was 42.7 ± 4.7 years; mean follow-up time was 4.4 ± 2.7 years. Sixteen percent of the women underwent hysterectomy; 37% of the women entered menopause. Hysterectomy was a strong predictor of symptom resolution (P < .001). Compared with women who were younger (first UPT at age <40 years), older women reported greater symptom resolution, even after the data were controlled for hysterectomy use and menopausal status (P = .028).ConclusionWomen who are ≥40 years old when they undergo their first uterus-preserving treatment experience greater symptom resolution than younger women. Framing UPTs as hysterectomy alternatives may be accurate only for a subset of women who are >40 years old.

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chronic_pelvic_pain

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