We randomly assigned 63 premenopausal women with abnormal
uterine bleeding refractory to cyclic
medroxyprogesterone acetate treatment to receive either a
hysterectomy or expanded medical treatment. Within each randomized group, the specific treatment approach was determined by patient and provider preference. The primary analysis compared changes in clinical outcomes at 6 and 24 months by using an intention-to-treat approach. Secondary as-treated analyses after adjustment for baseline covariates compared participants randomly assigned to medical treatment who continued the medical approach with those who crossed over to
hysterectomy.
RESULTS: The intention-to-treat analyses at 6 months revealed greater symptom improvement in the
hysterectomy group than in the medicine group for
pelvic pain (P <.01), urinary urgency (P =.03), incomplete bladder emptying (P =.03),
breast pain (P =.02), and cessation of
vaginal bleeding (87% versus 11%, P <.001). Seventeen of 32 women assigned to medicine (53%) eventually crossed over and received a
hysterectomy, and by 24 months the statistically significant differences by intention-to-treat were limited to greater improvement in hot flushes (P <.01) and cessation of
vaginal bleeding (P <.01). Within-group analyses at year 2 showed statistically significant improvements from baseline on most symptoms for women who had a
hysterectomy, whether through randomization or crossover. Women remaining on medical treatments had statistically significant improvements in
pelvic pain, pelvic/bladder pressure, and stress incontinence. In a nonrandomized comparison with women who remained on medical treatments through year 2, those crossing over to
hysterectomy experienced greater improvements in
bleeding (P <.01),
pelvic pain (P <.01),
low back pain (P =.02),
breast pain (P =.01), urinary frequency (P =.01), and urgency (P =.02). However, they also experienced more days off from work or usual activities (P <.01) and more days spent in bed (P <.01) than those who remained on medicine.
CONCLUSION: