Publication:

Hysterectomy for dysfunctional uterine bleeding in the era of uterine conservation

Background Hysterectomy is one of the modalities to manage dysfunctional uterine bleeding (DUB) where medical management fails or is contraindicated. Hysterectomy leads to guaranteed cure but does have a significant morbidity rate. In this era of popularization of various uterine conservation techniques there is a definite need to audit justification of causes which led to hysterectomy in DUB.

Methods Women with a diagnosis of DUB, based on clinical and ultrasound findings, which underwent endometrial sampling/curettage were recruited for the study. All these patients were followed up. Those who underwent hysterectomy for the sake of DUB were thoroughly studied. Information regarding the histopathology report of hysterectomy specimen was collected. Finally reason and justification of hysterectomy for these women was evaluated.

Results A total of 252 women were with DUB were included. In this group 76 women (30.2%) underwent hysterectomy. Noncompliance to medical management was the most common indication (in 37.6% women), which led to hysterectomy in our study group. Significant result was seen with final histology of simple endometrial hyperplasia in which 19 out of 41 (46.4 %) cases were missed on curettage. Similarly around 50% cases (21 out of 43) diagnosed as simple hyperplasia on curettage had normal endometrium on final histopathology. Contrary to this a 100% concordance was seen in complex hyperplasia (without atypia), with only two cases in our sample. More than three fourth (78%) cases had a coincidental pathology in the myometrium.

Conclusions Thorough counseling for the benefits and side effects of medical management prior to starting it is imperative, as the most common indication for hysterectomy for DUB was non-compliance to medical management.  If women with normal histopathology reports on curettage are not responding to medical management, further imaging and sampling is required. Women non responsive to medical management may have underlying/ co-existent myometrial pathology.