Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy

Objective  To conduct a prospective and concurrent evaluation of changes in health status and quality of life and psychological outcome measures over one year in women randomised to total or subtotal abdominal hysterectomy. The concurrent evaluation was the impact of total versus subtotal hysterectomy on bladder, bowel and sexual function.

Design  Prospective, randomised, double-blind study.

Setting  A large UK Teaching Hospital (St George's Hospital, London) and a large District General Hospital (Mayday University Hospital, Croydon).

Methods 

Sample  Two hundred and seventy-nine women undergoing hysterectomy for benign disease were randomly allocated to total hysterectomy (n= 146) or subtotal hysterectomy (n= 133).

Main outcome measures  Quality of life assessment using the Short-Form-36 health survey (SF-36) and psychological outcome measures using the General Health Questionnaire-28 (GHQ-28) before the operation and 6 and 12 months after.

Results  Quality of life and psychological symptoms were similar in the two groups at baseline. Following surgery, quality of life improved in six of the eight domains, with no significant difference between the groups, with the exception of emotions which showed a greater improvement in subtotal hysterectomy women between baseline and 12 months. When this difference was examined further by looking at change in the GHQ subscales, there were no significant differences between total and subtotal hysterectomy women in the amount of change in anxiety, depression, somatic symptoms or social dysfunction, between baseline and post-operative measurements. All women showed an improvement in psychological symptoms following both operations.

Conclusion  Hysterectomy, whether total or subtotal, may improve quality of life and psychological outcome.