Patient selection: women with abnormal uterine bleeding, chronic pelvic pain and/or symptomatic uterine fibroids
Risk factors for hysterectomy:
(1) absence of symptom resolution (despite interventions)
(2) previous use of a gonadotropin-releasing hormone agonist
(3) one or both of the following:
(3a) symptomatic fibroids
(3b) multiple pelvic symptoms (abnormal bleeding and chronic pelvic pain)
where:
• Gonadotropin-releasing hormone analogs include leuprolide (Lupron). goserelin (Zoladex), and triptorelin (Trelstar Depot).
total number of risk factors =
= SUM(number of risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
• The risk of hysterectomy increases (and uterine survival decreases) as the number of risk factors increase.
|
Number of Risk Factors
|
Percent of Women Undergoing Hysterectomy Over a 20 Year Period
|
|
0
|
25%
|
|
1
|
50%
|
|
2
|
80%
|
|
3
|
98%
|
from Figure 2, page 639
