Younger women more likely to report regret after hysterectomy for benign conditions

Key takeaways:

• Women aged 30 years or younger were more likely to regret undergoing hysterectomy for benign disease.
• Respondents with more time since hysterectomy were less likely to report loss-of-fertility regret.

Women aged 30 years or younger were more likely to report feelings of surgical and loss-of-fertility regret after undergoing laparoscopic hysterectomy vs. women aged 31 to 49 years, researchers reported in Obstetrics & Gynecology.

“Prior studies report high rates of symptom relief and patient satisfaction after hysterectomy; however, these studies include mostly older patients undergoing abdominal hysterectomy with concurrent bilateral salpingo-oophorectomy,” Nathan R. King, MD, a minimally invasive gynecologic surgeon at the University of Illinois at Chicago, and colleagues wrote. “Advances in minimally invasive techniques have decreased risks and recovery times after the procedure, which can affect satisfaction. Despite this high satisfaction, surgeons continue to use young age as a barrier to access hysterectomy due to concerns about regret.”

King and colleagues conducted a matched retrospective cohort study with 241 women who underwent laparoscopic hysterectomies for benign indications from 2009 to 2016 and completed surveys measuring surgical decision regret, loss-of-fertility regret, a questionnaire about current health state, relevant gynecologic care and fertility treatments.

Primary outcome was differences in rates of surgical and loss-of-fertility regret between participants aged 30 years or younger vs. those aged 31 to 49 years.

Overall, average time since hysterectomy for all respondents was 7.2 years and 32% of respondents were aged 30 years or younger.

Respondents aged 30 years or younger demonstrated higher regret compared with those aged 31 to 49 years for undergoing the surgery itself (32.5% vs. 9.1%; OR = 4.8; 95% CI, 2.3-9.8) and loss of fertility (39% vs. 13.4%; OR = 4.1; 95% CI, 2.2-7.8). Agreement that hysterectomy was the right choice was higher among respondents in the older vs. younger age groups (83.1% vs. 97%; P < .001).

Researchers observed higher rates of surgical and loss-of-fertility regret among respondents with self-reported pelvic pain (P = .003 and P = .011, respectively), preoperative endometriosis diagnosis (P = .037 and P = .046, respectively) and postoperative complications (P = .043 and P < .001, respectively) vs. respondents without.

Respondents with more vs. less time since hysterectomy had lower rates of loss-of-fertility regret (P = .003), but time since surgery did not impact surgical regret rates. In multivariable logistic regression analysis, age was similarly associated with surgical regret (aOR = 2.9; 95% CI, 1.3-6.5) and loss-of-fertility regret (aOR = 2.8; 95% CI, 1.3-6).

“It must be emphasized that these data should not preclude the option of hysterectomy when deemed appropriate, because a strong majority of patients in both age groups were satisfied with their decision,” the researchers wrote. “Instead, focus should be placed on shared decision making and respect for patient autonomy when counseling individuals about procedures that result in permanent sterilization, as the American College of Obstetricians and Gynecologists recently advised. Accordingly, our data should be used to counsel patients, especially those aged 30 years or younger, about the risk of regret during informed consent for hysterectomy.”