Persistence of Symptoms after Total versus Supracervical Hysterectomy in Women with Histopathologic Diagnosis of Adenomyosis.

OBJECTIVE: To compare symptom persistence in women with adenomyosis based on retention or removal of cervix at time of hysterectomy.

DESIGN: Retrospective cohort study and follow-up survey.

SETTING: Tertiary care academic hospital, Boston MA USA.

PATIENTS: 1,580 women who underwent laparoscopic hysterectomy for benign indications from 2008-2012 at Brigham & Women's Faulkner Hospital and Brigham & Women's Hospital.

INTERVENTION: Retrospective chart review and follow-up survey MEASUREMENTS AND MAIN RESULTS: 762 (48%) women responded to the postoperative symptom resolution survey. Of these, 623 subjects agreed to participate. Menopausal women or those who underwent bilateral salpingo-oophorectomy were excluded. Adenomyosis was identified on histopathologic evaluation of the uterus in 171 of the remaining 443 cases (39%). Compared to those without adenomyosis, women with adenomyosis were older on average (mean age 46.6 years ± 6.8 vs 45.0 ± 5.5 years, P= .009) and more likely to report that abnormal bleeding and pain led to their hysterectomy (87.7% vs 79.8%, P=.03) and (64.9% vs 51.4%, P=.009) respectively. The rates of total and supracervical hysterectomies were similar between the groups. Following surgery, women with adenomyosis were less likely to report persistent pain (aOR 0.43, 95% CI 0.20-0.93, P=.03) compared to those without adenomyosis. Persistent bleeding was similar between the two groups (aOR 0.97, 95% CI 0.49-1.93, P=.94). Among women with adenomyosis, multivariable logistic regression showed no difference in persistence of symptoms with cervical removal or retention at time of hysterectomy.

CONCLUSION: Compared to those without adenomyosis, women with histopathologic-proven adenomyosis were less likely to report persistent pain following hysterectomy. Retaining the cervix does not appear to increase the risk of symptom persistence or post-procedure patient satisfaction.