Prevalence Of Hysterectomy Research Articles

Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India

This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India.

Population-based hysterectomy rates in Germany from 2005 through 2006

Objectives: Population-based hysterectomy (HE) rates in Germany have not been estimated until now. The aim of this study was to provide German-wide and regional HE rates based on the national DRG hospitalization file. Study Design: DRG data of the years 2005 and 2006 covering 36.3 million hospitalisations all over Germany were used to calculate HE rates stratified by region, indication group, and surgical approach. We used ICD-10 codes and surgical procedures codes (OPS) to classify HEs. Results: Overall 305,015 HE were undertaken during the study period (3.6 out of 1,000 women). HE rates varied considerably across Federal States. After correction for the population at risk by the estimated prevalence of HE in the general population, this rate increased to 4.3 out of 1,000 women (19% increase). Only about 6% of all HEs were either performed by LAVH or laparoscopic procedures. The majority of HE for benign indications were performed as vaginal HEs (55%). Overall, 23% of all HEs included bilateral oophorectomy. Five percent all HEs due to benign diseases of the genital tract were subtotal HEs. The proportion of subtotal HEs in this group was highest for HEs undertaken as laparoscopic HE (64%). Conclusions: HE is one of the most frequent surgical procedures in gynecology. The international comparison of population-wide HE rates related to benign diseases of the genital tract of the recent years shows that Sweden has the lowest HE rate and the United States and Australia have the highest rates. Germany has a rate between these extremes.

Black–White Differences in Hysterectomy Prevalence: The CARDIA Study

We evaluated the cross-sectional association between race and hysterectomy prevalence in a population-based cohort of US women and investigated participant characteristics associated with racial differences. The cohort consisted of 1863 Black and White women in the Coronary Artery Risk Development in Young Adults (CARDIA) study from 2000 to 2002 (years 15 and 16 after baseline). We used logistic regression to examine unadjusted and multivariable adjusted odds ratios. Black women demonstrated greater odds of hysterectomy compared with White women (odds ratio [OR] = 3.52; 95% confidence interval [CI] = 2.52, 4.90). Adjustment for age, educational attainment, perceived barriers to accessing medical care, body mass index, polycystic ovarian syndrome, tubal ligation, depressive symptoms, age at menarche, and geographic location minimally altered the association (OR = 3.70; 95% CI = 2.44, 5.61). In a subset of the study population, those with directly imaged fibroids, the association was minimally attenuated (OR = 3.47; 95% CI = 2.23, 5.40). In both unadjusted and multivariable adjusted models, Black women, compared with White women, had increased odds of hysterectomy that persisted despite adjustment for participant characteristics. The increased odds are possibly related to decisions to undergo hysterectomy.

Breast cancer risk and hysterectomy status: the Multiethnic Cohort study.

The main objective was to examine the association between simple hysterectomy (without bilateral oophorectomy) and breast cancer risk. Because hysterectomy prevalence varies by ethnicity, the secondary objective was to examine whether inclusion of women with hysterectomies affects the estimates of breast cancer risk by ethnicity. The Multiethnic Cohort study was assembled between 1993 and 1996 and included 68,065 women from Hawaii and Los Angeles, aged 45-75 years, without any missing information or bilateral oophorectomy. Hysterectomy status was self-reported. After 7.7 years median follow-up, 1,862 cases of invasive breast cancer were identified. Proportional hazards models were used to estimate relative risks (RR) while controlling for known risk factors. Prevalence of simple hysterectomy varied from 12% to 29% among the ethnic groups (White, African American, Native Hawaiian, Japanese American, and Latina). Overall, hysterectomy was not associated with breast cancer risk (RR = 0.98). Although the RRs were nonsignificantly elevated by 15% in White women and nonsignificantly reduced by 15% in Latinas of non-US origin, the variation by ethnicity was not significant (p(interaction) = 0.48). The breast cancer risk associated with ethnicity was very similar when estimated with and without women with hysterectomies. This study suggests that simple hysterectomy status does not alter breast cancer risk. Therefore, inclusion of women with simple hysterectomies does not substantially change estimated risk of breast cancer by ethnicity.

Risk Estimates of Hysterectomy and Selected Conditions Commonly Treated with Hysterectomy

This study presents corrected rates and probability (risk) estimates of experiencing a hysterectomy and of selected conditions commonly treated with hysterectomy. Analyses are based on hysterectomy prevalence data from the Behavior Risk Factor Surveillance Survey (calendar years 2000-2006), hysterectomy incidence data from the National Hospital Discharge Survey (2001-2005), and population estimates from the U.S. Census Bureau (2001-2005). The correction involved removing those women without a uterus from the denominator in the rate calculation. Corrected hysterectomy incidence rates per 1000 women were greater than the uncorrected rates for women ages 18-44 years (6.0 vs. 5.0), 45-64 years (10.4 vs. 7.1), and 65 years and older (4.9 vs. 2.6). Correcting the rates had a comparatively larger impact in the South. Incidence rates of selected conditions associated with the female reproductive system were greater after correction for hysterectomy prevalence. For example, corrected compared with uncorrected rates of uterine fibroids per 1000 women were 2.9 vs. 2.7 for ages 18-44 and 5.0 vs. 3.4 for ages 45-64. The uncorrected and corrected 10-year risk of being diagnosed with uterine fibroids among women aged 50 who have not previously had fibroids is 3.87 (1 in 26) and 4.54 (1 in 22), respectively. The correction method employed produces greater incidence and age-conditional-risk estimates of hysterectomy and of conditions commonly treated with hysterectomy. Corrected rates and age-conditional risk estimates may allow women with intact uteri to better assess their probability of undergoing a hysterectomy and certain other conditions of the reproductive system.

Prevalence of Abdominal and Pelvic Surgeries in Patients With Irritable Bowel Syndrome: Comparison Between Caucasian and African Americans

Although controversial, studies suggest that irritable bowel syndrome (IBS) is associated with an increased risk of abdominal and pelvic surgeries. However, the role of race in this interaction has not been defined. We studied the prevalence of appendectomy, cholecystectomy, and hysterectomy among African American patients with IBS among the population at large and compared it with the Caucasians residing in same area. A total of 990 adults from 9 different sites in the Jackson, Mississippi, metropolitan area (670 African Americans and 320 Caucasians), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS, based on ROME II criteria. We recorded the patient's name, age, sex, race, history of smoking, and history of surgeries. Subjects with a history of IBD and gastrointestinal cancer were excluded. The prevalence of appendectomy and hysterectomy was compared between IBS patients and non-IBS control subjects. One thousand ninety-nine, or 84%, of those distributed were returned. On checking the exclusion and inclusion criteria, we eliminated 109 subjects. The reasons for elimination of 109 subjects included incomplete questionnaires and incorrect marking of questionnaires that resulted in invalid data. Overall, there was significantly higher prevalence of appendectomy (15.3% vs 5.1%) and cholecystectomy (6.6% vs 3.4%) but not hysterectomy (21.1% vs 17.6%; P = NS) among Caucasian Americans as compared with African Americans. The prevalence of appendectomy among IBS patients (n = 95) versus non-IBS subjects (n = 895) was not statistically significant (10.5% vs 8.2%; OR, 1.3; 95% CI, 0.7 to 2.7; P = 0.43). The prevalence of cholecystectomy in the 2 groups was also similar (5.3% vs 4.4%). Likewise, there was no statistically significant difference for the prevalence of hysterectomy among females IBS patients versus non-IBS females (23.3% vs 18.2%; OR, 1.4; 95% CI, 0.8 to 2.4; P = 0.29). Comparing the prevalence of these surgeries in with IBS patients (African Americans versus Caucasian Americans), we found significant difference in the prevalence of appendectomy to be 1.9% vs 21.4% (P < 0.01). In contrast, there was no difference in the prevalence of cholecystectomy or hysterectomy. Logistical regression suggested that race but not IBS was a significant factor in the prevalence of various surgeries. Based on responses to ROME II criteria questionnaire administered to community at large, IBS is not associated with greater prevalence of abdominal and pelvic surgeries. Caucasians are more likely to have these surgeries irrespective of whether they have IBS or not. Our study does not exclude the possibility that there may indeed be association between IBS and surgeries if only the IBS patients seeking health care are considered.

A prospective study of outcomes after hysterectomy in mid-aged Australian-born women

Objective To describe the prevalence of hysterectomy in a mid-aged population-based sample of Australian-born women who were menstruating at baseline and followed for 11 years, and to compare the hysterectomized women with the non-hysterectomized women with regard to symptom reporting and health outcomes.Methods This was a 12-year prospective observational study of 438 women who at baseline were aged 45–55 years, not taking hormone therapy (HT) and had menstruated in the previous 3 months. Interviews were conducted face-to-face.Results After 11 years of follow-up, 39 (9%) women had experienced a hysterectomy, of whom 43.5% had the uterus only removed, 13% had the uterus plus one ovary and 43.5% had the uterus and both ovaries removed. Hysterectomies were performed on average 5.8 years prior to the year 11 interview. The mean age at hysterectomy was 54 years. Multivariate logistic regression analysis, including all co-variates, found that women who had experienced a hysterectomy (±oophorectomy) were significantly more likely to complain of trouble sleeping (p < 0.01), have problems with urine control (p < 0.05) and with their bowels (p = 0.07), have used HT (p < 0.05) and have a higher body mass index (p < 0.05). There were no significant associations between hysterectomy and sexuality or hot flush reporting.Conclusion In a community-based sample of Australian-born women, the experience of a hysterectomy after the age of 45 years was associated with bladder, weight and sleeping problems 5–6 years after the surgery.

Persistent High Rates of Hysterectomy in Western Australia: A Population-Based Study of 83,000 Procedures Over 23 Years

Hysterectomy is one of the most common surgeries performed on women living in Western countries, but rates differ substantially both between and within countries. This population-based retrospective cohort study examined trends in the incidence rate of hysterectomy in Western Australia, which has one of the highest rates in the world and one similar to that reported for the United States. Rates were followed over a 23-year period from 1981 to 2003, during which time 83,068 hysterectomies were done in women 20 years of age and older. The average age at the time of hysterectomy increased from 41.7 years in 1981 to 48.0 years in 2003. The rate of hysterectomy declined 23% during this time. By 2003, the age-standardized rate, adjusted for the prevalence of hysterectomy in the community, was 4.8 per 1000 women. The rate of abdominal hysterectomy decreased by an average of 3.7% each year from 1981 to 2003, whereas at the same time, the rate of vaginal hysterectomy (VH) increased by an average of 1.4% annually. Since it was introduced in the early 1990s, the rate of laparoscopically-assisted VH (LAVH) has increased by an average of 13.3% a year. By 2003, VH accounted for 45% of all hysterectomies, abdominal hysterectomy for 40%, and LAVH for 15%. A decline in hysterectomies done for menstrual disorders was partially offset by an increase in hysterectomy as a treatment for fibroids. Hysterectomy for menstrual disorders was done significantly more often in women living in rural and remote areas. Regardless of site of residence, indigenous women had half the overall rates of hysterectomy than did nonindigenous women. Nevertheless, the rate of surgery for gynecologic cancer was higher in indigenous women. The rate of serious procedure-related problems was 2.2%, and approximately 20% fewer such events occurred in women having VH rather than abdominal hysterectomy. During the period under study, the average hospital stay for hysterectomy decreased from 11.5 to 5.0 days. Although Western Australia still has a relatively high rate of hysterectomy, significantly fewer abdominal procedures are done than in most other countries.

Impact of Hysterectomy and Bilateral Oophorectomy on Race-Specific Rates of Corpus, Cervical, and Ovarian Cancers in the United States

Population-based cancer incidence rates of the corpus uteri, cervix uteri, and ovaries are underestimated if they fail to remove women not at risk for developing the cancers from the denominator in the race calculation. This study compares incidence rates among selected racial groups for these cancers before and after correction for prevalence of hysterectomy and bilateral oophorectomy. The study covers 1998 through 2002 and involves Surveillance, Epidemiology, and End Results Program; Behavior Risk Factor Surveillance System; and National Health Interview Survey data. Prevalence data were obtained by using survey and life-table methods. Four racial groups are considered: whites, blacks, American Indians/Alaska Natives, and Asians/Pacific Islanders. Risk correction significantly increased rates of corpus uterine cancer by 73.1% for whites, 93.0% for blacks, 86.3% for American Indians/Alaska Natives, and 41.0% for Asians/Pacific Islanders. Corresponding percentages among these racial groups for cervical cancer were 37.7%, 60.2%, 45.6%, and 33.0%, and for ovarian cancer, 32.5%, 31.1%, 35.0%, and 23.6%, respectively. Risk correction had large influences on the comparison of rates among racial groups. For example, for uterine corpus cancer, Asians/Pacific Islanders had 32.9% lower rates than whites before correction, but 45.3% lower rates after correction. For cervical cancer, blacks had 27.6% higher rates than whites before correction, but 48.5% higher rates after correction; and for ovarian cancer, Asians/Pacific Islanders had 31.2% lower rates than whites before correction and 35.8% lower rates after correction. Corrected rates of corpus uteri, cervix uteri, and ovarian cancers have a large, but differential, impact on the racial groups considered.

Persistent high rates of hysterectomy in Western Australia: a population‐based study of 83 000 procedures over 23 years

To investigate incidence trends and demographic, social and health factors associated with the rate of hysterectomy and morbidity outcomes in Western Australia and compare these with international studies. Population-based retrospective cohort study. All hospitals in Western Australia where hysterectomies were performed from 1981 to 2003. All women aged 20 years or older who underwent a hysterectomy. Statistical analysis of record-linked administrative health data. Rates, rate ratios and odds ratios for incidence measures and length of stay in hospital and odds ratios for morbidity measures. The age-standardised rate of hysterectomy adjusted for the underlying prevalence of hysterectomy decreased 23% from 6.6 per 1000 woman-years (95% CI 6.4-6.9) in 1981 to 4.8 per 1000 woman-years (95% CI 4.6-4.9) in 2003. Lifetime risk of hysterectomy was estimated as 35%. In 2003, 40% of hysterectomies were abdominal. The rate of hysterectomy to treat menstrual disorders fell from 4 per 1000 woman-years in 1981 to 1 per 1000 woman-years in 1993 and has since stabilised. Low socio-economic status, having only public health insurance, nonindigenous status and living in rural or remote areas were associated with increased risk of having a hysterectomy for menstrual disorders. Indigenous women had higher rates of hysterectomy to treat gynaecological cancers compared with nonindigenous women, particularly in rural areas. The odds of a serious complication were 20% lower for vaginal hysterectomies compared with abdominal procedures. Western Australia has one of the highest hysterectomy rates in the world, although proportionally, significantly fewer abdominal hysterectomies are performed than in most countries.

Differences Between Painless and Painful Constipation Among Community Women

In the Rome II criteria, patients with both constipation and abdominal pain (AP) (i.e., "painful constipation" (PC)), who do not satisfy criteria for irritable bowel syndrome (IBS) are included in the same functional constipation (FC) category as patients with constipation without AP (i.e., "painless constipation" (PLC)). What differences, if any, exist between FC without (i.e., PLC) and with AP (i.e., PC) are unclear. To compare clinical features among PLC, PC, constipation-predominant IBS (C-IBS), and non-C-IBS, a validated questionnaire was mailed (with telephone follow-up of nonresponders) to an age-stratified random sample of 5,200 adult women in Olmsted County, Minnesota. Altogether, 2,800 women (53%) responded. The age-adjusted prevalence of PLC (7.1 per 100; 95% confidence interval (95% CI), 6.2-8.0) was higher compared to PC (0.9 per 100; 95% CI, 0.6-1.2). Compared to PLC, patients with PC reported worse general health (i.e., excellent or very good = 37.5% vs 51.2%), more somatic symptoms (mean score = 1.3 vs 0.9), and urinary urgency (% often = 58% vs 32%), and had a higher prevalence of hysterectomy. Bowel symptoms significantly impacted > or =1 domain of quality of life (QOL) in 18% of PC versus 9% of PLC. In a logistic discriminant model, age, general health, impact of bowel symptoms on QOL, somatic symptoms, and urinary urgency independently discriminated between bowel subtypes. Patients with PC more closely resemble those with C-IBS than PLC. Consideration should be given to separating PC from PLC in the Rome criteria and in therapeutic trials.

Impact of Hysterectomy on Endometrial Carcinoma Rates in the United States

In the United States, endometrial carcinoma incidence rates, uncorrected for hysterectomy prevalence, are higher among white women than black women. We estimated corrected endometrial carcinoma rates by racial/ethnic groups and age (30-74 years) for 1992-2000 using data from the Surveillance, Epidemiology, and End Results program and the Behavioral Risk Factor Surveillance Survey. Hysterectomy prevalence was higher among black women than among Hispanic and white non-Hispanic women. Correcting for hysterectomy prevalence increased age-adjusted endometrial carcinoma rates per 10(5) woman-years from 29.2 to 48.7 (66.8% increase) overall, from 14.6 to 28.5 (95.3% increase) in blacks, from 18.8 to 29.6 (57.6% increase) in Hispanics, and from 33.2 to 54.9 (65.1%) in white non-Hispanics. This correction reduced the rate ratio for white non-Hispanics compared with blacks from 2.27 to 1.93. Among blacks but not Hispanics or white non-Hispanics, the endometrial carcinoma risk factors of obesity and diabetes were more prevalent among hysterectomized than nonhysterectomized women. Failure to correct for hysterectomy prevalence may lead to underestimates of endometrial carcinoma risk, especially among blacks. The high prevalence of hysterectomy among blacks with strong endometrial cancer risk factors may partly account for lower cancer rates in this group.

Pelvic Organ Prolapse in Defecatory Disorders

To compare the prevalence of pelvic organ prolapse in subjects with defecatory disorders with that in control subjects. In 55 subjects with fecal incontinence, 42 subjects with obstructed defecation, and 45 healthy subjects without defecatory symptoms, a urogynecologist assessed pelvic organ prolapse by the pelvic organ prolapse quantification system, and a gastroenterologist evaluated perineal descent during simulated evacuation. A multiple logistic regression model evaluated whether obstetric-gynecological variables, including pelvic organ prolapse, could discriminate among controls, subjects with fecal incontinence, and subjects with obstructed defecation. Fifty-five percent of controls, 42% of those with obstructed defecation, and 29% of those with fecal incontinence had stage II or greater prolapse by clinical examination. Eleven percent of controls, 7% of those with obstructed defecation, and 47% of subjects with fecal incontinence had a forceps delivery. Eighteen percent of controls, 31% of those with obstructed defecation, and 64% of those with fecal incontinence had a hysterectomy. Even after controlling for a higher prevalence of obstetric risk factors and hysterectomy, fecal incontinence was associated with a lower risk of stage II or greater pelvic organ prolapse (odds ratio for fecal incontinence in > or = stage II pelvic organ prolapse relative to stage 0 pelvic organ prolapse = 0.1, 95% confidence interval 0.01-0.53). In contrast, pelvic organ prolapse severity was not associated with control versus obstructed defecation status. Seven percent of controls, 18% of subjects with obstructed defecation, and 7% of those with fecal incontinence had increased perineal descent during simulated evacuation. Excessive perineal descent was associated (P < .01) with pelvic organ prolapse. Despite a higher prevalence of risk factors for pelvic floor injury, pelvic organ prolapse severity was lower in those with fecal incontinence than in subjects without bowel symptoms. However, a subset of subjects with defecatory disorders, predominantly obstructed defecation, have excessive perineal descent, which is associated with pelvic organ prolapse.

Hysterectomy prevalence and cardiovascular disease risk factors in American Indian women

Objectives We investigated hysterectomy prevalence and associated demographic and reproductive factors among American Indian women. The association between hysterectomy and cardiovascular disease (CVD) risk factors was also examined. Methods Data were from 2689 American Indian women who participated in the first examination of the Strong Heart Study from 1989 to 1992. Odds ratios were estimated for factors related to hysterectomy adjusting for other covariates. The association between hysterectomy and CVD risk factors was examined among 1726 eligible women using analysis of covariance. Results Hysterectomy prevalence ranged from 24% to 34% across differing age groups and the percent with oophorectomy among those with a hysterectomy ranged from 43% to 63%. Geographic area, more prior pregnancy losses, more education, and less speaking of the native language were associated with increased hysterectomy prevalence. After adjustment for age, the women who had a hysterectomy with intact ovaries had higher total cholesterol and low-density lipoprotein cholesterol levels than those with a natural menopause. Conclusions American Indian women have comparable hysterectomy prevalence as non-Hispanic white women. Education and native language speaking related to hysterectomy in this population. Hysterectomy alone may relate to unfavorable changes of lipid profile.

Geographic and temporal variations in cancer of the corpus uteri: Incidence and mortality in pre- and postmenopausal women in Europe

Corpus uteri cancer is the fourth most common neoplasm in women in Europe and the tenth most common cause of cancer death. We examined geographic and temporal variations in corpus uteri cancer incidence and mortality rates in the age groups 25-49 and 50-74 in 22 European countries. The disease is considerably less common in premenopausal women, with incidence and mortality rates decreasing throughout Europe and mortality declines more marked in western and southern European countries. Incidence rates among postmenopausal women are highest in the Czech Republic, Slovakia, Sweden and Slovenia and lowest in France and the United Kingdom. Increasing incidence trends in this age group are observed in the Nordic countries (except Denmark) and in the United Kingdom. Some increases are also seen in eastern (Slovakia) and southern Europe (Spain and Slovenia), while relatively stable or modestly decreasing trends are observed in Italy and most western European countries. Postmenopausal mortality rates are systematically higher in eastern Europe, with death rates in the Ukraine, Latvia, Czech Republic, Russia and Belarus 2-3 times those seen in western Europe. Declining mortality trends are seen in most populations, though in certain Eastern European countries, the declines began rather recently, during the 1980s. In Belarus and Russia, recent postmenopausal death rates are stable or increasing. The rates are adjusted for misclassification of uterine cancer deaths but remain unadjusted for hysterectomy, and where there is an apparent levelling off of incidence or mortality rates recently, rising prevalence of hysterectomy cannot be discounted as an explanation. However, the trends by age group can be viewed in light of several established risk factors for endometrial cancer that are highly prevalent and most likely changing with time. These are discussed, as are the prospects for preventing the disease.

Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey.

We investigated hysterectomy prevalence among Hispanic women. We obtained data from 4684 Hispanic women and 20 604 non-Hispanic White women from the 1998-1999 National Health Interview Survey. We calculated nationally representative odds ratios of previous hysterectomy, controlling for confounders. Compared with non-Hispanic White women, the odds ratio for hysterectomy was 0.36 (95% confidence interval [CI] = 0.30, 0.44) for Hispanic women with no high school diploma, 0.57 (95% CI = 0.44, 0.74) for high school graduates, and 0.67 (95% CI = 0.42, 0.87) for college attenders. Country of origin had little influence on hysterectomy prevalence. Hysterectomy was positively associated with acculturation. Hispanic women undergo fewer hysterectomies than do non-Hispanic White women. The reasons for this, as well as information on ethnicity-specific appropriateness of hysterectomy, should be explored.

Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales.

To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal. Collation of available NHS and private sector information. England and Wales. NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage. METHODS AND MAIN OUTCOME: Measures NHS data by 5-year age group, year and operation type were collated for 1961-1995. non-NHS operations for 1981, 1986, and 1992/3 were back-projected. Hysterectomy incidence rates, 1961-95, were back-projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year. When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55-59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25-64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing. True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.

Effects of hormone replacement therapy on cognitive performance in elderly women

Objective: To determine the effects of 9 months of hormone replacement therapy (HRT) on cognitive performance in women aged 75 years and older. Methods: A 9-month randomized, double-blinded, placebo-controlled parallel trial. Fifty-two elderly postmenopausal women (age range 75–91 years) without known contraindications to HRT or evidence of dementia or depression were enrolled. Participants were randomly assigned in a 1:2 ratio to placebo or conjugated estrogens at 0.625 mg/d plus trimonthly medroxyprogesterone acetate at 5 mg/d for 13 days (HRT). Main outcome measures were change from baseline and rate of change from baseline for the following psychometric tests: Verbal Fluency Test, Weschler Paired Associate Learning and 20 min Delayed Recall, Trailmaking A and B Tests, Cancellation Random Letter and Random Form Tests. Results: At baseline, women in the HRT group reported a younger age of onset of menopause and a higher prevalence of hysterectomy, but otherwise did not differ from women in the placebo group. After 9 months of treatment, there were no significant group differences for any of the cognitive performance measures. The lack of an observed group-by-time difference for all cognitive tests remained after controlling for age of onset of menopause, education, and previous hysterectomy. Conclusions: Although conclusions are limited by small sample size and the relatively short duration of treatment, results suggest that 9 months of estrogen replacement in combination with trimonthly progestin does not improve cognitive performance in women over 75 years who do not have dementia or depression.

Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales

Objective To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal. Design Collation of available NHS and private sector information. Setting England and Wales. Sample NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage. Methods and Main Outcome Measures NHS data by 5–year age group, year and operation type were collated for 1961–1995. non–NHS operations for 1981, 1986, and 1992/3 were back–projected. Hysterectomy incidence rates, 1961–95, were back–projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year. Results When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55–59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25–64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing. Conclusions True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.

Prevalence Corrected Hysterectomy Rates and Probabilities in Utah

PURPOSE: A life table method is used for correcting hysterectomy rates and probabilities for prevalent cases of hysterectomies in the population. Both corrected and conventional hysterectomy rates and probabilities are reported. METHODS: Hysterectomy prevalence estimates are derived from cross-sectional hysterectomy and mortality using a life table method. Analysis is based on the Utah Hospital Discharge Data Base and State death certificates. RESULTS: Hysterectomy rates are strongly influenced by age, reaching 150 per 10,000 for ages 45–49 years. The corresponding corrected hysterectomy rate is 196. Differences between the corrected and uncorrected cause-specific hysterectomy rates tend to be most pronounced at their peaks, particularly later in life where the prevalence of hysterectomy is greatest. Probability of hysterectomy approaches slightly above 35% over the life span, whereas the corrected hysterectomy probability approaches 43%. Probability of hysterectomy in the next 10 years is 12.9% for women aged 35 years and 11.7% for women aged 45 years. Corresponding corrected hysterectomy probabilities are 14.3 and 15.1. Higher prevalence of hysterectomy in later ages explains the reverse in magnitude of the rates when the correction is applied to the hysterectomy rates. CONCLUSIONS: Conventional hysterectomy rates are underestimated, particularly in older age groups. A prevalence correction of the rates and probabilities is necessary to fully understand the potential health related consequences and impact of this medical procedure in the population.