Dr Melissa Graham: Treatments for Menstrual Symptoms: An Epidemiological Investigation.

Australian statistics indicate that hysterectomy is a common procedure amongst middle-aged Australian women. The appropriateness of hysterectomy to treat non-malignant conditions has been debated in recent years. A variety of procedures, less dramatic than hysterectomy, is available to treat menstrual problems. Factors such as socio-economic status, social support, geographical location, the number of menstrual problems experienced, the availability of information about menstrual problems and treatment options, and satisfaction with the outcomes of treatments may influence a woman’s decision to elect to have a hysterectomy.

To investigate these issues, an epidemiological investigation of women with menstrual problems was undertaken. The aim was to describe the characteristics of middle-aged Australian women with menstrual problems and to identify factors that predict hysterectomy as a treatment for the relief of menstrual symptoms. This study was conducted as two separate sub-studies of the ALSWH.

The cross-sectional study was developed to describe the characteristics of Australian women who choose hysterectomy as a treatment for menstrual symptoms and to identify relationships and pathways from menstrual problems to hysterectomy (n = 201). The study showed that there is not enough information available to women about treatment options for the relief of menstrual problems, excluding hysterectomy. Satisfaction with hysterectomy as a treatment for menstrual problems was reported by the majority of women, in spite of these women also reporting the onset of new problems. Few women had tried a range of treatment options for the relief of their menstrual problems prior to their hysterectomy.

The prospective study was developed to identify factors which predict the number and type of treatments tried for the relief of menstrual problems (n = 486). Three main factors were identified as predictors of the number of treatments tried: better access to health care professionals, experiencing more limitations in daily activities, and negative emotions to a greater degree as a result of menstrual problems. The prospective study also allowed for the examination of changes in women’s experiences over time. This study demonstrated that the number of menstrual problems experienced by middle-aged women decreases over time.
A comparative analysis was also undertaken of those women who had a hysterectomy (cross-sectional study) and those who did not (prospective study baseline data). The sample consisted of 687 women who participated in either the cross-sectional or prospective study. Regression analysis was used to determine the factors that predict women’s choice of treatments for the relief of menstrual symptoms. The findings indicate that more menstrual symptoms or conditions experienced, more information that is perceived to be available about menstrual problems, and greater influence on the treatment decision-making process, all increase the likelihood of hysterectomy. Dissatisfaction with treatments tried for the relief of menstrual problems also increases the likelihood of hysterectomy and progression to hysterectomy puts many women at risk of also having oophorectomy and thus, surgical menopause.