A life course approach to hysterectomy : working towards an improved understanding of the predictors and long-term health consequences of a common surgical procedure
The epidemiology of hysterectomy is not fully understood. This has allowed a long standing, emotive debate about the necessity of this common surgical procedure to continue without resolution. This thesis informs the debate by examining some of the main potential predictors and long-term health consequences of hysterectomy, using a life course approach. The National Survey of Health and Development, a cohort of 5,362 British males and females followed-up since birth in March 1946 was used. Of 1,797 women with appropriate data, 403 had undergone hysterectomy by age 57 years. Using survival analyses the associations between lifetime socioeconomic position, body mass index (BMI), reproductive characteristics and subsequent hysterectomy rates were investigated. Linear and logistic regression models were used to examine the relationships between hysterectomy and subsequent BMI, musculoskeletal and psychological health and quality of life. Education, age at menarche, parity, irregular/infrequent menstrual cycles and BMI in adulthood all predicted subsequent hysterectomy rates independently of each other. The association between hysterectomy and higher subsequent BMI could be explained by the greater exposure to risk factors for poor health of hysterectomised women. This difference in risk profiles only partially explained associations found between young age at hysterectomy and poor musculoskeletal and psychological health. The majority of hysterectomised women believed that their hysterectomy had a positive effect on their quality of life. This work suggests that hysterectomy rates are determined by a complex of factors that operate via medical need as well as supply and demand. The UK's Chief Medical Officer's recent call to reduce hysterectomy rates to the same low levels across all areas of the country may not be achievable or beneficial. Although there is no clear evidence to suggest that hysterectomy directly influences subsequent health, hysterectomised women are a defined group who may require more support to maintain good health with age.