Counselling reduces rate of surgery for women

Doctors have found a way of reducing serious surgery in women and increasing their satisfaction with alternative treatments – by talking to them about their options.

One woman in five has a hysterectomy before she is 55, often for heavy menstrual bleeding. But a study of 894 women in six hospitals in south-west England found fewer women opted for a hysterectomy if they were given an opportunity to talk through other options.

Almost half (48 per cent) of the women in the control group, given no information or chance to discuss the options, chose hysterectomy, compared with 38 per cent in the group who received an information pack and an appointment to discuss it

Giving women the information pack alone, without the consultation, had no effect. They were as likely to opt for a hysterectomy as those who had no information.

Andrew Kennedy, formerly of the health economics research group at Brunel University, who led the research, published in the Journal of the American Medical Association, said: "A lot of women referred to hospital with this condition think hysterectomy is the only option.

"Quite often they have already been given various drugs by their GP. But it's not just about talking to them. It is about having the information and being able to use it."

For years the standard treatment for heavy menstrual bleeding was dilatation and curettage, which involved scraping the lining of the womb. This has now been discredited as a treatment and superseded by new drug treatments and minimally invasive surgery.

These new treatments, including hysterectomy, have different risks and benefits and Mr Kennedy said women needed help in the shape of "decision aids" to choose between them.

"We gave them lists of clinical outcomes and lifestyle outcomes so they could assess what mattered to them. The clinical outcomes included questions such as, 'Did they want to keep their womb?' and 'Were they for or against long-term drug therapy?'

"The lifestyle questions asked what they felt about not being able to function properly for three months after hysterectomy, having a long hospital stay or having pain and discomfort. It is the values that you associate with different outcomes that count," Mr Kennedy said.

The trial, between October 1996 and February 1998, was the biggest to examine the effect of decision aids in influencing treatment choices. It found the women who used them had less invasive treatment, which cost less (£1,000) than in the control group (£1,800) but they were more satisfied with it.

Mr Kennedy said: "The same treatment may not be right for everyone. These interventions ensure women get the treatment they want."