Determinants of hysterectomy and oophorectomy in women attending menopause clinics in Italy.

OBJECTIVE: To analyse determinants of hysterectomy for benign uterine conditions with or without oophorectomy in Italy, a country with among the lowest rates of hysterectomy worldwide.

METHODS: Between 1997 and 1999, a large cross sectional study was conducted on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counselling about menopause or treatment of menopausal symptoms. A total of 25644 women entered the study. Characteristics of women who underwent and women who did not undergo hysterectomy and oophorectomy were compared.

RESULTS: Out of the 25644 women considered, 4727 were hysterectomized (18.4%). Mean age at surgery was 46.8 years. The OR of hysterectomy decreased with increasing educational level: in comparison with women with primary and none education, the OR of hysterectomy was 0.8 (95% CI 0.7-0.9) and 0.6 (95% CI 0.5-0.7) respectively for women with intermediate or high/university degree. Body mass index (BMI, kg m(-2)) was related to the frequency of hysterectomy; in comparison with women with BMI< or =23.8, the OR of hysterectomy was 1.2 (95% CI 1.1-1.3) and 1.4 (95% CI 1.2-1.5) respectively for women with a BMI 23.8-27.2 and >27. 2. The frequency, of bilateral oophorectomy increased with age at hysterectomy: in comparison with women who have had hysterectomy when aged < or =43 years, the OR of bilateral oophorectomy during hysterectomy was respectively 1.9, 3.4 and 4.3 in women who had hysterectomy at age 44-47, 48-51 and > or =52 years. The frequency of bilateral oophorectomy was lower in more educated women: in comparison with women reporting none or primary degree, the OR was 1. 0 and 0.8 respectively for women with intermediate and high/university degree.

CONCLUSIONS: The results of this analysis indicate that hysterectomy for benign conditions is more frequently performed in less educated women, in nulliparae and in women with higher BMI. During hysterectomy for benign conditions, bilateral oophorectomy is more frequent in less educated women and its frequency increases with women's age.