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. 2021 Apr;128(5):846-855.
doi: 10.1111/1471-0528.16469. Epub 2020 Sep 6.

Impact of hysterectomy on analgesic, psychoactive and neuroactive drug use in women with endometriosis: nationwide cohort study

M Brunes  1   2 , D Altman  3   4 , M Pålsson  5 , M W Söderberg  1   2 , M Ek  1   2
Affiliations

Impact of hysterectomy on analgesic, psychoactive and neuroactive drug use in women with endometriosis: nationwide cohort study

M Brunes et al. BJOG. 2021 Apr.

Abstract

Objective: To evaluate how hysterectomy affects the prescription of analgesic, psychotropic and neuroactive drugs in women with endometriosis using population-based nationwide registers.

Design: Nationwide cohort study.

Setting: Swedish national registers, from 1 January 2009 to 31 December 2018.

Population: Women with benign disease undergoing a total hysterectomy during the 4-year period of 2012-2015. Women with endometriosis (n = 1074) were identified and compared with women who did not have endometriosis (n = 10 890).

Methods: Prospectively collected data from two population-based registers were linked: the Swedish National Quality Register of Gynaecological Surgery and the Swedish National Drug Register. Multivariate logistic regression was used as the main statistical method.

Main outcome measures: Changes in drug prescription over time for 3 years prior to and 3 years after hysterectomy.

Results: The frequency of prescription of analgesics was higher in women with endometriosis compared with women without endometriosis (OR 2.2, 95% CI 1.7-2.9). Among women with endometriosis, the prescription of analgesics (OR 1.0, 95% CI 0.8-1.2) did not decrease 3 years after hysterectomy compared with the 3 years prior to surgery. There was also a significantly higher rate of prescription of psychoactive (OR 1.6, 95% CI 1.4-2.0) and neuroactive drugs (OR 1.9, 95% CI 1.3-2.7) in the long term postoperatively.

Conclusions: In women undergoing hysterectomy, endometriosis was associated with a higher prescription rate of analgesics. In the endometriosis group the prescription of analgesic, psychoactive and neuroactive drugs did not decrease when comparing prescription rates for the 3 years prior to and the 3 years after surgery.

Tweetable abstract: In women with endometriosis, the long-term prescription of analgesics did not decrease after hysterectomy.

Keywords: Endometriosis; hysterectomy; pain; prescription.

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Figures

Figure 1
Figure 1
Flow chart of the study population.
Figure 2
Figure 2
Comparison of frequency of women with (n = 1074) or without (n = 10 890) endometriosis being prescribed analgesics, over time. Graph showing point estimate and 95% confidence interval (shadowed area). *A comparison of overall differences in frequency of women with or without endometriosis being prescribed analgesics over the time period of 6 years. 95% CI, 95% confidence interval; aOR, adjusted odds ratio; cOR, crude odds ratio; preop, before hysterectomy; postop, after hysterectomy. 1Adjusted for all variables in Table 1 in a stepwise multivariate logistic regression model, removing variables with P > 0.25; 2adjusted for all variables in Table 1. Numbers of observations in regression models: 1aOR = 2016; 2aOR = 917. For more details, see Table S6.
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