Hysterectomy types in Estonia are still different from the Nordic countries.

OBJECTIVE: To describe hysterectomy rates in different age groups, indications and proportion of surgery types over time. DESIGN: Nationwide register-based study. SETTING: Estonia. POPULATION: Women who had hysterectomies for benign indications from 2004 to 2011. METHODS: For each case, diagnosis according to ICD-10, type of surgery according to Nordic Medico-Statistical Committee, age, and time of operation were retrieved from the Estonian Health Insurance Fund database. Mid-year female population statistics were obtained from Statistics Estonia. MAIN OUTCOME MEASURES: Rate of hysterectomies per 100 000 women, proportions of different operation types, and main indications for hysterectomies. RESULTS: The total number of hysterectomies was 12 336, with a yearly mean of 1542. The rate of hysterectomies per 100 000 women/year decreased between 2004 and 2011 from 239.1 to 204.9. The proportion of abdominal hysterectomies decreased from 86.0 to 56.1% and the proportion of laparoscopic hysterectomies increased from 6.3 to 34.7%, while the proportion of vaginal hysterectomies remained more or less stable (7.8-9.1%). Most hysterectomies (74.4%) occurred in the age group 35-54 years. The main indications for hysterectomies were leiomyoma (61.5%), female genital prolapse (9.0%) and endometriosis (8.8%). CONCLUSIONS: Population rates and indications for hysterectomies in Estonia were similar to those in most Nordic countries, but the proportion of abdominal hysterectomies was higher and that of vaginal hysterectomy lower. The rates of laparoscopic and vaginal hysterectomies should be increased.

Prevalence and risk factors of urinary incontinence among Estonian postmenopausal women.

AIMS: To estimate the prevalence of urinary incontinence (UI) and to assess its risk factors among postmenopausal Estonian women. METHODS: In 2004, 1363 women participating in the Estonian Postmenopausal Hormone Therapy Trial were asked at the closure visit to the trial physician about symptoms of UI. The type of incontinence was assessed with the help of a questionnaire, based on recommendations from the working group set up by the Finnish Gynaecological Association. Frequency characteristics were analysed by descriptive statistics. Risk factors were examined using logistic regression. RESULTS: Mean age of study women was 53.3 years (min = 48, max = 67; SD 4.0). The prevalence of UI was 18.12% (95% CI: 16.07 - 20.17). Stress incontinence was diagnosed in 78.83% (95% CI: 73.32 - 84.33) and urge or mixed incontinence in 21.17% (95% CI: 15.67 - 26.68) of women who reported incontinence. Prevalence of UI slightly increased with age. Women who used hormone therapy (HT) (OR 1.67; 95% CI: 1.17 - 2.39), had had hysterectomy (1.73, 95% CI: 1.06 - 2.83), and those with secondary education (OR 1.87, 95% CI: 1.23 - 2.82) or basic education (OR 3.29, 95% CI: 1.80 - 6.02) had a higher risk for UI. Parity, having a BMI over 30 kg/m(2), being a smoker or a former smoker, having diabetes and being physically or sexually active, tended to increase the risk of UI. CONCLUSIONS: About one in five postmenopausal women in Estonia reported to have UI. Risk factors linked with UI, its prevalence in other age groups and the impact of UI on quality of life deserve more research. TRIAL REGISTRATION: Number: ISRCTN35338757.

Feminine life-course of Estonian women born in 1937-47: a questionnaire survey.

BACKGROUND: This study describes reproductive health, use of contraception, age at menopause, the prevalence of climacteric complaints, and hormone replacement therapy among Estonian women born in 1937-47. METHODS: A sample of 800 Estonian women born in 1937-47 was composed at random from the Estonian population registry in 1997. A postal questionnaire was sent to all participants. RESULTS: Curettage before menopause (16.6%, 95%CI=13.5-20.0) and hysterectomy (11.7, 95%CI =9.0-14.8) were the most common gynecological operations. 66.7% (95%CI =62.5-70.6) of women had never used contraception, with the most popular method of contraception being intrauterine device (19.9%, 95%CI = 16.6-23.6). About three quarters of the respondents had had induced abortions, with 30.4% (95%CI =26.5-34.4) having had three or more abortions. After exclusion of women with surgical menopause (57 cases, 10.6%, 95% CI=8.1-13.5), women who were unable to assess the time of menopause (17 cases, 3.2%, 95%CI=1.8-5.0), and those who were still menstruating (73 cases, 13.6%, 95%CI = 10.8-16.8), the average age of menopause (based on 388 study subjects) was 50.3 (95%CI =49.9-50.6) years. The prevalence of climacteric complaints was as follows: hot flushes 51.0% (95%CI =46.7-55.3), night sweats 44.1% (95%CI =39.9-48.4%), depression/irritability 35.6% (95%CI =31.5-39.8), bleeding problems 10.1% (95%CI=7.6-12.9). Hormone replacement therapy was currently being used by 8 respondents (1.5%, 95%CI=0.6-2.9). Previous hormone replacement therapy use was reported by 4 (0.7%, 95% CI =0.2 2.9) of the women. CONCLUSIONS: The feminine life-course of women born in Estonia in 1937-47 is characterized by a high number of induced abortions and hysterectomies, and relatively little contraceptive use. Hormone replacement therapy use is very low.