Increasing climacteric symptoms in untreated perimenopausal Finnish women: a 10-year cohort study.

OBJECTIVE: This study aimed to examine changes over a 10-year period in experiencing climacteric symptoms and their associations with sociodemographic and health-related background factors in a birth cohort of Finnish women who have never used menopausal hormone therapy (MHT). METHODS: This nationwide population-based follow-up study consists of 1491 women who during the follow-up period moved from the age group 42-46 years to the age group 52-56 years. The experience of climacteric symptoms was assessed by 12 symptoms commonly associated with the climacterium. The data were analyzed using statistical techniques. RESULTS: Both the intensity, expressed as a symptom score of four symptoms associated with a decrease in estrogen production (sweating, hot flushes, vaginal dryness, sleeping problems), and the prevalence of the five most common symptoms (sweating, hot flushes, sleeping problems, lack of sexual desire, depressive symptoms) increased clearly during the follow-up period. The examined sociodemographic and health-related variables did not explain the changes in experiencing the symptoms. CONCLUSIONS: The results of this study can be considered in primary and occupational health care and in gynecological settings when working with symptomatic women or women with hidden climacteric problems and carrying out health promotion and counseling for them.

Vortex-bound solitons in topological superfluid3He.

The different superfluid phases of3He are described byp-wave order parameters that include anisotropy axes both in the orbital and spin spaces. The anisotropy axes characterize the broken symmetries in these macroscopically coherent quantum many-body systems. The systems' free energy has several degenerate minima for certain orientations of the anisotropy axes. As a result, spatial variation of the order parameter between two such regions, settled in different energy minima, forms a topological soliton. Such solitons can terminate in the bulk liquid, where the termination line forms a vortex with trapped circulation of mass and spin superfluid currents. Here we discuss possible soliton-vortex structures based on the symmetry and topology arguments and focus on the three structures observed in experiments: solitons bounded by spin-mass vortices in the B phase, solitons bounded by half-quantum vortices (HQVs) in the polar and polar-distorted A phases, and the composite defect formed by a half-quantum vortex, soliton and the Kibble-Lazarides-Shafi wall in the polar-distorted B phase. The observations are based on nuclear magnetic resonance (NMR) techniques and are of three types: first, solitons can form a potential well for trapped spin waves, observed as an extra peak in the NMR spectrum at shifted frequency; second, they can increase the relaxation rate of the NMR spin precession; lastly, the soliton can present the boundary conditions for the anisotropy axes in bulk, modifying the bulk NMR signal. Owing to solitons' prominent NMR signatures and the ability to manipulate their structure with external magnetic field, solitons have become an important tool for probing and controlling the structure and dynamics of superfluid3He, in particular HQVs with core-bound Majorana modes.

Nonlinear two-level dynamics of quantum time crystals.

A time crystal is a macroscopic quantum system in periodic motion in its ground state. In our experiments, two coupled time crystals consisting of spin-wave quasiparticles (magnons) form a macroscopic two-level system. The two levels evolve in time as determined intrinsically by a nonlinear feedback, allowing us to construct spontaneous two-level dynamics. In the course of a level crossing, magnons move from the ground level to the excited level driven by the Landau-Zener effect, combined with Rabi population oscillations. We demonstrate that magnon time crystals allow access to every aspect and detail of quantum-coherent interactions in a single run of the experiment. Our work opens an outlook for the detection of surface-bound Majorana fermions in the underlying superfluid system, and invites technological exploitation of coherent magnon phenomena - potentially even at room temperature.

Stress urinary incontinence after hysterectomy: a 10-year national follow-up study.

PURPOSE: Hysterectomy has been associated with increased risk for developing stress urinary incontinence (SUI) and having a SUI operation. We examined the long-term rate of SUI operations after hysterectomy and associated risk factors. METHODS: We followed up 5000 women without prior urinary incontinence (UI) who had a hysterectomy in a prospective FINHYST 2006 cohort study until the end of 2016 through a national health register. The main outcome was SUI operations, and secondary outcomes were outpatient visits for UI, and their association of preoperative patient and operation factors. RESULTS: During the median follow-up time of 10.6 years (IQR 10.3-10.8), 111 (2.2%) women had a SUI operation and 241 (4.8%) had an outpatient visit for UI. The SUI operation rate was higher after vaginal hysterectomy and laparoscopic hysterectomy (n = 71 and 28, 3.3% and 1.8%, respectively) compared to abdominal hysterectomy (n = 11, 0.8%). In a multivariate risk analysis by Cox regression, the association with vaginal hysterectomy and SUI operation remained significant when adjusted for vaginal deliveries, preceding pelvic organ prolapse (POP), uterus size, age and BMI (HR 2.4, 95% CI 1.1-5.3). Preceding POP, three or more deliveries and laparoscopic hysterectomy were significantly associated with UI visits but not with SUI operations. CONCLUSION: After hysterectomy, 2.2% of women underwent operative treatment for SUI. The number of SUI operations was more than double after vaginal hysterectomy compared to abdominal hysterectomy, but preceding POP explained this added risk partially. Preceding POP and three or more vaginal deliveries were independently associated with UI visits after hysterectomy.

Suppressing the Kibble-Zurek Mechanism by a Symmetry-Violating Bias.

The formation of topological defects in continuous phase transitions is driven by the Kibble-Zurek mechanism. Here we study the formation of single- and half-quantum vortices during transition to the polar phase of ^{3}He in the presence of a symmetry-breaking bias provided by the applied magnetic field. We find that vortex formation is suppressed exponentially when the length scale associated with the bias field becomes smaller than the Kibble-Zurek length. We thus demonstrate an experimentally feasible shortcut to adiabaticity-an important aspect for further understanding of phase transitions as well as for engineering applications such as quantum computers or simulators.

AC Josephson effect between two superfluid time crystals.

Quantum time crystals are systems characterized by spontaneously emerging periodic order in the time domain1. While originally a phase of broken time translation symmetry was a mere speculation2, a wide range of time crystals has been reported3-5. However, the dynamics and interactions between such systems have not been investigated experimentally. Here we study two adjacent quantum time crystals realized by two magnon condensates in superfluid 3He-B. We observe an exchange of magnons between the time crystals leading to opposite-phase oscillations in their populations-a signature of the AC Josephson effect6-while the defining periodic motion remains phase coherent throughout the experiment. Our results demonstrate that time crystals obey the general dynamics of quantum mechanics and offer a basis to further investigate the fundamental properties of these phases, opening pathways for possible applications in developing fields, such as quantum information processing.

Spin, Orbital, Weyl and Other Glasses in Topological Superfluids.

One of the most spectacular discoveries made in superfluid 3 He confined in a nanostructured material like aerogel or nafen was the observation of the destruction of the long-range orientational order by a weak random anisotropy. The quenched random anisotropy provided by the confining material strands produces several different glass states resolved in NMR experiments in the chiral superfluid 3 He-A and in the time-reversal-invariant polar phase. The smooth textures of spin and orbital order parameters in these glasses can be characterized in terms of the randomly distributed topological charges, which describe skyrmions, spin vortices and hopfions. In addition, in these skyrmion glasses the momentum-space topological invariants are randomly distributed in space. The Chern mosaic, Weyl glass, torsion glass and other exotic topological states are examples of close connections between the real-space and momentum-space topologies in superfluid 3 He phases in aerogel.

Half-quantum vortices and walls bounded by strings in the polar-distorted phases of topological superfluid 3He.

Symmetries of the physical world have guided formulation of fundamental laws, including relativistic quantum field theory and understanding of possible states of matter. Topological defects (TDs) often control the universal behavior of macroscopic quantum systems, while topology and broken symmetries determine allowed TDs. Taking advantage of the symmetry-breaking patterns in the phase diagram of nanoconfined superfluid 3He, we show that half-quantum vortices (HQVs)-linear topological defects carrying half quantum of circulation-survive transitions from the polar phase to other superfluid phases with polar distortion. In the polar-distorted A phase, HQV cores in 2D systems should harbor non-Abelian Majorana modes. In the polar-distorted B phase, HQVs form composite defects-walls bounded by strings hypothesized decades ago in cosmology. Our experiments establish the superfluid phases of 3He in nanostructured confinement as a promising topological media for further investigations ranging from topological quantum computing to cosmology and grand unification scenarios.

Bose-Einstein Condensation of Magnons and Spin Superfluidity in the Polar Phase of

The polar phase of ^{3}He, which is topological spin-triplet superfluid with the Dirac nodal line in the spectrum of Bogoliubov quasiparticles, has been recently stabilized in a nanoconfined geometry. We pump magnetic excitations (magnons) into the sample of polar phase and observe how they form a Bose-Einstein condensate, revealed by coherent precession of the magnetization of the sample. Spin superfluidity, which supports this coherence, is associated with the spontaneous breaking of U(1) symmetry by the phase of precession. We observe the corresponding Nambu-Goldstone boson and measure its mass emerging when applied rf field violates the U(1) symmetry explicitly. We suggest that the magnon BEC in the polar phase is a powerful probe for topological objects such as vortices and solitons and topological nodes in the fermionic spectrum.

Metal removal from Municipal Solid Waste Incineration fly ash: A comparison between chemical leaching and bioleaching.

Bio- and hydrometallurgical experimental setups at 2-l reactor scale for the processing of fly ash from municipal waste incinerators were explored. We aimed to compare chemical H2SO4 leaching and bioleaching; the latter involved the use of H2SO4 and a mixed culture of acidophilic bacteria. The leaching yields of several elements, including some of those considered as critical (Mg, Co, Ce, Cr, Ga, Nb, Nd, Sb and Sm), are provided. At the end of the experiments, both leaching methods resulted in comparable yields for Mg and Zn (>90%), Al and Mn (>85%), Cr (∼65%), Ga (∼60%), and Ce (∼50%). Chemical leaching showed the best yields for Cu (95%), Fe (91%), and Ni (93%), whereas bioleaching was effective for Nd (76%), Pb (59%), and Co (55%). The two leaching methods generated solids of different quality with respect to the original material as we removed and significantly reduced the metals amounts, and enriched solutions where metals can be recovered for example as mixed salts for further treatment. Compared to chemical leaching the bioleaching halved the use of H2SO4, i.e., a part of agent costs, as a likely consequence of bio-produced acid and improved metal solubility.

Primary familial brain calcification linked to deletion of 5' noncoding region of SLC20A2.

OBJECTIVES: Primary familial brain calcification (PFBC) is a rare neurological disease often inherited as a dominant trait. Mutations in four genes (SLC20A2, PDGFB, PDGFRB, and XPR1) have been reported in patients with PFBC. Of these, point mutations or small deletions in SLC20A2 are most common. Thus far, only one large deletion covering entire SLC20A2 and several smaller, exonic deletions of SLC20A2 have been reported. The aim of this study was to identify the causative gene defect in a Finnish PFBC family with three affected patients. MATERIALS AND METHODS: A Finnish family with three PFBC patients and five unaffected subjects was studied. Sanger sequencing was used to exclude mutations in the coding and splice site regions of SLC20A2, PDGFRB, and PDGFB. Whole-exome (WES) and whole-genome sequencing (WGS) were performed to identify the causative mutation. A SNP array was used in segregation analysis. RESULTS: Copy number analysis of the WGS data revealed a heterozygous deletion of ~578 kb on chromosome 8. The deletion removes the 5' UTR region, the noncoding exon 1 and the putative promoter region of SLC20A2 as well as the coding regions of six other genes. CONCLUSIONS: Our results support haploinsufficiency of SLC20A2 as a pathogenetic mechanism in PFBC. Analysis of copy number variations (CNVs) is emerging as a crucial step in the molecular genetic diagnostics of PFBC, and it should not be limited to coding regions, as causative variants may reside in the noncoding parts of known disease-associated genes.

Observation of Half-Quantum Vortices in Topological Superfluid

One of the most sought-after objects in topological quantum-matter systems is a vortex carrying half a quantum of circulation. They were originally predicted to exist in superfluid ^{3}He-A but have never been resolved there. Here we report an observation of half-quantum vortices (HQVs) in the polar phase of superfluid ^{3}He. The vortices are created with rotation or by the Kibble-Zurek mechanism and identified based on their nuclear magnetic resonance signature. This discovery provides a pathway for studies of unpaired Majorana modes bound to the HQV cores in the polar-distorted A phase.

Characteristics associated with initiation of hormone replacement therapy among Finnish women: A register-linkage study.

OBJECTIVE: To investigate which patient characteristics are associated with the initiation of hormone replacement therapy (HRT) in a cohort of Finnish women. STUDY DESIGN: Responses to postal questionnaires distributed to a nationwide, randomly selected cohort of women in 1998, 2000, 2003, 2005 and 2010 were analyzed. The cohort members were aged 40-44 years at the beginning of the study. Information on hormone replacement therapy was received from the national prescription register. Women who started taking HRT between January 1, 1999 and December 31, 2011 were included and previous users were excluded from the analysis. MAIN OUTCOME MEASURES: Initiation of HRT was the main outcome measure. The following explanatory factors for predicting the use of HRT were examined: sociodemographic factors, personality, health behavior, physiological and mental symptoms, chronic diseases and use of psychopharmaceuticals. The associations between starting HRT and the explanatory factors were analyzed with single-predictor and multi-predictor logistic regression models. RESULTS: Factors predicting that a woman would start taking HRT were: living with a partner, weak sense of coherence, BMI less than 30kg/m(2), heavy or moderate alcohol use, symptoms of hyperactivity of the sympathetic nervous system, climacteric symptoms and use of psychopharmaceuticals. CONCLUSIONS: Women with a good sense of coherence can cope with climacteric symptoms without resorting to HRT. Clinicians need to bear in mind the burden of menopausal symptoms on a woman's personal and working life when HRT is being considered.

Prevalence of Pain Symptoms Suggestive of Endometriosis Among Finnish Adolescent Girls (TEENMAPS Study).

STUDY OBJECTIVE: To evaluate the prevalence of pain symptoms suggestive of endometriosis among adolescent girls aged 15-19 years. DESIGN: Cross-sectional study. SETTING: University hospital. PARTICIPANTS: Adolescent girls aged 15-19 years attending elementary school, high school, or vocational institute at 3 cities in Southwest Finland in 2010-2011. INTERVENTIONS: The school nurses distributed a detailed questionnaire to 2582 girls who were attending school at the time of the study. Completion of the questionnaire was voluntary and anonymous. MAIN OUTCOME MEASURES: Prevalence and severity of dysmenorrhea, acyclic abdominal pain, dyspareunia, dyschezia, and dysuria. Severity was evaluated with an 11-point numerical rating scale (NRS). RESULTS: A total of 1103 eligible answers were analyzed. The prevalence of dysmenorrhea was 68% (738/1092) with mean NRS of 7.0 (SD = 2.0). Acyclic abdominal pain, dyspareunia, dyschezia, and dysuria were less frequent (19% [207/1085], 12% [53/458], 8% [87/1088] and 5% [50/1084], respectively). The prevalence of severe dysmenorrhea (NRS 8-10) was 33% (355/1089). Severe dysmenorrhea was associated with increased risk of concurrent acyclic abdominal pain (odds ratio [OR] = 2.7; 95% confidence interval [CI], 2.0-3.6), dyschezia (OR = 2.5; 95% CI, 1.6-3.9), and regular absenteeism from school or hobbies (OR = 10.0; 95% CI, 4.2-23.6). Using different criteria, 2%-10% (21-106/1103) of all girls could be identified as having symptoms suggestive of endometriosis. Five percent of girls (n = 53/1103) had severe dysmenorrhea, used oral contraceptive pills, and reported inadequate relief from pain medication. CONCLUSION: One-third (355/1089) of 15- to 19-year-old girls had severe menstrual pain and 14% (49/355) of them were regularly absent from school or hobbies. Five percent of all teenage girls (53/1103) were poor responders to conventional therapy for primary dysmenorrhea.

Antibiotic prophylaxis for hysterectomy, a prospective cohort study: cefuroxime, metronidazole, or both?

OBJECTIVE: To evaluate cefuroxime and metronidazole antibiotic prophylaxis. DESIGN: Observational nonrandomised 1-year prospective cohort study. SETTING: Fifty-three hospitals in Finland. POPULATION: A total of 5279 women undergoing hysterectomy for benign indications, with cefuroxime given to 4301 and metronidazole given to 2855. Excluding other antibiotics, cefuroxime alone was given to 2019, metronidazole alone was given to 518, and they were administered in combination to 2252 women. METHODS: Data on 1115 abdominal hysterectomies (AHs), 1541 laparoscopic hysterectomies (LHs), and 2133 vaginal hysterectomies (VHs) were analysed using logistic regression adjusted for confounding factors. MAIN OUTCOME MEASURES: Postoperative infections. RESULTS: Cefuroxime had a risk-reductive effect for total infections (adjusted odds ratio, OR, 0.29; 95% confidence interval, 95% CI, 0.22-0.39), but the independent effect of metronidazole and the interaction effect of cefuroxime and metronidazole were nonsignificant. In subgroup analyses of AHs, LHs, and VHs involving those receiving the two main antibiotics only, the effect of cefuroxime alone nonsignificantly differed from that of cefuroxime and metronidazole in combination for all types of infection. The absence of cefuroxime, assessed by comparing metronidazole alone with cefuroxime and metronidazole in combination, led to an increased risk for total infections in AHs (adjusted OR 3.63; 95% CI 1.99-6.65), in LHs (OR 3.53; 95% CI 1.74-7.18), and in VHs (OR 4.05; 95% CI 2.30-7.13), and also increased risks for febrile events in all categories (AHs, OR 2.86; 95% CI 1.09-7.46; LHs, OR 13.19; 95% CI 3.66-47.49; VHs, OR 12.74; 95% CI 3.01-53.95), wound infections in AHs (OR 6.88; 95% CI 1.09-7.49), and pelvic infections in VHs (OR 4.26; 95% CI 1.76-10.31). CONCLUSIONS: In this study, cefuroxime appeared to be effective in prophylaxis against infections. Metronidazole appeared to be ineffective, with no additional risk-reductive effect when combined with cefuroxime.

Validation of [18F]fluorodeoxyglucose and positron emission tomography (PET) for the measurement of intestinal metabolism in pigs, and evidence of intestinal insulin resistance in patients with morbid obesity.

AIMS/HYPOTHESIS: The role of the intestine in the pathogenesis of metabolic diseases is gaining much attention. We therefore sought to validate, using an animal model, the use of positron emission tomography (PET) in the estimation of intestinal glucose uptake (GU), and thereafter to test whether intestinal insulin-stimulated GU is altered in morbidly obese compared with healthy human participants. METHODS: In the validation study, pigs were imaged using [(18)F]fluorodeoxyglucose ([(18)F]FDG) and the image-derived data were compared with corresponding ex vivo measurements in tissue samples and with arterial-venous differences in glucose and [(18)F]FDG levels. In the clinical study, GU was measured in different regions of the intestine in lean (n = 8) and morbidly obese (n = 8) humans at baseline and during euglycaemic hyperinsulinaemia. RESULTS: PET- and ex vivo-derived intestinal values were strongly correlated and most of the fluorine-18-derived radioactivity was accumulated in the mucosal layer of the gut wall. In the gut wall of pigs, insulin promoted GU as determined by PET, the arterial-venous balance or autoradiography. In lean human participants, insulin increased GU from the circulation in the duodenum (from 1.3 ± 0.6 to 3.1 ± 1.1 µmol [100 g](-1) min(-1), p < 0.05) and in the jejunum (from 1.1 ± 0.7 to 3.0 ± 1.5 µmol [100 g](-1) min(-1), p < 0.05). Obese participants failed to show any increase in insulin-stimulated GU compared with fasting values (NS). CONCLUSIONS/INTERPRETATION: Intestinal GU can be quantified in vivo by [(18)F]FDG PET. Intestinal insulin resistance occurs in obesity before the deterioration of systemic glucose tolerance.

Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis.

AIM: Endometriosis is relatively common condition in fertile women and may affect the alimentary tract. Laparoscopic rectosigmoid resection for endometriosis has been found to be both feasible and safe. The aim of the present study was to prospectively evaluate the quality of life and sexual function of patients who have undergone rectosigmoid resection for endometriosis. METHOD: All patients undergoing rectal or sigmoid resection for endometriosis in two specialist hospitals were prospectively recruited in the study. Details regarding demography, endometriosis-related symptoms, procedure and postoperative recovery were collected. One year after the operation patients were sent a postal questionnaire asking about endometriosis-related symptoms, quality of life and sexual functioning. The 15D Questionnaire and McCoy Female Sexuality Questionnaire were used for this purpose. RESULTS: A total of 26 patients responded to the 15D questionnaire. Endometriosis-related bowel symptoms decreased significantly after the operation. The responses showed improvements in the overall score and scores for five different dimensions (usual activities, P = 0.04; discomfort and symptoms, P < 0.001; distress, P < 0.001; vitality, P < 0.001; sexual activity, P < 0.001). Sexual satisfaction was greater 1 year after the operation (P = 0.01). Sexual problems and partner satisfaction scores had not changed significantly. CONCLUSION: Laparoscopic rectal and sigmoid resection for endometriosis significantly reduce endometriosis-related symptoms and improve quality of life and sexual well-being.

A cohort effect on serum testosterone levels in Finnish men.

OBJECTIVE: To investigate whether a population-level decline in serum testosterone exists in Finnish men. In comparison with other European populations, Finnish men have compared well in the studies of reproductive health (i.e. semen quality, incidence of cryptorchidism and testicular cancer); thus, we expected no significant cohort-dependent decrease in serum testosterone. METHODS: We analysed serum levels of testosterone, gonadotrophin and sex hormone binding globulin (SHBG) in 3271 men representing different ages (25-74 years) and birth cohorts within three large Finnish population surveys conducted in 1972, 1977 and 2002. RESULTS: Serum testosterone levels decreased (from 25.3 nmol/l in 25- to 29-year-old men gradually to 16.9 nmol/l in 70- to 74-year-old men), whereas SHBG and gonadotrophin levels increased with increasing age. In addition, a significant secular trend in testosterone (total and free), SHBG and gonadotrophin levels was observed with lower levels in more recently born age-matched men. Serum testosterone level decreased in men aged 60-69 years from 21.9 nmol/l (men born 1913-1922) to 13.8 nmol/l (men born 1942-1951). These decreases remained significant following adjustment for BMI. An age-independent birth cohort effect existed on reproductive hormones measured in the Finnish men. In concert with the lower free testosterone levels, we observed lower gonadotrophin levels, suggesting that while there may be detrimental changes at the gonad level, the hypothalamus-pituitary-axis is not responding appropriately to this change. CONCLUSIONS: The more recently born Finnish men have lower testosterone levels than their earlier born peers. This study offers no explanation for this substantial recent adverse development.

Pharmaceutical thrombosis prophylaxis, bleeding complications and thromboembolism in a national cohort of hysterectomy for benign disease.

BACKGROUND: Pharmaceutical thrombosis prophylaxis (PTP) with low-molecular-weight heparin (LMWH) is highly effective in preventing venous thromboembolic events (VTEs) and fatal pulmonary embolism. Important risk factors for VTEs are surgery and immobilization, along with malignancy. Many studies involving gynaecological malignancies show no increased risk for bleeding complications with PTP. Little is known about the PTP-associated risk for bleeding complications with hysterectomy for benign disease, or about current VTE incidence in the less-invasive hysterectomy methods. METHODS: Our observational prospective national 1-year cohort from 1 January to 31 December 2006 in 53 hospitals represented 79.4% (5297 of 6645) of hysterectomies performed for benign cause in Finland in 2006. We evaluated PTP use and VTE incidence. Operative and post-operative bleeding complications were analysed with logistic regression adjusted for confounders: age, BMI, experience of the gynaecological surgeon, hospital type, indication for hysterectomy, uterine weight, operative haemorrhage, concomitant surgery, adhesiolysis and antibiotic prophylaxis. RESULTS: Hysterectomies were performed by three main approaches: 2345 vaginal hysterectomies (VHs, 44%), of which 1433 were for uterine prolapse and 912 for other indications, 1679 laparoscopic hysterectomies (LHs, 32%) and 1255 abdominal hysterectomies (AHs, 24%). PTP was given to 64.8% of patients (3420 of 5279) and was identified as LMWH in 3313 patients (97%); 107 left unidentified. By type of hysterectomy, PTP was given in VH for uterine prolapse to 73.2% of patients, VH for other indication to 51.6%, in LH to 59.4% and in AH to 71.9%. For all hysterectomies analysed together, PTP doubled the odds for post-operative haemorrhage or haematoma. By type of hysterectomy, PTP associated with post-operative haemorrhage or haematoma in VH for prolapse [2.7% of PTP given, versus 0.8% of no PTP; odds ratio (OR): 4.82, 95% confidence interval (CI): 1.38-16.83]; and in AH (3.1% versus 1.4%; OR: 2.87, 95% CI: 1.03-7.98), and in AH also with post-operative transfusion (3.1% versus 1.4%; OR: 3.34, 95% CI: 1.41-7.88). For LH and VH for indications other than prolapse, the effect of PTP on post-operative haemorrhage was non-significant. For VH, the risk for post-operative haemorrhage fell with age. Operative mean haemorrhage with all hysterectomy types, and operative bleeding complications in AH and VH also fell with age. Obesity increased haemorrhage and operative bleeding complications for LH and VH, whereas post-operative bleeding complications were less for the obese in AH. VTEs were 6 of 5279 (0.1%): two PEs each occurred after AH and VH, and two deep venous thromboses after LH. CONCLUSIONS: With a relatively wide PTP coverage (64.8%), VTEs were rare (0.1%). All affected had received PTP. Analysis of efficacy, meaning interpretation of how many VTEs or deaths were prevented, cannot be done from our observational study but related to safety in hysterectomy for benign disease, PTP associated with post-operative bleeding complications with AH and with VH for prolapse. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov protocol (NCT00744172).