Comparison of Treatments

Drugs

Hysterectomy

Myomectomy

Embolisation

Length of hospital stay

N/A

5 days -2 weeks

1-2 weeks

1 night
^{[29],[30],[60],[65],[68]} 

General anaesthetic

N/A

Yes

Yes

No - local & light sedation

Major surgery

No

Yes

Yes

No

Haemorrhage

No

Yes - 370-796ml
^[1],[2]

Risk increases with large fibroids >500ml in 55.3%  ^[70] 

Yes - 450ml ^[1]
more than hysterectomy ^[8]

No  
^{[29],[30],[60],[64],[65],[68]}

Painful

No

Very

Very

None - very
^{[29],[30],[60]}, 

Duration of pain

3-10 days ^[4]

3-10 days ^[4]

1-2 days
^{[29],[30],[60],[64],[68]} 

Infection

No

Urinary tract 3.3% -25% ^[3],[4]
wound 25% ^[4]  

Similar to hysterectomy

Less likely (1%)
^{[29],[30],[60],[64],[65], [68]}

Unexplained fever

Possible
Hot flushes likely ^[5]  

Possible 14-49%
^[1],[2]

Possible 32% ^[1]

Possible (4%)
^{[29],[30],[60],[68]}
  

Blood transfusion

No

Yes 2.2-7.5% 
^[6],[7]  

Yes, higher than hysterectomy ^[8]

No

DVT

Unlikely

Possible 15-18% (for all gynae surgery) ^{[26],[27],[28]} 

Possible 15-18% (for all gynae surgery)
^{[26],[27],[28]}

Much less likely

Damage to bladder

No

Possible 1.1-1.7 %
^[1],[7],[9] 
 

Less likely

No

Damage to urinary tract

No

Possible 0.1-1.7 %
^[1],[7],[9]
 

Less likely

No

Damage to bowel

No

Possible 0.5-5%
^[1],[7],[9] 
 

Less likely

No

Fertility post-op

Infertile while on treatment

Infertile

Maintain fertility

Maintain fertility

1-7% developed amenorrhoea 
^[65],[68] 

Side Effects

Hot flushes &menopausal symptoms, memory loss, bone loss, insomnia, osteoporosis, vaginitis
^[5],[20]  

Menopause 5 years earlier, clinical depression,  cardiovascular incidents more likely
^{[10],[11],[12]}

Pain, pelvic adhesions and re-growth of fibroid
^{[4],[21],[22],[23]}

Flu-like symptoms, expulsion or removal of  fibroids (5-7%), discharge (1-20%) which resolves spontaneously  or following hysteroscopy
^{[29],[30],[31],[60], [64],[65],[68]} 

Other complications

Very unpleasant side effects in most
^{[5],[19],[20]}

Overall short-term complications - 9-16%  ^[13],[15],  >50% had worse symptoms ^[14] 

Surgical complication rate increases to 61.7% with very large fibroids^[70]

Longer term disease -
depression, 

urinary incontinence 14-17% ^[72] increases odds by 30%   ^[73]

sexual dysfunction
 

1.8-25%

Adhesions 55-100%
^{[21],[23],[24],[25]}

No permanent injuries or disease 

Complications 5% ^[68]

Further surgery

Possible - treatment ineffective long term ^[19]  

To correct any damage or bleeding ^[15]

Most go on to hysterectomy
^{[21],[23],[24]}

0.25-7% go on to hysterectomy
^{[29],[30],[60],[65],[68]}

Effectiveness

Ineffective 24 weeks after drug ceases fibroids return to original size ^[19] 

Yes

Only temporary,
re-growth of fibroids & adhesions -likely to need a  hysterectomy
^{[8],[21],[23],[24],[25]} 

93-97%
^{[29],[30],[60],[65]}

Fibroid re-growth

Yes returns to normal after 24 weeks ^[19] 
 

No

Yes requiring surgery in 51% of cases for re-growth
^[23]

Unlikely
(1%)
^{[29],[30],[60], [65]}

Psychological effect

Mood swings and possible depression ^[5],[20] 
 

Loss of femininity, possible clinical depression
^[12],[17]

None reported

No adverse effects reported

Ability to have HRT if desired/required

No - will counteract effects of drug, fibroids will re-grow
 

Yes, required especially if ovaries removed, may need it sooner as menopause earlier

Not affected

but usually leads to hysterectomy

Not affected

Driving

Not affected

Not for 6  weeks post-op 

Not for 6  weeks post-op

Not affected

Scar

No

Yes 

Yes