|
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
|
None
|
|
Lifting & physical exercise
|
No restriction
|
None until at least 6 weeks
post-op
|
None until at least 6 weeks
post-op
|
No restriction
|
|
Home care after procedure
|
No
|
Yes, need personal care for many
weeks
|
Yes, need personal care for many
weeks
|
None to 4 weeks
|
|
Time back to work
|
N/A - but side effects may affect
ability to work
|
2-3 months
|
2-3 months
|
2-5 weeks
[29],[30],[60],[65]
|
|
Time to full recovery
|
24 weeks
|
Up to 6 months
|
Up to 6 months
|
1-2 months
[29],[30],[60]
|
|
Resumption of sex
|
No restriction
|
After 6 weeks
|
After 6 weeks
|
No restriction
|
|
Enjoyment of sex
|
Can reduce libido, lubrication
& cause soreness
[5],[20]
|
Can reduce libido (in 42-74%) [55],
lubrication, genital sensation, orgasm (in 33-35%) [55] &
cause soreness, difficulty in penetration
[12],[14],[17],[18]
|
No known effects after
recovery
|
No adverse effect - may
improve
[66],[67]
|
|
Pregnancy post procedure
|
Unlikely while being treated
|
No,infertile
|
Yes,27-67%
[21],[22]
|
Yes
There have been at least 50 successful pregnancies to date
|
|
Mortality
|
Unknown
|
1 in 3,300 to 1-2 in 1,000 [15]
41 deaths p.a. for all
non-malignant gynae surgery ('96/7) [26]
|
41 deaths p.a. for all
non-malignant gynae surgery ('96/7)
[26]
|
Approx. 1 in 12,500
|
