DISADVANTAGES OF TRADITIONAL TREATMENTS

On this page ...

•   Hysterectomy
  •    Patient's perception & fears
  •    Social considerations
  •    Complications
  •    Mortality
•    Myomectomy
•    Gonadorelin Analogues - GnRH Agonists
•    Myolysis

Hysterectomy

Approximately 30% of the 70-90,000 hysterectomies performed each year in the UK are for fibroids.  While hysterectomy is an effective treatment there have been recent calls to reduce the number of hysterectomies as less invasive treatments available.^[15]

Patient's Perception and Fears

Hysterectomy is one of the most dreaded and feared operations.  Women fear the invasive nature of the operation, the long recovery, long-term side effects and loss of femininity and sexuality.

Social Considerations

The post-operative convalescence requires nursing for 6 weeks, which is often difficult for family members to organise.

Women may suffer economically from a long period away from work.  The normal time back to work is 2-3 months depending on the physical content of the job.  Some companies will not pay sick leave for this long and women on piecework or those who are self-employed may not be paid.

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Complications

The overall complication rate is 9-16%, although some researchers put this figure as high as 50%.  Long-term outcomes have shown as many as 50% of women believed their symptoms had worsened two years or more after surgery. ^{[13],[14],[15],[53],[54]}

DVT rates in gynaecological surgery are high 15-18% and this has been commented upon as an area for improvement  by NCEPOD.   Pulmonary embolism is a major cause of death in patients having hysterectomy for fibroids. ^{[16],[26],[27],[28]}

Haemorrhage and infection are a concern.  Blood transfusions cause patient fears and are necessary in 2.2-7.5%, while infection rates are relatively high up to 25% in both the urinary tract and wound. ^{[3],[4],[6],[7]}

Surgical trauma can be caused to the bladder 1.1-1.7%, urinary tract 0.1-1.7%, bowel 0.5-5% and vagina. Although these are repaired at the time, they are usually repaired by gynaecologists not the appropriate specialist and this can lead to long-term difficulties.  NCEPOD criticised this practice. ^{[1],[7],[9],[15],[26]}

Early menopause & depression will be a side effect in a large proportion of patients. ^{[10],[11],[12]}

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Sexual dysfunction has been little researched, but is of great concern to women.  Many studies put any loss of libido down to depression, but the reduction in testosterone levels after oophorectomy will lead to loss in frequency and desire for sex.  42% of women after hysterectomy but with conservation of at least one ovary had sexual intercourse less often, while 74% after removal of both their ovaries had less sex. The uterus and cervix are involved in the female orgasm and have rhythmic muscle contractions during it.  Removal of the uterus and sometimes the cervix as well can result in a lessening of the sensation of an orgasm, which is quite noticeable in some women.   The pressure effects and orientation of these organs are also lost when they are removed which adversely affects the orgasm.

The vagina is likely to become narrower and shorter after hysterectomy.  This can make sex painful and full penetration difficult.  Lubrication may also be reduced.

Surgical damage  to the nerves, particularly to the vagina can result in loss of sensation.  Few studies have been carried out on this important issue but changes in climax have been noted in 33-35% of women. ^{[16],[17],[18],[55]}

Mortality

The mortality for hysterectomy for fibroids in the latest audit - Maresh et al is 1 in 3,300.  Other studies give higher mortality rates 1-2 in 1,000 ^[15],[26]

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Myomectomy

This is normally only offered to younger women wishing to have children as it almost inevitably leads to hysterectomy.  It is an invasive operation with recovery and social considerations similar to hysterectomy.   Short-term complications are few, but longer term adhesions and fibroid re-growth usually result in hysterectomy. ^{[4],[8],[21],[23],[24],[45]}

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Gonadorelin Analogues - GnRH Agonists

This is only a temporary treatment, normally used to shrink the fibroids prior to surgery or myolysis.  Fibroids will return to their original size 24 weeks after treatment stops. This treatment should only be used once for 6 months.  There are very debilitating side effects and some gynaecologists do not therefore use this option. ^{[5],[19],[20]}

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Myolysis

This is a new and controversial treatment available at only a few centres in the UK.  It should not be given to women with pregnancy wishes, as there have been cases of uterine rupture and foetal death following myolysis. ^{[32],[33],[34],[35]}

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Last updated: 12 Apr 2004