Approximately 60% of the 70,000 hysterectomies performed each year in the UK, in the NHS and private sector 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.
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.
Here is what some women have said to us -
“I visited my GP last month who again referred me to a Gyn who suggested I have the big H, but hell no, I am 43 years of age ( a young 43) and would still like the opportunity to have a child, if nature obliges. I was told nothing else could be done, the fibroids have grown and will continue to grow and eventually I will need to have the big H.”
I've been diagnosed with large fibroids and was advised to have a complete hysterectomy. I don't want one, as I want to keep my fertility and financially, it's just not a viable option! I'm self employed and can not take off three or months off work without pay!!!”
“I am unwilling to have such an invasive treatment as a hysterectomy when there is a real and less invasive alternative. I am really desperate for any guidance which you can offer me.”
“I had a myomectomy earlier this year but still have fibroids and was advised I didn't stand much chance of conceiving because of them. I was 40 this year. I really want to have a baby - how do I go about having embolisation - do I have to go via my doctor although I know she'll advise I go back to the consultant who did the myomectomy - how can I see someone and possibly have embolisation.”
The post-operative convalescence requires nursing for 6 weeks, which is often difficult for family members to organise. It will mean either they take their holiday or go without pay or both.
The overall complication rate for hysterectomy 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. ,,,,
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. ,,,
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. ,,,
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. ,,,,
Early menopause and depression will be a side effect in a large proportion of patients. ,, Early menopause from hysterectomy is the commonest reason for early HRT treatment. HRT is associated with breast cancer. HRT is very expensive for women. The standard prescription charge is levied on each hormone and so is at least twice the normal charge.
Sexual dysfunctionhas 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 oophorectomywill 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. ,,,
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. Young women have to take 3 months off work. Short-term complications are few, but longer term adhesions and fibroid re-growth usually result in hysterectomy. They is some controversy over pregnancy outcomes from myomectomy versus UAE. A number of useful research projects are underway to determine which treatment is best for which types of fibroids and patients.,,,,,
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 [NICE]. There are very debilitating side effects and some gynaecologists do not therefore use this option. ,,
These are new and controversial treatment available at only a few centres in the UK. Myolysis should not be given to women with pregnancy wishes, as there have been cases of uterine rupture and foetal death following myolysis. ,,, More hospitals are beginning to offer focused ultrasound but it is best suited for small fibroids. The treatment takes 2-3 hours and it is a day-case. Here are the NICE guidelines on MR-guided focused ultrasound.