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Comparison of Treatments

(For details please see individual treatment sections)

MR-Guided Focused Ultrasound and Myolysis is not included, as there is little data on it and few centres offering this treatment.  New NICE Interventional Procedures guidelines are due to be published in spring 2011.

 

 

  Drugs Hysterectomy Myomectomy Embolisation
Length of hospital stay N/A 5 days - 2 weeks 1-2 weeks 1 night     [29],[30],[60],[65], [68], [74]
General anaesthetic N/A Yes Yes No - local and 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 No 3-10 days [4] 3-10 days [4] 1-2 days                                    [29], [30],[60]. [64]. [68]
Mortality Rate Unknown but little risk 1 in 1,500                   1 in 3,300 to 1-2 in 1,000 [15]  41 deaths p.a. For all non-malignanat gynae surgery '96'7  [26] Not known but low   41 deaths p.a. for all non-malignant gynae surgery ('96/7)   [26] 1 in 20,000 [BSIR]
Infection No Urinary tract 3.3% -25% [3],[4] wound 25% [4] Similar to hysterectomy Less likely- 1- 2.9%       [29], [30], [60], [64], [65], [68], [74]
Unexplained fever Hot flushes likely [5] Possible 14-49%    [1]. [2] Possible 32% [1] Possible 1-4%  [29], [30], [60], [68], [74]
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
Further Hospital Treatment Yes, this is only a temporary treatment for up to 6 months. Further treatment will be necessary Repair to surgical trauma Hysterectomy 2.7 - 10% go on to hysterectomy usually due to infection , overall re-treatment rate 10.8% including re-embolisation [74]
Fertility post-op Infertile while on treatment Infertile Maintain fertility Maintain fertility1-7% developed amenorrhoea [65],[68]
Side Effects Hot flushes and 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], serious complication rate 5% 1.8-25% No permanent injuries or disease  Complications 14.3 % of which only 0.14 % were serious [74]
  Surgical complication rate increases to 61.7% with very large fibroids [70] Longer term disease - depression, urinary incontinence, sexual dysfunction Adhesions 55-100%, fibroid regrowth   [21], [23], [24], [25] Complications 5% [68], [74]
Further surgery Possible - treatment ineffective long term [19] To correct any damage or bleeding [15] Most go on to UAE or hysterectomy due to fibroid re-growth    [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 Yes, but other treatment is very likley due to fibroid re-growth    [8], [21], [23], [24], [25] 84-97%                                                                              [29], [30], [60], [65], [74]
Fibroid re-growth Yes returns to normal after 24 weeks [19] No Yes requiring surgery in 51% of cases for re-growth    [23] Less likely - 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  if ovaries removed, also menopause  5- years earlier after hysterectomy Not affected 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 and 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 1-5 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 and cause soreness [5],[20] Can reduce libido (in 42-74%) [55], lubrication, genital sensation, orgasm (in 33-35%) [55] and cause soreness, difficulty in penetration   [12], [14], [17], [18] No known effects after recovery No adverse effect reported- may improve In one study 53% - no change, 26% - improved, 10% - a deterioration             [66], [67], [75], [76]
Pregnancy post procedure Unlikely while being treated No, infertile Yes, 27-67%                                                    [21], [22] Yes - There have been at 100s of  successful pregnancies to date, one UK centre has 60 successful pregnan cies.  More research is underway     [76]