Considerations for choice of surgical procedure

• hysterectomy
  • generally cures menorrhagia
  • advantages - no requirement for contraception post-procedure, risk of cervical and endometrial cancer is removed (if total hysterectomy undertaken)
  • disadvantages - operation is longer than with endometrial destruction techniques, hospital stay and return to work is longer than with endometrial destruction, risks of complications higher; also if subtotal hysterectomy is performed then the patient will still be at risk of cervical cancer and require cervical smears
    
    
• endometrial destruction
  • these techniques are successful in reducing menstrual blood loss in the majority of women
  • in comparison with a hysterectomy - there is conservation of the uterus, there is a smaller risk of complications, operating time is shorter, there is a shorter hospital stay and the patient returns to work sooner (1)
  • disadvantages include:
    • in a few women, endometrial destruction will not result in less bleeding and women will require repeat treatments (or may require a hysterectomy)
    • endometrial destruction procedures carry a small risk of uterine perforation - this may then lead to an emergency hysterectomy (1)
    • the patient requires contraception (pregnancy is not advised after endometrial destruction); also there remains the risks of cervical cancer and endometrial cancer

Reference:

• (1) Drug and Therapeutics Bulletin (2000), 38 (10), 77-80.