Hysterectomy, removal of the womb, is carried out when excessive menstrual pain and bleeding affects a woman's health. This can be because of hormonal problems or physical causes such as fibroids (benign growths in the wall of the uterus) or endometriosis (womb tissue outside the womb).
Cancer of the womb, cervix or ovaries is another reason for performing the procedure.
The number of hysterectomies for benign causes of heavy, prolonged bleeding is decreasing. This is because of the availability of other medical interventions and a realisation that 20 per cent of women can take three months or longer to recover from the operation.
Investigations for heavy or painful periods include blood tests to check hormonal function and hospital procedures such as hysteroscopy and diagnostic curettage (D&C). The latter involves a day-case general anaesthetic and "scraping" of the womb. The tissue is then sent for analysis. A hysteroscope is a fine telescope introduced through the neck of the womb under local anaesthetic. It allows the gynaecologist to visualise the womb directly and take a tissue sample. Hysterectomy requires a four- to five-day hospital stay and six weeks' recovery at home. It costs £2,600 in the Republic and £2,154 sterling in the North.
Northern Ireland: Helen is a 41-year-old hospital worker who had heavy and painful periods since 1998. Married with three children, she struggled on until December 1999 when she went to her GP. The family doctor knew she had fibroids and tried medical treatment first.
By April 2000 the symptoms had worsened and she was referred to a gynaecologist in the Ulster Hospital. She was seen six weeks later in outpatients and arrangements were made for a hysterectomy on July 18th, 2000. Helen had a difficult time after the operation, developing a wound infection as well as depression. She has now recovered fully.
The Republic: Sarah is a 50year-old married woman in Co Galway who works full time at home. She developed heavy, more frequent periods and became tired and lacking in energy.
Her GP found she was anaemic and, as well as starting her on iron replacement therapy, he referred her in March 2000 to the gynaecology outpatients in University College Hospital, Galway. She was seen in June 2000 and arrangements made for a D&C and hysteroscopy in late July. They confirmed a number of large fibroids (benign growths) in the womb. A hysterectomy, was carried out in October 2000. She made a good recovery and was back to herself two months later.
Comparison: Because of prevailing medical opinion, which is to try medical treatment for benign cases of heavy vaginal bleeding first, it is more appropriate to look at the time taken to be seen in outpatients rather than the interval to hysterectomy.
The NHS managed a six-week gynaecology outpatient wait compared with the Republic's three months (public hospital). The delay for subsequent investigations was one and two months respectively.
These waiting times are not excessive if the ultimate diagnosis is benign. However, is it good enough to wait five months in the Republic to discover you have a gynaecological cancer? In the North the same answer takes 2 1/2 months. Should not both services be able to arrange investigations within six weeks of referral?
The cost of hysterectomy is comparable North and South.