Can I refuse zoladex before hysterectomy?

[GCAcademic]

Consultant wants me to go have zoladex for three months before hysterectomy to shrink fibroids so they can attempt the surgery laparoscopically rather than abdominally. It sounds awful and I’m worried about the side effects and how I’m going to manage at work (busy, high-pressured role, long hours, etc, that I need to be on the ball for). Frankly, I’d rather take my chances with having the surgery done abdominally. Am I allowed to refuse?

It takes more than a month for drugs like Zoladex to take full effect, which is why they prescribe a course of 3 months. So the side effects will take some time to show up and will be fairly brief if you do have them. I've been on Prostap (same thing) twice, once for 9 months with HRT before surgery and a second time for 3 months with no HRT. Zoladex will mimic menopause, yes, especially without HRT. Menopause affects everyone differently but I would say my experience was overall positive -- some hot flashes mainly at night, some irritability but nothing that would prevent me from doing my job. And it did made my surgery easier and quicker than anticipated. Making surgery easier for the surgeon means you'll spend less time in theatre, you'll probably need less anaesthetic if they think it will be a shorter procedure, and it should make your recovery easier too if they are able to accurately excise the thing they're trying to get out.

Just thinking about your big, full on job.... please take it easy as you recover from your procedure. You may need to take off/be fully signed off work for longer than someone in a less demanding job whose return can be more gradual. Listen to your body and don't overdo it. You will feel more tired than usual as you heal internally and recover.

I had to have a three month course of Decapeptyl before my total hysterectomy for endometriosis. I was very, very reluctant, mostly for similar work reasons - very full on job, lots of travelling plus young family. I put it off for ages until the surgeon told me it really was time for it to happen (and though of course I could refuse the pre-surgery treatment their argument was in my case it’d give a good indication of whether surgery would ‘work’).

I was so, so apprehensive. In the end, almost unbelievably, I was on it for 2.5 years (3 monthly injections) due to covid/lockdown/delays. I have to say I didn’t want to come off it! My life was so much better and by that point the endo symptoms were so far behind me the thought of going from (feeling) perfectly healthy to major surgery seemed bonkers. Rationally of course that doesn’t stack up as I had to get off Decapeptyl.

I suppose all I’m saying is it sounds like I was feeling very similar to how you are now and it was honestly completely fine. Prescribed HRT and at my first injection asked the nurse when I should start taking it and she said ‘today! Don’t delay’. So that I’m sure helped. Took a while to get my head around menopause at 36 but the relief from 20+ years of severe endo was life-changing. This is of course just my experience, we’re all different. Good luck with whatever you decide, OP.

I don't know about zolodex and obviously you're aware of the increased surgical risks of undergoing a full laparotomy. But an open laparotomy will also increase the number of adhesions and if they cause problems it can be really awful. They won't necessarily do so, but, trust me, if they do, it's miserable.

I had zoladex injection in my stomach once a month for 6 months for heavy bleeding with fibroids- I had no side effects and it put me through a symptom free menopause and I’ve never bled since and this was a good few years ago. It worked amazingly for me

I'd try to avoid the open abdominal surgery if at all possible - with a lot of large fibroids it will be a big operation and an long recovery time. The Zoladex would be a small price to pay, to avoid that type of surgery.

Re the injection phobia, get some Emla cream and you won't feel anything happening at all. Good luck !

I had Zoladex 9 years ago before surgery to remove a massive fibroid. I had no side effects whatsoever.

I'm now in my mid 50s and going through the menopause, and have no physical symptoms so far. The brain fog is a different matter!

@GCAcademic i had my ovaries out and I’m 48. One doc suggested keeping and three said take out, but all agreed it was a pretty even decision. I was told the recommendation is if you’re under 45 keep them and over 50 get rid, in between it’s personal choice. I’ve had cysts and wildly swinging hormones for years, I chose to get rid so I can control my hormones myself with HRT. My friend who’s 49 kept hers and now takes no medications at all. Depends on your priorities.