Radiation Therapy in Excessive Uterine Bleeding from Causes Other than Cancer

FOR many years we have been studying and practising irradiation in the treatment and management of menorrhagia; and the study of the literature and our cases over a period of seventeen years has brought us to the conclusion that radiation is the method of choice in the treatment of these cases. To this method, as to all others, there are certain contra-indications, such as very large rapidly growing fibroids, those causing pressure symptoms demanding quick relief, pedunculated tumors, uterine polypi, tumors which can be removed leaving the uterus intact, tumors which have undergone cystic degeneration, ovarian cysts, extreme mental depression, and cases in which partial hysterectomy has been done and bleeding continues from residue of uterus. Also, we believe that no woman in the child-bearing period and having no tumor should be subjected to radiation until all other methods of treatment short of hysterectomy have failed to effect cure. The idea is rather prevalent in the medical profession, and it has permeated the laity to some extent, that radiation destroys the woman's sexual desire and enjoyment. As to this, we have interviewed and followed through the cases of 58 of the patients in this series. We find that in 40 of these there was no change in sex life; in nine, desire and capacity were reduced for a time, but normal sex power returned; in seven, two of whom were frigid before treatment, there was increase ranging from a moderate to a marked degree; one, aged 50 when treated has remained sexually insensitive for ten years, and one has remained much below normal in this sense for ten years, although she has sex powers to a limited extent. These findings convince us that, following radiation, there is more apt to be increase than decrease in sexual desire and enjoyment. We are convinced also that any change in this respect is entirely psychic. We find that recovery from lowered or lost sexual appetite promptly follows positive assurance and conviction that recovery will occur. The greatest care should be given to the selection of these cases, so that those having positive contra-indications may not be subjected to treatment. We find that a very large percentage of these patients have been treated for a long time by various methods without satisfactory results, and on account of this they are very apprehensive and doubtful about any treatment curing them; consequently, it is of great importance that sufficient time and effort be taken to fully discuss with the patient all phases of the treatment and just what is to be expected from it. Our experience has taught us to expect one, and sometimes two, menstrual periods during the time which is required to establish permanent menopause and the flow is usually profuse at the first period. Some have radiation sickness, while almost all of them experience some discomfort from the usual menopausal symptoms.