Doc suggested removal of cervix, just cuz. UPDATED: now 5 days post myomectomy

She said it serves no benefit to keep it, but it makes the surgery easier to remove it, since fibroids are so large.

She said that she would do whatever I wanted.

Now, I am completely panicked that I decided to get a hysterectomy at all. My biggest worry with the myomectomy is that all the fibroids will not be removed. I have 20 as seen on the MRI, but some are large and some are small. Also, being 45, I could have another 10 years before my period. That probably is enough time for them to come back. I never had kids mostly because of all these problems plus timing and I am dying and panicking, but also sometimes accepting. Because of location and size and number of fibroids, Dr. said that getting pregnant would be excruciating, bloody, and probably result in a premature baby.

What are your thoughts on cervix, keep or remove,
myomectomy at 45 with many fibroids, possibility of not getting all and new ones growing, and
The reality of having a myomectomy at 45, healing and getting knocked up naturally? I do know three women who got knocked up at this age, one without actually have traditional intercourse!

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Originally Posted by ARoggen She said it serves no benefit to keep it, but it makes the surgery easier to remove it, since fibroids are so large. She said that she would do whatever I wanted. Now, I am completely panicked that I decided to get a hysterectomy at all. My biggest worry with the myomectomy is that all the fibroids will not be removed. I have 20 as seen on the MRI, but some are large and some are small. Also, being 45, I could have another 10 years before my period. That probably is enough time for them to come back. I never had kids mostly because of all these problems plus timing and I am dying and panicking, but also sometimes accepting. Because of location and size and number of fibroids, Dr. said that getting pregnant would be excruciating, bloody, and probably result in a premature baby. What are your thoughts on cervix, keep or remove, myomectomy at 45 with many fibroids, possibility of not getting all and new ones growing, and The reality of having a myomectomy at 45, healing and getting knocked up naturally? I do know three women who got knocked up at this age, one without actually have traditional intercourse!

Well.....all I can say from experience. ...surgeon said normally I would take the cervix but I don't know how easy it will be with all my endo and scar tissue. He left it and the first thing he said was....remember you still have to have smear tests. In my case was just too dangerous to remove it as it was too entwined with my bladder and scar tissue.
I'm 48 and for many reasons had to put off the op for 4 years .

Yes, it certainly served a purpose in your situation.

Just the question of whether to keep or remove the cervix is making me revisit the whole question of hysterectomy and myomectomy. With the hysterectomy, I am so scared of prolapse, urinary or bowel issues, but was told because I never carried to term/gave birth, those aren't really issues. True? With the myomectomy, it will be longer, 4.5 to 5 hours, instead of 2-2.5 with the hysterectomy, and therefore more expensive, maybe all fibroids will not be removed and symptoms will remain, maybe new ones will grow before menopause, what is the likelihood that I will concieve and have a baby at this age after all these problems, probably just a pipe dream.

Can anyone help me sort this all out. I know only I can make these decisions.

I see now that you did get the procedure after all that waiting. are you happy and feeling much relief? I hope so.

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Originally Posted by Teresa Willis Well.....all I can say from experience. ...surgeon said normally I would take the cervix but I don't know how easy it will be with all my endo and scar tissue. He left it and the first thing he said was....remember you still have to have smear tests. In my case was just too dangerous to remove it as it was too entwined with my bladder and scar tissue. I'm 48 and for many reasons had to put off the op for 4 years .

Have you considered an alternative procedure like UFE that can treat all fibroids? It takes time for them to shrink and the rate of shrinkage varies from patient to patient. Myomectomy is still the gold standard for pregnancy but the newer studies show there is no difference between UFE and myomectomy with getting pregnant afterwards.
I have a lot of fibroids too the largest being 18.9 cm. Personally for a lot of different reasons I don't want a hysterectomy so I am looking into the possibility of a UFE or a UFE/myomectomy combo. MYO to remove the two largest fibroids that will actually be the easiest to remove and the UFE to help with bleeding during surgery but more importantly to treat the medium to small fibroids. I recently learned from an IR that to really help preserve fertility they can do a UFE with gelfoam instead of the normal spheres. This what they recommended in my case with a MYO. They think the gelfoam would last long enough to kill the fibroids but it does eventually dissolves (~6 weeks) to restablish the blood supply back to the uterus.
If you really want help in making a decision since it sounds like you want a child. Why not get fertility testing done just to see what the possibilities are? Then you can make a more educated decision about the hysterectomy or not. There are so many other treatment options for fibroids that a hysterectomy is not your only option.

If you want to preserve your fertility, then yes, you should look into other options besides hysterectomy. If your doctor isn't willing to work with you on that (and seems to be discouraging the idea of a pregnancy), then maybe you should get a second opinion.

Doctors have conflicting info on the benefits of keeping the cervix. My doctor didn't want to remove anything that was healthy, but she didn't know what condition my cervix was in until surgery. Going into it, I had no idea if I'd come out of surgery with my cervix or not. As it is, I still have mine. My doctor said it helps prevent prolapse but other doctors say it doesn't. I think that comes down to the doctor's personal beliefs.

The only "downsides" to keeping the cervix are that you still have to get pap smears (that never bothered me) and, if you keep at least one ovary, the small possibility of mini periods. I have both ovaries and so far, have had no mini periods, either (my doctor said she cauterized the cervix well to cut down on the possibility).

I'm leery when doctors want to remove the cervix with no good reason if they're doing abdominal (with vaginal surgery, it's a given that the cervix is removed). Sometimes, it seems that they just do what they're used to or what they prefer instead of what's in the best interest of the patient.

My doctor told me the same; because I had never been pregnant which weakens the pelvic floor I I am less likely to have prolapse. That said I still think about it especially every time I strain at all for a BM

My doctor also told me that it's possible to have fibroids grow on your cervix, since it's made of the same endometrial tissue as the lining of your uterus. She didn't think there was much good evidence showing that the cervix helps with pelvic floor issues or with sexual responsiveness (two reasons I've heard for keeping it). Of course, that is one provider's opinion!

I had a period of intense ambivalence before my hysterectomy and wondered if I was making the right decision. I had to remind myself of all the reasons why I decided on this surgery in the first place. If you are still pursuing fertility I would recommend a second opinion or additional fertility testing as others have suggested.

And, of course, an unbiased person to talk to is wonderful! My therapist has been a blessing throughout all this and I don't think I could have managed this without her. Highly recommended.

I suggest embolization. Your doctor makes it seem as giving up organs is no biggie. I think it is a very big deal because you want a baby. I know some have gotten pregnant after UFE but there are no guarantees however the fibroids will stop growing. With 20 fibroids you would want to inquire about artery embolization with an interventional radiologist so all fibroids can be treated at once.

If you really want a baby then seek out a fertility specialist as these are often skilled myo surgeons. Don't have a hysterectomy if you don't want one. I had a 22 week size uterus embolized and it was the best choice I ever made as now my uterus measures 5-6 weeks. No surgical menopause or long recoveries.

Hi,
I, too, went through the dilemma about my cervix. There are times that if they find a fibroid growing on the cervix, it has to go, but generally, it is an easier surgery to NOT remove it. It may just be that your MD usually does Total Hysts, and doesn't have as much experience doing partial and leaving the cervix.

I copied my "intro" post below. Skip down to the end for my take on the issues of "to keep or not to keep" your cervix.


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Hi, I have found some helpful information on this forum (such as binders, good pre/post op surgery diet), so I thought I should register and help/share my experience.

I'm 41, married, no natural children, and have been just dealing with large fibroids for several years. Very heavy periods, but not intolerable. They have grown so large that I look pregnant and feel bloated.

I'm a solo practice lawyer, and it was going to be very hard to be out of the office for any length of time. Also, after doing much reading and research, I hated the long-term potential side effect of losing my uterus. I first decided on trying to have a myomectomy, but found it difficult to find someone to do it with such a large uterus, and even if I did, insurance wasn't likely to pay.

Finally, I decided that I just needed to take care of the problem before potential trouble with insurance and the changes in the health care system over the coming years. I have a supra cervical abdominal hysterectomy scheduled for 12/17/2014. Christmas and New Years is my slowest work time, so I'm taking it off this year.

I spent many weeks reading all of the research and medical journals - both U.S. and foreign - and I decided that I was going to keep my cervix. I had to fight with my doctor ....she just kept saying "it's the standard of care" to take out the cervix. The only reason she could give me was preventing potential cervical cancer. I would have changed Dr's, but after some discussion and comparing research, she relented to my choice.

I think is very important for women to be informed about that choice. You can't keep your cervix with a vaginal hyst., but can with a lapro or abdominal you can. The only reasons I ever found to remove it -- preventing cervical cancer, need for continued PAP tests, and possible tiny monthly bleeding. If you have no risk factors for cervical cancer, you can easily keep getting annual screenings, and it is one of the most easily detected and easily cured types.

Possible benefits (I found no definitive research on either side -- this is an area that has not been widely researched...so they just don't really know!): increased pelvic floor support, reduced risk of loss of sexual feeling, reduced risk of too short of a vagina, and easier surgery.

Women always talk about things being their "choice." Has your doctor given you a choice about your cervix? Have you done your research and reading? I was frustrated when I realized what a complex issue that was, and that my doctor never brought it up. The first time I asked her (before all of my self-study) she just said "oh, I just always take it out unless the women is too obese and I can't easily reach it")