Laparoscopic Hysterectomy - or not??

Well, my dr called me last night with the results of my ultrasound.

He said that I have 4 fibroids that are small and have increased just slightly in size. He gave me three ways to treat these. #1 Embolization - which he said is typically done for much larger fibroids and it just reduces the size, he doesn't like this treatment and wouldn't suggest it for me. #2 Myomectomy. #3 Laparoscopic Hysterectomy. He said the choice is mine, I could not do anything or I could. If I wanted to do something he would recommend the laparoscopic hysterectomy - he feels confident that mine could be done this way because the uterus is enlarged a little because of the fibroids. He said ovaries and cervix would stay - unless something changes once he gets a look inside. He said one night stay in hospital and very short recovery - 2 weeks if I am really motivated.

He said there is a cyst on my left ovary but those usually resolve themselves and come and go with ovulation and the techs have to write down everything they see.

He also said that the major bloating, swelling and sore breasts, fatigue, unmotivated, sadness, wanting to be alone and untouched are all PMS symptoms that a hyster wouldn't necessarily help. He had given me a RX for Prozac at my appointment which I haven't filled because I am unsure if I should take it. He feels this would help me a lot and said I could always stop and maybe I should try to RX first for a couple months to see if this helps the other sypmtoms also - crampy/pressure feeling, low back pain (sometimes), soreness, icky feeling in abdomen, severe cramps that wake me during night (every once in a while). Don't recall him mentioning anything helping the little bit of urinary incontinence I have been experiencing.

Got a copy of the report and here is what it says:

uterus measures 10.1x5.9x4.4 cm

several uterine fibroids are identified - #1 is 2.2 cm in the posterior aspect of the mid to lower right uterine body use to be 1.8 cm. #2 is 1.6 cm in the posterior fundal region use to be 1.1 cm. #3 is 1.1 cm in the mid posterior uterine body not on previous study. #4 is anteriorly in the uterine body which appears to be partially submucosal in position which is 1.1 cm - this use to be 2.2 cm but was taken off by ablation in Oct. 2007.

Endometrial strip is 5mm - don't know what normal is especially after having an ablation.

Right ovary measures 2.8 x 2.6 x 2.0 cm and is unremarkable. Left ovary is 4.7 x 2.9 x 2.6cm - there is a complex hypoechoic mass in left ovary measuring 2.0 x 2.0 x 1.7 cm.

So, now it is time to decide what to do. Any input/advice from you ladies would be greatly appreciated in helping me look at every aspect in making my decision.

Thanks!!!

Have you had a second opinion since you have gotten your results? Another doctor may have an entirely different take on what is best for you! Or, a second opinion may confirm that what you doctor thinks is best is right for you and that could help you make your decision!

S

Hi LabLover,

I agree with Wesier...and seek out a 2nd opinion if you can. As Weiser replied, a 2nd opinion might suggest something differently....or agree with what your current Dr. is advising. I got two opinions myself and it is still one of the best things I ever did.

In what you posted... it sounds like your Dr is well trained since he can do laparoscopic hysts and in my opinion, he offered you (3) very reasonable options.

In pre-op, I actually discussed the same (3) options with my Drs. I decided against a UFE (Uterine Fibroid Embolization) since both my Drs felt my fibroids would most likely grow back after the procedure...and I wanted one surgery/procedure to handle my fibroids. I did not opt for a myomectomy since I was past child bearing years and I did not feel the need to preserve my fertility. And again...my Drs felt my fibroids would grow back after the myo-surgery. A footnote...my younger sister did have a myomectomy a number of years ago. She then went on to have my two nieces. She only had a hyst for reoccurring fibroids a couple of years ago. In hindsight, her myomectomy allowed her to retain her uterus and fertility and to have my two nieces. Thus it put off a hyst for a few years...which allowed her a lot time to consider all options.

In my case..I opted for a less invasive hyst (LSH) since I was a good candidate for the surgery type. It sounds like that is what your Dr. is recommending. It is a lap hyst and the cervix is retained and the ovaries are optional. In my case, I had a *window of opportunity* for a LSH due to the size of my fibroids at the time. Both my Drs. felt that if I had done a ~wait and see~, my fibroids in most likelihood..would have kept growing and then I would have only been a candidate for an abdominal hyst. A question to ask your Dr. might be the growth activity of your fibroids. Are they slow or fast growing?? If slow...that might give you a chance for a wait and see right now if you feel you need more time to research.

In the end...just do what is *best* for you. In my case, my LSH is still one of the best things I ever did for my long term health. It gave me back my quality of life.

Just remember...Drs give us options and we make the final decision when it comes to our bodies.

Sending best wishes~

Mary

Hi LabLover,

Just to add one more option, are your hormones in need of tweaking? The PMS symptoms can be eased. Did your doc check your hormone levels? Maybe a little progesterone or something else would be of benefit for you. I was offered it by two different docs many years before my fibroids got out of control. My one regret in hind site is that I didn't try it. I too suffered more from PMS symptoms than from my fibroids for many years. I was afraid of HRT because of all the bad press. Now that I am on it I realize how much better I could have felt all those years and could kick myself for believing all the anti-HRT hype instead of my doc. Just another suggestion for you to consider.

Good luck, keep us posted.

Hi Lablover,
Of course what ever you decide has to fit your particular circumstances. I was given the same options by my third opinion, so I can tell you how and why I made my decision.

I had LARGE fibroids 12,7,6,5cm and a polyup. Pretty ugly uterus that was at 20 week pregnancy size.

I opted not to have a UAE because it would only shrink my fibroids 50% and that was still a uterus with big fibroids. Also someone on this site mentioned not wanting to have large pockets of dead fibroids inside them and that really stuck with me. So no to UAE.

Myomectomy was also offered. My 3rd opinion doc is a fertility specialist, so he is very skilled in this surgery.
A myomectomy can save your uterus and your fertility. There have also been some studies that say your uterus also releases some hormones, so having it removed can alter that. My doctor likes to do them as open surgeries, so he can see all the fibroids for removal. The recovery time for this is around 6 weeks. I did find a couple of web sites similar to this one where women share their myo experiences. They do seem to heal faster than a TAH. Not sure why. Maybe because you are not loosing a major organ. PM me if you want links.
Also after a myomectomy fibroids can grow back. It might take 5 years, or 10, or even 2. If you are close to menopause you might not have that problem. I wish I had statistics for fibroid regrowth. It might help you make up your mind.
I opted not to do this either for the silly reason of a longer recovery.

and finally the LSH. It is still major surgery, but -and double check with your doctor about this- you have no sutures. Everything is cauterized, that is one reason why healing is so much faster. I have 4 incisions that are tiny. I spent one night in the hospital. Pain was not bad. I was up and walking within 6 hours after surgery. I was slow and sore inside the first 2 weeks. By week 3 the only pain I had was from my pants rubbing on my incision. Every week got better. Although I went back to my office job at 17 days on a half day basis, so I wasn't completely 100% until about week 5 or 6.

And now for hormones. I kept both ovaries. I to had bad PMS symptoms, which I will say after going through two cycles are maybe a little bit less intense. This month I had one day where I wanted to rip someones face off, and sore breasts for a week a bit of bloating, NO foggy thinking and no fatigue. So that has improved.
I take high quality vitamins and an herbal supplement which with diet changes has balanced my hormones naturally and very well. PM me and I can give you a link. I used to have horrible mood swings and well frankly think about driving off the road because I felt so overwhelmed. My doctor wanted to put me on a prozac like drug for it. I was using progesterone cream at that point and a supplement that helps metabolize estrogen at the time. Stopped that and started to get more level.

Honestly, I am happy I had an LSH. At 8 weeks I feel great. Like I have my life back somehow. It truly is an amazing surgery with a faster recovery time that makes it very worth while.

Do your research so you can make an informed decision.
And good luck with what ever you decide.

Oh I also wanted to add. I had a bit of incontinence too. One of my fibroids was pushing on my bladder. I did not mention that to the doctor, but since my LSH it has completely gone away. The pressure I felt in my abdomen is gone, crampy throbbing fibroid is gone. I did not realize how many symptoms were actually coming from the fibroids and enlarged uterus until it was gone and I don't have them anymore.

	Quote:
Originally Posted by LabLover~ Well, my dr called me last night with the results of my ultrasound. He said that I have 4 fibroids that are small and have increased just slightly in size. He gave me three ways to treat these. #1 Embolization - which he said is typically done for much larger fibroids and it just reduces the size, he doesn't like this treatment and wouldn't suggest it for me. #2 Myomectomy. #3 Laparoscopic Hysterectomy. He said the choice is mine, I could not do anything or I could. If I wanted to do something he would recommend the laparoscopic hysterectomy - he feels confident that mine could be done this way because the uterus is enlarged a little because of the fibroids. He said ovaries and cervix would stay - unless something changes once he gets a look inside. He said one night stay in hospital and very short recovery - 2 weeks if I am really motivated. He said there is a cyst on my left ovary but those usually resolve themselves and come and go with ovulation and the techs have to write down everything they see. He also said that the major bloating, swelling and sore breasts, fatigue, unmotivated, sadness, wanting to be alone and untouched are all PMS symptoms that a hyster wouldn't necessarily help. He had given me a RX for Prozac at my appointment which I haven't filled because I am unsure if I should take it. He feels this would help me a lot and said I could always stop and maybe I should try to RX first for a couple months to see if this helps the other sypmtoms also - crampy/pressure feeling, low back pain (sometimes), soreness, icky feeling in abdomen, severe cramps that wake me during night (every once in a while). Don't recall him mentioning anything helping the little bit of urinary incontinence I have been experiencing. Got a copy of the report and here is what it says: uterus measures 10.1x5.9x4.4 cm several uterine fibroids are identified - #1 is 2.2 cm in the posterior aspect of the mid to lower right uterine body use to be 1.8 cm. #2 is 1.6 cm in the posterior fundal region use to be 1.1 cm. #3 is 1.1 cm in the mid posterior uterine body not on previous study. #4 is anteriorly in the uterine body which appears to be partially submucosal in position which is 1.1 cm - this use to be 2.2 cm but was taken off by ablation in Oct. 2007. Endometrial strip is 5mm - don't know what normal is especially after having an ablation. Right ovary measures 2.8 x 2.6 x 2.0 cm and is unremarkable. Left ovary is 4.7 x 2.9 x 2.6cm - there is a complex hypoechoic mass in left ovary measuring 2.0 x 2.0 x 1.7 cm. So, now it is time to decide what to do. Any input/advice from you ladies would be greatly appreciated in helping me look at every aspect in making my decision. Thanks!!!

Hello, I just wanted to touch base with the PMS. I was diagnosed with PMDD, which is basically PMS on steriods. LOL

My doc gave me Prozac. I was afraid to take it until I talked with my family doc who's also a good friend. She said it was a common practice. Although Prozac turned out to not be my friend & made me severly depressed. My GYN then switched me to Welbutrin. So far so good. But if you're having sever PMS, I would definitely give it a try.

Thanks everyone for your help!

I haven't gotten a second opinion. I don't really see that there is a need for one. I know I have fibriods, I have had them come and go for years. I figured since I already have three children and have made the decision not to have anymore (we made that 11 yrs. ago when DH had a vasectomy and then I went and had the ablation 1 1/2 yrs. ago) that the only way to get rid of them is with a hysterectomy - I don't need my uterus anymore anyway. Then maybe I will be free of the bloating, the cramps, the pressure, the urinary incontinence, the bowel problems, the sharp stabbing like pains, the uncomfortable sex, etc., etc., etc.

I believe my fibroids are slow growing because they only have seemed to grow a little bit (1 cm or less) in 1 1/2 yrs - with the exception of the new one that popped up in this time frame. So I am going to take my time, research more on the laparoscopic hyster to see how others have made out, etc. And, also plan it at a more convenient time for me.

As for the PMS issues - no, my doctor didn't do any bloodwork to check my hormone levels. I did find this strange, that he would give me a RX for something without knowing what my levels were. But, I did start the Prozac last week. I figured I would give it a try for a couple months to see how things go.

Willowstar - so would you say it really is still a 6 week recovery time? My dr. told me 2 weeks if I am motivated.

No I wouldn't say 6 weeks not at all. I will say I was not back to "normal" ie high energy, working 8 hours in an office and then riding 2 horses after work plus farm chores until about 5 weeks. By 6 weeks I was at 100%, and now coming up on 9 weeks I forget that I had surgery.
The recovery is much faster than open surgery for sure. I was back riding horses in 3 weeks, and back to my office job at 17 days albeit part time. They were very worried at work that I would overdo it, so I took them up on the offer to work half days. I didn't really need to, but since they offered.

I went to a dog agility class at about 19 days. I did run a very little bit, and brought an ice pack for the ride home. That night I was a bit uncomfortable and took advil, but was fine in the morning.

At 2 weeks my husband went out of town for the weekend and left me with 3 stalls to clean. I didn't have to move bales of hay around or anything, but I did notice that my belly was more swollen at night after I did chores. I would lay on the couch after wards with an ice pack. It wasn't really painful, just a bit achy . I had him do stalls for another week after he got back.
At my 3 week check I still was wearing loose capris, and my "fat jeans. I did not have to wear granny panties or maternity pants-not that much of a swelly belly, but I did have some swelling. I did have some, well I guess pain, but more irritation on my lowest incision. Pants would rub it.
At week 4 I was frustrated that I wasn't completely back to normal.Remember my normal is pretty active and physical. I was still only riding one horse a day. And I was over people telling me to take it easy. I thought I would never fell strong again.
My doctor told me that because they cauterize everything at 3 weeks I could not do any damage. He rides horses as well, so he knows what all is involved. He explained the difference between damage pain and "owie" -I over did it pain. Damage pain gets worse, or stays. Owie pain changes and goes away. He told me that I could just go up to where it hurt and then back off and go a bit further the next day. I will admit to being a bit cautious, but with hind sight I probably was a bit over cautious.
I guess I really thought I would be 100% back to normal at 2 weeks. That was not so. But I was not laying in bed like I would have been at 2 weeks post TAH with lifting restrictions.
Being super fit and strong going in helped me a lot, and walking helped me a lot afterwards. I was walking 2 blocks a couple of times a day one day post surgery. On Vicodin of course, but it helped with the CO2 gas.



I am happy to answer any questions you have.
Good luck with your decision.