Myomectomy or Hysterectomy?

Carrolle,

If somebody had all the answers, the choice about whether or not to have a hysterectomy would sure be easier, wouldn't it?

I don't think anyone claims to know why some of us develop uterine fibroids, or for that matter, why some cause no problems and others cause a whole host of symptoms. Most of the reading I have done indicates that the current conventional wisdom is that estrogen feeds fibroid growth once you have already developed them. Obviously conventional wisdom is a pretty fluid concept - medical science learns more and more all the time. I'm sure there are probably a number of other factors that contribute to their growth, as well, and may eventually be determined to actually have a greater impact.

It's because of the estrogen link that one of the present treatment options is hormone therapy to block estrogen. Here's another WebMD link to check out:

http://my.webmd.com/content/article/1680.51244

Good luck with your decision. You need to be comfortable with it, whatever route you take!

It's good to know that it is possible for a TVH to be done easily even if you've had no vaginal deliveries. My main concern about a TVH was maintaining good support of the other pelvic organs, but so far the women I've talked to and those I've heard from on this site haven't had any problems. It sounds like it usually isn't an issue. I just wonder if later in life (like in my 70's and 80's - when I still plan to be very active!), the pelvic ligaments will be weaker due to the surgery, and that the bladder/vagina/rectum would be more prone to prolapse. I know that these things can also be fixed, but the risk is greater at an older age. I realize that there is no perfect solution. I'm just trying to find the one that will allow me to go on with my life with the least amount of problems.

My biggest problem with having a hysterectomy is the possibility of my ovaries shutting down. I have read that anywhere from 10% to 50% of women experience ovarian failure, or at least reduced hormone production within 3 to 5 years following a hysterectomy without oophorectomy. However, since many of these women were probably perimenopausal anyway, who knows if it would have happened even without the surgery? I'd rather not go on HRT, but heck, I've been on an even stronger form of that (BCP's) for ten years, and have been lucky to have had very little adverse effects. I have noticed a slight rise in my blood pressure over the last couple of years, so I would prefer to come off of them. I might be able to even with a myomectomy, but chances are I would need them to regulate my period again, since I was having a period every two weeks before I went on them. The higher dose of estrogen might also cause any microscopic fibroid "seedlings" left behind to grow more. The question is, would they grow enough to cause problems in the 4 -5 years I have before menopause? Then, there's the question of going on HRT, and whether that lower dose would be enough to cause growth .... It's really a guessing game, isn't it?

Well, I think I'm getting closer to a decision, and hearing from you all has really helped. If I do finally decide that a hysterectomy is the best for me, at least I know I can find lots of support here!

Tante,
Thank you for all the good information, and the great link to the WebMD article! I wish you a speedy recovery. It sounds like you are doing great.

Liz,

You're right. You make as informed a decision as you can, but it really is a guessing game in many ways. Sounds like you've got a great attitude about it, and I'm sure you'll make the right decision for you. Keeping you in my prayers.

Back Atcha,
Margaret

Hi Carrolle,
I'm not sure how common it is to develop granulation and you are right that it is associated with the healing at the top of the vagina. Usually silver nitrate treatments resolve the problem and sometimes more than one treatment is necessary. I had about six and finally it went away. I don't know about BCP's vs. HRT affects on fibroid regrowth. This is something you may want to research or ask your dr. about. Good luck.

See if your gyne can recommend a surgeon who could do a laprascopic assisted supracervical hysterectomy. A relatively new procedure, this is done through small incisions and retains your cervix. Only the offending organ, the uterus, was removed. Search the board under LSH for more detail. I was in a similar situation,and I had a myomectomy which was only a short term (3 years) solution. The LSH could be another option. Good luck!

Eleanor,
Thanks very much for the suggestion. I have seen that mentioned a couple of times, and asked my doctor about it. Unfortunately, it is not an option for me for a couple of reasons. Firstly, I am active duty Navy, and even though I am able to go to the best hospital in the Navy (National Naval Medical Center in Bethesda, Maryland), since I am stationed in Washington, DC, they do not have the equipment available to do that yet. Even if it were available, it would be a long and complicated procedure in my case, due to the size of my fibroid and uterus. I also have a "very vascular" fibroid, which would cause a high risk of severe bleeding.

So, it was definitely a thought, but not really a good option for me. But, thanks so much for trying to help!

After much research and soul-searching I have finally opted for a supracervical hysterectomy (abdominal). This creates the least amount of disruption of my internal anatomy. It does require an abdominal incision, but my doctor said he would make it as small as possible (my uterus isn't HUGE yet - about a "10-week" size). I am also in pretty good shape physically, so hopefully the recovery won't be problematic.