Myomectomy or Hysterectomy??? Advice Needed

Hello,
I am 38 years old and have had fibroids for a long time causing all sorts of issues. I was recently diagnosed with an enlarged uterus (size of a cantaloupe) and prolapsed bladder. I originally approached my doctor because of the symptoms associated with the prolapsed bladder and after my u/s and exam he determined that he could fix the bladder but due to the size of my uterus and a fibroid pressing on my bladder I wouldn't get the results I wanted unless we did either a myomectomy or hysterectomy. He seemed to be pushing for the hyster because in his words, to have a uterus the size I do at my age, a hysterectomy is a given in my future.

I can do a myomectomy but he says that I'll have to have an abdominal incision because of the size of my fibroids. So I'm down for 6 weeks anyway. He also thinks I'll have to have an abdominal hyster because of the size of my uterus but he won't know until he goes in. I really do not want a hysterectomy at this point (not thrilled about the possible sexual dysfunction and other lovely side effects) but am wondering if it's short sighted of me to completely rule it out. I have to do the bladder surgery, quality of life is an issue at this point. Very nervous about the mesh so I'll be discussing other options with doc about that.

If I have a myomectomy, will the removal of the fibroids shrink my uterus back down to "normal" size or will it still be as big as it is now? Since I'll likely have a hysterectormy in the next 5-10 years anyway should I go ahead with it now? I have an appt with my doc after the new year to go over some additional questions that I have and to schedule either the myo or hyster.

Any help would be greatly appreciated. BTW: fertility preservation is not a consideration for me.

I had my myomectomy at 31 for preservations of feritility and it was about the same size as yours. No babies Husband was a flake, just had the Hysterectomy at 41. The Myomectomy helped relieve the symptoms and the lighten my cycle, but those fibroids were attached to the outside of my uterus. And my fibroids grew back in that time period and invaided my uterus . Both had to be done abdominial as well. I say why have the surgery twice. Just my opinion I am only 2 weeks post op on the Hysterectomy....two abdominal incisions have done nothing for my stomach muscles. And from what I am learning and form several of my friends who have had the hysterectomy keeping the ovaries is part of keeping some of the problems at bay. Maybe a vet can give more insight.

My doctor said that a myomectomy was actually a more complicated surgery than the hysterectomy. He also said that there is a risk of the fibroids growing in remaining part of the uterus.

Dear ilovechristmas:

I think you should get a second medical opinion to help you figure out the next step. Altho hyst was recommended for me, the 3rd doc that I saw had a less invasive surgery in mind for me. Here is a link to the Fibroids section of our Resources Directory: https://www.hystersisters.com/vb2/lin...=browse&cid=26

I hope you are able to find the right answers soon. I am sending huge cyberhugs

I had a myomectomy a year ago. Like you my first doc recommended a hysterectomy. I was extremely frightened by the sexual side effects because once it is done it is done. After the advice here, I got a second opinion. (I was 38)

BEST MOVE I EVER MADE. Ended up having a myomectomy a year ago. Removed the fibroid vaginally (took 2 surgeries).

My uterus did shrink, ended up losing 15 pounds over the next few months...I think just cuz I felt so much better. I still have some minor bladder issues but not enough to make a deal of it right now.

My doc did say there was no guarantee it won't come back and may need a hysterectomy in the future but for now my periods no longer rule my life. My bladder issures no longer rule my life. I no longer wear "diapers" or even ULTRA tampons. A regular one and I am good to go. Getting out of bed during my period was the biggest achievement.

The second opinion allowed me to find a doctor I completely trust. He is a specialist who deals only in problems (no babies). He is VERY conservative and for me that is what I needed.

The road is soooooo overwhelming at times so I suggest from this moment forward you get a calender and keep track daily of your events. (Periods, Mental, physical, pain, pads, tampons etc) Also keep it handy (in your purse) so you can write down questions when you think of them. When you go to the doctor write the answers down as well because you get flooded with info.

You need to fell good about your decision and you need to fully understand the whats and whys and you need a doctor who is willing and able to help you with those needs.

Hang in there....a year later....I cannot believe how different life is.

Dear ilovechristmas,

I would get a 2nd opinion too (and 3rd and 4th if needed). I am 51 (soon to be 52) have not gone through menopause yet and was also told by several doctors to have a hysterectomy for an 8cm fibroid. I found a doctor here in Boston who is 'cut from a different cloth' and really believes that a woman does better if the uterus can be preserved whenever possible. I had a laparoscopic robot assisted myomectomy on November 30, 2010 and the recovery has been fantastic. I was back to work within a week and back exercising after 2 weeks.

Here are the things I learned:

1. Not all doctors are skilled at performing a myomectomy or hysterectomy laparoscopically. However, the recovery is far easier for the patient. If you go the H route I would at most definitely seek out a very experienced laparocopic surgeon.

2. Not all doctors believe that preserving the uterus is important. I have cardio vascular disease in my family and preserving the uterus for this reason was very important to me.

3. Otono is right - a myomectomy can be more complicated than a hysterectomy. Closing up the uterus after the tumor has been removed takes skill, time, patience and a fundamental belief by the surgeon that he is 'doing the right thing.'

4. With the use of the da Vinci robot a skilled robot surgeon can close up the uterus 'as if you had an open incision' - it's far easier with the robot.

5. You have the right to find the best surgeon and you should set about doing just that.

I also had bladder issues as the firbroid was sitting right on top of it. I know this because before it was confirmed I was a candidate for the myomectomy I had an MRI - the images were very clear and from that the surgeon could plan how he would approach the actual removal of the fibroid. I urge you to find other opinions - you are so young to have a hysterctomy that may not be necessary.

Having just been through this decision making I am very passionate that woman really need to advocate for themselves. I know I have done it for my children when they have had medical issues - I didn't even flinch at getting a second opinion for them I felt it my obligation as a parent. We need to start looking after ourselves in the same way.

Whatever you decide I wish you the best of luck. You should check out the doctor referrals on this site and others and also check out the de Vinci robot site.

Happy Holidays,
Carol

Thanks everyone for your responses! After alot of soul searching and scouring of the internet I decided that I really wanted to keep my uterus at this point. I am having an abdominal myomectomy and TOT bladder repair in about a month! I am very excited and nervous at the same time. My doctor was awesome and totally supportive of my decision and patiently answered every question I had! I did speak with him about the Da Vinci and he felt that with the number of fibroids that I have, that it would be better to go in abdominally. He said Da Vinci is wonderful for a small number fibriods. I have so many that they stopped counting on the u/s. After hearing his reasoning and explanations I feel certain that an abdominal myomectomy gives me the best chance to have all the fibroids removed at one time.

Thanks again for all your support!

Glad that you have made a decision. Sounds like you doctor is not a robotic surgeon though so is perhaps not the best person to tell you if you are a candidate or not. I would ecourage you to check the da Vinci website and see if there is a surgeon in your area - just to get an opinion. With the bladder repair maybe you would have to have an open incision anyway - but what a shame it would be to find out after the event that it all could have been taken care of laparoscopically. The recovery is so very much easier. I understand it is never easy to look to another doctor when we have a good relationship with our current doc, but if he doesn't perform robotic-assisted laparoscopic surgery he is not really qualified to tell you if it's an option. Hey, for me the hard part was making the decision to have surgery - so congratulations and whichever way you go you are going to feel so much better once it's over. Hoping you can at least get a consult with a specialist. Hoping for the best for you and a really easy recovery and good outcome. Carol V