Should I do it?

I have seen two doctors for my symptoms, and feel more confused than ever.

I am 48 years old. I suffer from HEAVY bleeding (with clots) even after being prescribed birth control 8 months ago. I have chronic lower back pain, painful menstrual cramps and menstrual migraines, as well as PMS. I also suffer from chronic fatigue. I have an under-active thyroid but take meds for it and have tested within the normal range for years. I take iron supplements every day and test barely into the normal range.

An abdominal and vaginal ultrasound show a fibroid the size of a small grapefruit on the right anterior side.

Both drs. told me that it could possibly shrink at menopause which should not be that many years off for me. Both drs. seem to lean towards removing it via hysterectomy, but don't seem to have any urgency about it. My husband has been pressuring me to have it removed.

I am hopeful that by removing it, I would have relief from my symptoms (for sure the bleeding would be gone), but am concerned that even if I go through with it the fatigue, back pain and borderline anemia might still exist. In reading all the post-op stories, I became even more worried. If I'm tired now, how the heck will I recover from surgery?

I have a follow up appt on the 18th when we will basically decide what action to take. I am a teachers assistant. If I don't work, I don't get paid. If I want to do this, I have to schedule for this summer as I am off for two months anyway. If I don't do it, and things get worse, I will have to wait a full year before I can schedule.

Sorry this is so long. I am very confused.

Hi ((Ig07))!

You have already made a couple wise decisions! You sought a second medical opinion and you are asking questions!

First, a hysterectomy is a major surgery that is not without risks. So you do want to be sure it is the right treatment option for you. If we could look into the future and know how well we would do post hysterectomy, it would sure help with the decision pre hysterectomy!

Did either of your doctors offer you suggestions besides a hysterectomy that could eliminate your symptoms? There are a variety of options to treat fibroids and/or bleeding issues including an ablation, UAE, myomectomy, and/or D&C. We have a lot of information in our Resource Database you may want to check out.

Did you discuss each of the various symptoms you are experiencing with both doctors and ask if they would be eliminated with a hysterectomy? Are your back issues related to GYN issues? How about the chronic fatigue?

Your ovaries would be an issue for the menstrual migraines and PMS. Are you considering an oophorectomy as well? I have suffered with menstrual migraines but my neurologist is not an advocate for removing the ovaries for the migraines as the success rate is not that high. If you did have an oophorectomy, would you be a candidate for HRT to help with surgical menopause issues?

Were both doctors you spoke to GYNs? Do you have a GP? You might want to discuss the overall health issues with your GP and ask for suggestions as well.

In the end, we each have to weigh our own pros and cons to determine if a hysterectomy is right for us. I wish you all the best as you work with your medical team to determine what is best for you!

Thanks for responding to my post.

Both Drs. I saw are OB/GYNs. Alternative options were discussed with both of them, however they both seemed to advocate partial hysterectomy as the best option. The reason I sought a second opinion was because the first dr. recommended that if I opt for a hysterectomy, I should have my cervix and ovaries removed also to eliminate any risk of future cancer. I found this odd since she assured me that the tumor was benign, and I have no risk factors for either ovarian or cervical cancer. The second dr. was much more in favor of preserving the ovaries and cervix and saw no reason to remove them. Neither one of them could tell me if my back pain is related to my GYN issues. Maybe yes maybe no. Same for the chronic fatigue. Oh and I forget to mention earlier, stress incontinence. The thought is that pressure from the tumor might be causing stress incontinence and back pain. The bleeding might also be causing the borderline anemia which might be contributing to the fatigue.

Dr #1 didn't see that the surgery was absolutely necessary, but before I left her office, wanted to schedule it as soon as possible. Weird! Dr. #2 gave me my second opinion when I was menstruating. I will see him on the 18th for an exam and follow-up discussion. He is a well respected Dr. in the community. Many local drs. send their wives to him. I feel comfortable with him. Because of the size of my tumor, he felt that a partial abdominal hysterectomy would be the way to go. He favored that over a vaginal.

Anyway, in weighing the pros and cons, I worry is the relief I will feel 5 days out of the month worth the risk of possible complications.

Obviously the choice is yours, but why go with such an extreme option as the first choice, especially with removal of ovaries and cervix (which my research suggests you should never have removed unless there is a significant risk of cancer)? Unfortunately, as I discovered, VERY few gyns will suggest anything other than a hyst for someone your age. I am 42 and had to get three consults before I found one that would. True, a hyst will be a final solution to your problems, but it's also irreversible.

Why not consider something like a UFE? I've talked to a number of women who had very good results with this procedure, even with large or numerous fibroids, and it is minimally invasive and offers a very quick recovery. To get the best information regarding UFE, you need to see an Interventional Radiologist, as they are the ones that perform the procedure. I had a consult with a very well-respected gyn/surgeon in my city who gave me misinformation regarding UFE. Many gyns don't know enough about it to give you good advice, especially since they don't perform it.

As I said, I had to have three consults before I found an open-minded gyn, but I know women who have had to have more. Depending on where you live, it may be a harder search for you, as there don't seem to be so many around. I ultimately found an expert (she runs a fibroid clinic at the local teaching hospital/medical school) who agreed that I absolutely did not need a hyst. I will be having an abdominal myomectomy on June 11 (BTW, I have numerous fibroids - too numerous to count, according to my MRI - from pea size to the largest being approximately the size of a grapefruit. My uterus is the size of a six month pregnancy.). As I discovered, it's a tough search, but if you want to keep your uterus (or at least try something less invasive before something as final as a hyst), then it's worth it. Do your homework. There are lots of excellent resources out there on fibroids. And basically, know that a hyst is RARELY the only viable option. If you want one, go for it. But if you don't, stick to your guns and find a doctor that respects your wishes. They're rare, but they exist.

Josie

Hi lg07,

I had two large fibroids and I had a partial hysterectomy. I kept my cervix and ovaries with my laparoscopic hyst and I am still very pleased with the results. My hyst gave me back my quality of life.

In pre-op, I was experiencing scary-heavy periods, pelvic pressure 24/7, bladder incontinence and no energy with my fibroids. Today...it is really nice to live without all that. For me, a partial hyst was a good decision.

In the end...just do what is *best* for you. That is what is most important.

Best wishes~

Mary

DO NOT let them talk you into removing perfectly healthy ovaries. My doctor told my Hubby & I that I would no longer have to "worry" about ovarian cancer and at 47 I was nearing menopause anyway. The biggest mistake of my life! And I am not saying that lightly. When I list the 10 things I regret about my life, that is always #1 on my list. Your ovaries play a very important service your entire life, even after menopause (which I was no where near anyway) But I believed the dr and just did it, no second opinion, just did it! You can not put them back, and HRT has too many scarey side affects for me to even consider. I wish I never had ANY of this surgery as I am in constant pain now from adhesions & I never even had cramps or heavy periods my entire life! One lousy cyst had forever changed my life. Of course, only you can decide what is best for you, and if you are bleeding to the point of anemia you may have no choice, but please, if there is another option,, explore it first. You can not undo this once it is done! So, if you feel it is best for you to let your uterus go, that is up to you. But NOT healthy ovaries, no, don't be "scared" into that mistake, please.
Continue your research & make the best decision for your health & your piece of mind. I know ALOT of woman, my mother, sister included who had just their uterus removed & were absolutely happy & healthy when it was all done, and they never looked back! No adhesions like I formed, but, most importantly, they went through "natural" menopause. There is a reason mother nature gives woman up to 10 years to get to the point os menopause! Having my healthy ovaries taken out, I awoke from surgery drenched in sweat, meno. hit me like a Mack truck hitting a stone wall!
Research my dear, then research again.
Best of luck to you, this is never an easy choice and I am glad you are thinking it over instead of blindly following a dr's advise like I did.

Hi lg07,

I agree with what Whatsnormal posted. From being on Hyster Sisters, it appears that some Drs like to remove the ovaries if the Hyster Sister is over 45 and to retain the ovaries if the Hyster Sister is under 45.

The ovaries secrete very important hormones..and newer studies are showing that the ovaries secrete their important hormones well into menopause. Also, in pre-op...my Dr. told me that 5% or less of women get ovarian cancer. 5% to me was good odds..since that meant 95% of women did not get ovarian cancer. I agree with Whatsnormal and Drs can sometimes use a scare tactic with the ovaries.

In the end...as I replied before...just do what is *best for you.

Best wishes again~

Mary

You might also want to consult a surgeon that is very experienced with laproscopic surgery. With only one fibroid, you may well be a candidate and recovery is only two-three weeks. I have spoken with several women who did not even stay in the hospital overnight after their lap myo. As I mentioned, I also have a grapefruit sized fibroid and I consulted a surgeon who said its size was not a problem. For me, the issue was too many fibroids for a laproscopic procedure.

Statistically speaking, only 30% of women who have fibroids removed will have them return. The closer you are to menopause and the fewer you have, the lower the odds that they will return and cause problems.

Everyone's different, but personally, I think a hyst is a very extreme answer to be the first line of defense. It's always going to be an option if other treatments don't work.

Josie