Do I need biopsy if hysterectomy is in the cards?

Hello,

I have been having a variety of problems for years: painful intercourse (mostly at the beginning...yes we use lube), sometimes painful orgasms, bleeding after sex, at least one day of "flooding" during my period. Went to a gyn years ago and found out I had a couple of fibroids, which he said were probably bleeding a bit from the sex. Was told it wasn't a health issue that required any action, but that I should have an ultrasound every couple of years to monitor the fibroids. Did a second one two years later, no change, and more recently, my GP didn't see any need for me to have one, as he did a pelvic and said there was nothing that felt strange or enlarged.

For the past few months, though, I've been having clearish discharge, sometimes with some blood, showing up just after my period and lingering (very annoyingly) for days. Decided to get the ultrasound done (hadn't had one for four years...oops) again and go to a gyn, since I was feeling like my GP pretty much didn't have a clue.

Results show that one of the fibroids has gotten quite large, and they are "highly vascularized". There is also evidence (the new gyn tells me) of "chronic cervixitis", though PAPs have all been normal. She is not sure what is causing the discharge at this point. We've ruled out infection.

Her suggestions: get a biopsy to check for cancerous or pre-cancerous cells, though she says that would be very rare. However, she also tells me that you can have cancer and the biopsy won't catch it if the tumors are within the muscle. Spoke to the radiologist who read the ultrasound and he said the larger fibroid is pretty much filling the whole inside of the uterus, so he thought the gyn would probably get a sample of it in the biopsy.

The gyn went on to say that probably the only way to deal with all of my various issues is to remove the whole uterus. BAM! That was a new one on me! I was pretty stunned and I really didn't like the gyn (she has the look and all the warmth of Imelda Marcos), so didn't ask all the right questions. I tried to, but she wasn't at all easy to talk to. I've heard she is a very good surgeon, so my dislike of her and difficulty in communicating may not stop me from having her do the surgery, but there are things I want to know, which I would appreciate any answers on:

1. Is there any point in doing a biopsy (which sounds uncomfortable, if not outright painful), if we're pretty much planning a hysterectomy? The radiologist didn't think so, as they would biopsy the uterus afterwards anyways.

2. I saw a video online interviewing a doctor who says that your ovaries "atrophy" after a hysterectomy. Is that true, and why would that happen? There is no plan to remove my ovaries, but am I risking bringing on hormonal problems with this, even so?

3. I believe the plan for me is a laparoscopic procedure -- what, in your experience, is the recovery time before you can be lifting and moving around normally? I have horses and their daily care is physically demanding.

4. How long do they typically keep you in the hospital for this type of procedure?

5. I had my tubes tied several years ago and didn't fare too badly with that. Wondering how much more of a "big deal" I can expect this to be in terms of pain, recovery, etc.

THANK YOU, SISTERS!

Hi! First of all, There is incredible information on this site. I had to get a biopsy for my fibroids even though I was told there was a 99% chance they weren't cancer. My doc said she didn't want any surprises so I think that is pretty standard. I'm not eligible for the DiVinci. I can't answer any of your other questions but I'm sure the other sisters can! Good luck!

Hi...new here also. TVH/LSO next month and i just had an endometrial bx yesterday. Dr said standard protocol before surgery to check for precancerous cells. I don't have fibroids so not sure if this is helpful to you....also, the Bx was just a bit uncomfortable. Good luck to you

Hi,
I am scheduled to have a laparoscopic hyster March 5 because of fibroids. I was told the biopsy was necessary becasue the laser would remove the uterus in sections and they wouldn't want to cut & spread cancer cells. I am sure he said it in a more professional manner, but that is why i understand the biopsy is standard and necessary. And it did hurt, if i wouldn't have checked this site that morning before the procedure i woiuldn't have been prepared for pain. Motrin helped a little.

It sounds like fibroids are the root of all your issues. They are very common, can grow to be very large and are usually benign. They can be treated without having to have a hysterectomy, though they often come back.

I had an endometrial biopsy over the summer. I read too much on the internet from women who had horrible experiences. I was so worked up I cancelled my first appointment. When I did go in, my doctor advised me to take 800 mg of ibuprofen about 30-45 minutes before. It was definitely not as bad as I thought. Don't get me wrong, it was uncomfortable (sharp & crampy poking), but it was pretty quick. In my opinion, if you decide you're going to have the hysterectomy soon, I wouldn't do it. The biopsies will be done after surgery.

2. There are lots of sisters here who experienced "sleepy" ovaries after their hysterectomies, but they do "wake up" and start working again after the shock wears off. I had an RSO in March 2011 and I didn't have any issues while my left ovary was learning to take over. If your ovaries are healthy, I wouldn't remove them.

3. I had a DaVinci hysterectomy & LSO done on January 9th. I thought after having two previous laparoscopic procedures done on my ovaries that it would be like that...a 2 week recovery and then I would be back to normal life. However, while I did feel pretty good and have an easy recovery, it definitely has taken longer to feel normal than I thought. The worst pain/discomfort was during the 1st week, but I was still sore to the touch into the 3rd week. I was able to do light housework, like making meals, washing dishes, emptying the dishwasher, cleaning the bathrooms and dusting after the first week, but stayed away from sweeping, mopping and vacuuming until just recently. My restrictions when I left the hospital were steps only once a day for the first week, twice for the second and then as I saw fit, no lifting over 10 lbs, no intercourse, no baths, no driving for 4 weeks (though I called and got cleared at 2 weeks), no exercising and no sweeping/vacuuming.

4. I stayed in the hospital overnight. They would have let me go home the same day if I really wanted to, but I had trouble peeing after the cath was removed and was really nauseous. For procedures where they need to make an abdominal incision, you could be there for 1-4 days.

5. This is a much bigger deal than having your tubes tied. See my response to #3. You have to be prepared mentally that this is major surgery and it will take 4-6 weeks.

Hope that gives you some answers...I know its a lot. Also, you should get a second opinion from another ob/gyn, especially if you're not comfortable with the information that you have received so far. Best of luck to you and keep looking on the forums here. There's lots of information that will help you make the best decision for you.

Not only did I have to have a biposy, I had to have a colpscopy before my hysterectomy. The reason was, if cancer cells showed up (I had pre-cancerous cells show up on my pap) the hysterectomy would have been a radical hysterectomy opening me up through the abdomen rather that the LAVH I did have.

I was in the beginnings of menopause before surgery (having some hot flashes) and that continued after surgery- finally put me on 1 mg of estrogen which has helped.

The LAVH was a good experience for me. I had 3 tiny incisions on my tummy which never bothered me a bit. I was sore "down there" for awhile but it passed. I spent 2 nights in hospital as I had some trouble with post op pain and nausea.

This surgery took a lot out of me. I was very very tired- just having a shower made me go back to bed! I truly thought I was going to be raring to go back to work and life after 4 weeks but it was 6 weeks off work and even then I was exhausted. I wasn't completely healed at my 6 week post op check so the surgeon tacked another 3 weeks on before any type of intimacy ect. I'm now at 16+ weeks post op and feel pretty darned good most days. Still have weird twinges and pains occasionally but all the pre-op pain I was having from the fibroids is gone! Haven't had a period since Sept, don't miss that at all!

You will hear it said here and my surgeon told me, a full year before recovery is complete. It's a big surgery and everyone heals differently.

I also agree that I'd get a second opinion- you want to have a good rapport with your surgeon.