Surgery vs. Monitoring: Weighing Risks for Uterine Fibroids and Endometriosis

What are the risks of surgery versus not having surgery?

At 47 years old, I have a uterine fibroid on the right side measuring approximately 10 cm and a chocolate cyst on the left side measuring about 8 cm.
My menstrual cycle and bleeding volume are normal, and I do not experience severe dysmenorrhea.
I have never given birth and do not plan to become pregnant.
I have been following up with a gynecologist who mentioned that the decision to undergo surgery is up to me.
I would like to know what risks are associated with choosing surgery, and what risks might arise from opting for regular monitoring.
What examinations should be conducted to further assess these risks?

Xiao Yu, 40~49 year old female. Ask Date: 2017/07/25

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if there are no discomforts, you may consider monitoring and follow-up for the time being.
Wishing you good health.

Reply Date: 2017/07/25

More Info

When considering the management of uterine fibroids and endometriosis, particularly in a 47-year-old woman with a 10 cm fibroid and an 8 cm chocolate cyst (endometrioma), it is essential to weigh the risks and benefits of surgical intervention versus monitoring.

Surgical Risks
If you opt for surgery, particularly a myomectomy (removal of fibroids) or a laparoscopic procedure to address the endometrioma, there are several potential risks to consider:
1. Anesthesia Risks: General anesthesia carries risks such as allergic reactions, respiratory complications, and cardiovascular issues, especially in older patients or those with pre-existing conditions.

2. Infection: Any surgical procedure carries a risk of infection, which can complicate recovery and may require additional treatment.

3. Bleeding: There is a risk of significant bleeding during or after surgery, which may necessitate blood transfusions or further surgical interventions.

4. Damage to Surrounding Organs: Surgical procedures in the pelvic area can inadvertently damage surrounding organs, such as the bladder, ureters, or intestines, leading to complications that may require additional surgeries.

5. Adhesions: Surgery can lead to the formation of scar tissue (adhesions), which may cause pain or complications in the future.

6. Impact on Fertility: Although you mentioned no plans for pregnancy, it is worth noting that surgical interventions can sometimes affect future fertility, depending on the extent of the surgery and any complications that arise.

Risks of Monitoring
Choosing to monitor the fibroids and endometriosis instead of undergoing surgery also comes with its own set of risks:
1. Growth of Fibroids: Fibroids can continue to grow, potentially leading to increased symptoms such as pelvic pain, pressure, or changes in menstrual patterns.

2. Complications from Endometriosis: Endometriosis can lead to chronic pain, infertility, and other complications if left untreated. The chocolate cyst may also rupture, leading to acute pain and potential complications.

3. Psychological Impact: Living with untreated fibroids or endometriosis can lead to anxiety or stress, particularly if symptoms worsen over time.

4. Need for Future Surgery: If monitoring leads to a situation where surgery becomes necessary later, the risks may be higher due to potential complications from prolonged disease progression.

Monitoring and Assessments
Regardless of the path you choose, regular follow-up with your healthcare provider is crucial. Here are some assessments that can help evaluate your condition:
1. Pelvic Ultrasound: This imaging test can help monitor the size and characteristics of the fibroids and endometriomas over time.

2. MRI: An MRI can provide a more detailed view of the pelvic organs and help assess the extent of endometriosis.

3. CA-125 Blood Test: While not specific, elevated levels of CA-125 can indicate the presence of endometriosis or other pelvic conditions.

4. Symptom Tracking: Keeping a detailed record of your symptoms, including pain levels, menstrual changes, and any new symptoms, can help guide your decision-making process.

5. Regular Gynecological Exams: Routine check-ups with your gynecologist can help monitor any changes in your condition and allow for timely intervention if necessary.

Conclusion
Ultimately, the decision between surgery and monitoring should be made in collaboration with your healthcare provider, taking into account your personal health, symptoms, and preferences. It is essential to have an open discussion about the potential risks and benefits of each option, as well as any concerns you may have regarding your condition. Regular monitoring and follow-up will be key, regardless of the path you choose.

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