Uterine Fibroids: When to Consider Hysterectomy

Fibroids and Hysterectomy Issues

I am 42 years old and unmarried.
About eight years ago, I underwent a myomectomy due to fibroids causing urinary obstruction, during which one 8 cm fibroid and one 5 cm fibroid, along with some smaller ones, were removed.
I returned for follow-up two years later and found that two new fibroids had developed.
On my family's suggestion, I consulted a traditional Chinese medicine practitioner, and subsequent follow-ups indicated that their growth seemed to be suppressed.
I have intermittently continued to see the traditional Chinese medicine practitioner and have regular follow-ups every three to six months.
Over these eight years, I have observed that whenever I take Western medication, receive dental anesthesia, or mistakenly consume certain Chinese herbal medicines for treatment, the fibroids noticeably enlarge or new ones develop.
Additionally, I have other health issues, and treatments for those have led to increased urinary frequency.
Sometimes, I experience sudden urges that are difficult to control, almost leading to incontinence, especially before my menstrual period when the fibroids tend to grow.
Before menopause, I believe I will need to undergo another surgery to address the problems caused by the fibroids.
Living with these fibroids for eight years has been exhausting, and I am uncertain about when I will need surgery.
I want to take advantage of my early forties when my body is still relatively resilient, and my parents are not too old yet, as I feel I should be the one taking care of them rather than the other way around.
I am considering directly undergoing a hysterectomy (removing only the uterus while preserving other organs).
Currently, I have three fibroids larger than 3.5 cm and several smaller ones.
I am unsure if the doctor will agree to perform the surgery.
Additionally, I wonder if my body will weaken quickly after the surgery or if I will age rapidly.
Are there any other solutions? Thank you, doctor, for patiently reading my concerns.

Han Zhu, 40~49 year old female. Ask Date: 2018/04/01

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, your fibroid is not very large.
If some of your symptoms are indeed related to the fibroid, I recommend considering surgery sooner rather than later; otherwise, we can just monitor it for now.
Wishing you good health.

Reply Date: 2018/04/01

More Info

When considering a hysterectomy for uterine fibroids, especially in your case where you have a history of fibroid-related complications, it’s essential to weigh the benefits and risks carefully. Uterine fibroids, which are benign tumors of the uterus, can cause various symptoms, including pressure on the bladder leading to urinary issues, heavy menstrual bleeding, and pelvic pain. Given your experience with fibroids over the past eight years, it seems you have been managing them with a combination of surgical interventions and traditional Chinese medicine, but the recurrence and growth of new fibroids have understandably caused you distress.

When to Consider Hysterectomy
1. Severity of Symptoms: If your fibroids are causing significant symptoms that affect your quality of life—such as frequent urination, urinary urgency, and pelvic pain—this is a strong indication for considering a hysterectomy. You mentioned that the fibroids are causing you to experience near-leakage of urine and other discomforts, which suggests that the fibroids are impacting your daily activities.

2. Size and Number of Fibroids: You currently have multiple fibroids, with some measuring over 3.5 cm. Larger fibroids are more likely to cause symptoms, and the presence of multiple fibroids can complicate treatment options. If your healthcare provider believes that the fibroids are unlikely to respond to other treatments and are likely to continue growing, a hysterectomy might be recommended.

3. Ineffectiveness of Other Treatments: Since you have tried various treatments, including medication and traditional remedies, and have seen limited success, this could be a factor in deciding to proceed with a hysterectomy. If conservative measures are not managing your symptoms effectively, surgical intervention may be warranted.

4. Desire for Future Fertility: Since you are currently unmarried and may consider future family planning, it’s crucial to discuss your reproductive goals with your healthcare provider. A hysterectomy would eliminate the possibility of pregnancy, so if this is a consideration for you, it may influence your decision.

Concerns About Hysterectomy
- Recovery and Health Post-Surgery: Many women worry about how their bodies will change after a hysterectomy. While it is true that the surgery can lead to hormonal changes, especially if the ovaries are removed, many women report relief from fibroid symptoms and improved quality of life post-surgery. Recovery times vary, but many women return to normal activities within a few weeks.

- Aging and Health: There is a common misconception that hysterectomy accelerates aging. However, the surgery itself does not cause aging; rather, it alleviates the symptoms that may have made you feel older due to chronic pain or discomfort. Post-operative care and lifestyle choices play a significant role in your overall health and well-being.

Alternative Solutions
If you are hesitant about a hysterectomy, you could consider other options such as:
- Uterine Artery Embolization (UAE): This is a minimally invasive procedure that cuts off blood supply to the fibroids, causing them to shrink. It can be effective for women who want to preserve their uterus.

- Myomectomy: This is a surgical procedure to remove fibroids while leaving the uterus intact. It may be suitable if you wish to retain your fertility.

- Medications: Hormonal treatments can sometimes help manage symptoms, although you mentioned that medications have led to increased fibroid growth in your case.

Conclusion
Ultimately, the decision to undergo a hysterectomy should be made in consultation with your healthcare provider, who can assess your specific situation, discuss the potential risks and benefits, and help you make an informed choice. It’s important to express all your concerns and preferences during your consultation to ensure that the treatment plan aligns with your health goals and lifestyle.

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