Do You Really Need a Hysterectomy for Uterine Fibroids?

Is a hysterectomy always necessary for uterine fibroids?

My mother is nearly 50 years old and has recently experienced intermenstrual bleeding, although the amount is not significant.
For her health, she visited the obstetrics and gynecology department at a local regional hospital, where the doctor diagnosed her with a uterine fibroid measuring approximately 6.6 cm and recommended surgery.
Later, she consulted another medical center, where the doctor stated that it could not be confirmed whether it was a fibroid and that they would only know after surgery.
The doctor also suggested whether she should consider a hysterectomy to prevent potential future issues related to cervical or other gynecological conditions.

If the uterus is removed, does that truly eliminate the risk of such conditions? If only the fibroid is removed, what is the likelihood of recurrence? Are there any side effects associated with these procedures?

Xiao Mi, 20~29 year old female. Ask Date: 2006/12/21

Dr. Xu Junzheng reply Obstetrics and Gynecology

Uterine fibroids are benign tumors, and the decision to undergo surgery is primarily guided by the patient.
Thank you!

Reply Date: 2006/12/21

More Info

When it comes to the management of uterine fibroids, the decision to undergo a hysterectomy (the surgical removal of the uterus) is a significant one and should be made after careful consideration of various factors. Uterine fibroids, which are non-cancerous growths in the uterus, can cause a range of symptoms, including heavy menstrual bleeding, pelvic pain, and, as you mentioned, abnormal bleeding outside of the menstrual cycle.
In your mother's case, the recommendation for surgery was based on the size of the fibroid (approximately 6.6 cm) and the presence of abnormal bleeding. It's important to note that while many women with fibroids experience no symptoms and do not require treatment, those who do have significant symptoms may benefit from surgical intervention.

Hysterectomy vs. Myomectomy
1. Hysterectomy: This procedure involves the complete removal of the uterus and is often recommended for women who have severe symptoms, are nearing menopause, or have other conditions such as endometriosis or adenomyosis. The advantages of a hysterectomy include the elimination of fibroids and the prevention of future fibroid development, as well as the resolution of related symptoms. However, it also leads to the loss of fertility and can have hormonal implications, especially if the ovaries are also removed.

2. Myomectomy: This is a surgical procedure specifically aimed at removing fibroids while preserving the uterus. This option is often preferred for women who wish to maintain their fertility. The recurrence rate of fibroids after myomectomy can vary, with studies suggesting that about 15-30% of women may experience new fibroids within five years. However, many women find significant relief from symptoms after this procedure.

Considerations for Surgery
- Symptoms: If your mother’s symptoms are manageable and not significantly affecting her quality of life, a watchful waiting approach may be appropriate. Regular monitoring through ultrasound can help track the fibroid's growth and any changes in symptoms.

- Age and Menopause: Given that your mother is approaching 50, she may be nearing menopause, a natural transition that often leads to a decrease in fibroid size and symptoms. This factor can influence the decision to pursue surgery.

- Risks and Side Effects: Both hysterectomy and myomectomy come with risks, including infection, bleeding, and complications related to anesthesia. Hysterectomy also carries risks of hormonal changes, especially if the ovaries are removed, which can lead to menopausal symptoms.

- Second Opinions: It’s wise to seek multiple opinions, as you have done. Different physicians may have varying approaches based on their experiences and the latest research.

Conclusion
Ultimately, the decision to proceed with a hysterectomy or to consider myomectomy should be made collaboratively between your mother and her healthcare providers, taking into account her symptoms, overall health, and personal preferences regarding fertility and quality of life. It’s essential to have a thorough discussion about the risks, benefits, and potential outcomes of each option. If your mother is uncertain, asking for a referral to a specialist in fibroid management or a reproductive endocrinologist may provide additional insights and options tailored to her specific situation.

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