Should You Consider Hysterectomy for Uterine Fibroids?

Do uterine fibroids require a hysterectomy?

Hello Doctor: In 2011, I underwent a minor surgery to address a large uterine fibroid, which was successful.
However, since 2012, it has recurred, and medication has not alleviated the pain.
I would like to inquire whether I can undergo a hysterectomy or if there are other methods for a permanent solution.
I am also concerned about potential side effects.
My colleagues mentioned that it could lead to aging and psychological factors, which makes me anxious.
Therefore, I would like to ask the doctor: 1.
Should I consider this surgery? 2.
What are the potential side effects of the surgery? 3.
How many days will I need to stay in the hospital? 4.
How long is the recovery period? 5.
How should I take care of myself post-surgery? 6.
Is there a chance of recurrence after the surgery? Thank you for taking the time to address my concerns.
Thank you.

Aimee, 30~39 year old female. Ask Date: 2013/12/05

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
Generally, fibroids are mostly benign, so surgery is not absolutely necessary.
The reasons for treatment primarily focus on the symptoms caused by the fibroids, including pain, heavy menstrual bleeding, and urinary frequency due to bladder pressure.
Some individuals may opt for medication to manage symptoms, such as pain relievers, hormonal contraceptives (to regulate menstrual cycles), or progesterone.
To reduce menstrual bleeding, some may take uterotonics, others may use progesterone, and some may have an intrauterine device (IUD) that releases progesterone.
2.
Surgery is also an option.
It is not mandatory to undergo surgery simply because one has fibroids; rather, surgery is considered when the symptoms caused by the fibroids are intolerable, and medication is ineffective or if the patient prefers not to rely on medication.
Therefore, individuals can assess the severity and urgency of their condition.
Those with more severe symptoms or those needing prompt treatment may consider surgical intervention.
3.
Currently, laparoscopic hysterectomy or myomectomy is quite common.
After surgery, there will be three small incisions of about 1 cm on the abdominal surface.
Once healed, the scars are not very noticeable.
A small number of patients may experience adhesions, and very few may have injuries to the bladder or intestines, but these can be surgically repaired.
There is no risk of premature aging, so there is no need for concern.
4.
Typically, hospitalization lasts 3 to 6 days, depending on the individual's recovery speed.
5.
In the case of laparoscopic surgery, if the individual does not engage in heavy labor, they can usually return to normal activities shortly after discharge.
If traditional open surgery is performed, an additional two to three weeks of recovery time is required.
6.
Postoperatively, it is advisable to avoid lifting heavy objects.
7.
If a hysterectomy is performed, fibroids will not recur.
If only the fibroids are removed and the patient is nearing menopause, recurrence is generally unlikely.
However, if there are many years until menopause, the likelihood of recurrence is higher.
Respectfully,
Dr.
Li-Cheng Lu, Department of Obstetrics and Gynecology, Taoyuan General Hospital

Reply Date: 2013/12/05

More Info

When considering a hysterectomy for uterine fibroids, it is essential to weigh the benefits against the potential risks and complications associated with the procedure. Uterine fibroids, which are non-cancerous growths in the uterus, can cause a variety of symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms. If conservative treatments, such as medication, have not provided relief, a hysterectomy may be a viable option.

1. Should You Consider Hysterectomy?
A hysterectomy is often considered when fibroids are large, symptomatic, and not responsive to other treatments. Since you mentioned that your fibroids have recurred and medication has not alleviated your pain, a hysterectomy could provide a definitive solution by removing the source of your symptoms. However, it is crucial to discuss this with your healthcare provider, who can assess your specific situation, including the size and location of the fibroids, your overall health, and your personal preferences regarding fertility.

2. Potential Postoperative Complications:
Like any surgical procedure, a hysterectomy carries risks. Common complications include bleeding, infection, and damage to surrounding organs. Additionally, some women may experience hormonal changes, especially if the ovaries are removed during the procedure, which can lead to menopause symptoms. Concerns about aging or psychological impacts are valid; however, many women report relief from fibroid symptoms and improved quality of life post-surgery.

3. Hospital Stay Duration:
The length of hospital stay after a hysterectomy can vary depending on the surgical approach (abdominal, vaginal, or laparoscopic). Generally, a hospital stay can range from one to three days. Laparoscopic procedures often allow for shorter recovery times and hospital stays.

4. Recovery Time:
Recovery time also varies based on the surgical method. Vaginal and laparoscopic hysterectomies typically have shorter recovery periods, often allowing patients to return to normal activities within four to six weeks. In contrast, abdominal hysterectomies may require a recovery period of six to eight weeks.

5. Postoperative Care:
After surgery, it is essential to follow your doctor's instructions for care, which may include managing pain, avoiding heavy lifting, and gradually increasing activity levels. Attending follow-up appointments is crucial to monitor your recovery and address any concerns.

6. Risk of Recurrence:
A hysterectomy is considered a definitive treatment for fibroids, meaning that the fibroids themselves will not recur since the uterus is removed. However, if the ovaries are preserved, there is a possibility of developing new fibroids in the future, although this is less common.

In conclusion, a hysterectomy can be an effective solution for managing symptomatic uterine fibroids, particularly when other treatments have failed. It is essential to have an open discussion with your healthcare provider about your symptoms, treatment options, and any concerns you may have regarding the surgery and its aftermath. They can provide personalized advice based on your medical history and current health status. Remember, the decision to undergo surgery should be made collaboratively with your healthcare team, considering all factors involved.

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