Uterine Fibroids: Should You Remove the Uterus and Ovaries?

Uterine fibroids

Hello Dr.
Lu, I have a uterine fibroid that is 9.9 cm and is pressing on my bladder, causing frequent urination.
I initially planned to wait for menopause for it to shrink, but since I still have monthly menstruation, I have decided to have it removed.
The doctor believes that at my age, it may be advisable to consider a total hysterectomy, including the removal of the ovaries.
I am concerned that my body or physical condition may deteriorate after the surgery.
I would like to ask Dr.
Lu if it is necessary to remove the uterus, cervix, and fallopian tubes along with the fibroid? Why is the removal of the fallopian tubes also recommended?

Pi Niu, 50~59 year old female. Ask Date: 2015/07/01

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
From the perspective of the surgical procedure, if the fibroids are removed along with the uterus, only a hysterectomy needs to be performed.
This process is relatively straightforward, involves less blood loss, and has a shorter operation time.
Therefore, the physician may recommend removing the fibroids along with the uterus.
If only the fibroids are removed, a different procedure called myomectomy is required, which involves separating the fibroids from the uterus.
This separation process tends to result in more blood loss and a longer surgery duration.
Of course, if you insist on undergoing a myomectomy, it is still possible, especially for those who wish to preserve their ability to conceive, as they want to keep the uterus.
Some individuals also view the uterus as an important symbol of femininity and prefer to retain it.
The key is to communicate your thoughts with the surgeon and find a surgical approach that is acceptable to both parties.
2.
The cervix can be removed along with the uterus, making the surgical execution easier and significantly reducing the future risk of cervical cancer.
Therefore, many physicians recommend this approach.
However, some physicians believe that preserving the cervix provides better support for the bladder, reducing the likelihood of bladder prolapse.
Thus, you may also choose not to have the cervix removed; this is feasible surgically.
The important thing is to communicate your thoughts with the surgeon and find a surgical method that is mutually acceptable.
3.
Some physicians recommend removing the fallopian tubes as well, arguing that it can decrease the future risk of developing tumors in the fallopian tubes.
However, since fallopian tube tumors are quite rare, I personally believe that it may not be necessary to remove the fallopian tubes.
4.
Therefore, communication with the surgeon is crucial, and it is best to reach a consensus.
If a consensus cannot be achieved, you may need to seek another physician who agrees with your perspective.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/07/01

More Info

When considering the management of uterine fibroids, particularly in cases where they are large (like your 9.9 cm fibroid) and causing symptoms such as urinary frequency due to pressure on the bladder, it is essential to weigh the benefits and risks of surgical intervention. In your situation, the recommendation to consider a hysterectomy (removal of the uterus) along with the ovaries and possibly the fallopian tubes is based on several factors.

Firstly, uterine fibroids are benign tumors of the uterus that can cause a variety of symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms like frequent urination. If the fibroid is significantly large and symptomatic, surgical removal may be warranted. A hysterectomy can provide definitive relief from these symptoms, as it removes the source of the problem.

The decision to remove the ovaries and fallopian tubes along with the uterus is often influenced by the patient's age, the size and number of fibroids, and the presence of any other gynecological conditions. In women approaching menopause, some surgeons may recommend oophorectomy (removal of the ovaries) to prevent the development of ovarian cancer and to eliminate the hormonal stimulation that can contribute to fibroid growth. However, this decision should be made carefully, as removing the ovaries will lead to immediate menopause, which can have significant implications for your health, including the risk of osteoporosis and cardiovascular disease.

Regarding the fallopian tubes, recent studies have suggested that removing them during a hysterectomy may reduce the risk of ovarian cancer. This is particularly relevant for women with a family history of ovarian cancer or other risk factors. The rationale is that many ovarian cancers may originate in the fallopian tubes, so their removal could be a preventive measure.

You expressed concern about how your body and energy levels might be affected post-surgery. It is common for patients to worry about changes in their physical health after such a significant procedure. While some women report feeling fatigued or experiencing changes in their body image and hormonal balance after a hysterectomy, many also find relief from the symptoms that prompted the surgery. Recovery can vary widely among individuals, and it is crucial to have a thorough discussion with your healthcare provider about what to expect in terms of recovery, potential hormonal therapy (if ovaries are removed), and lifestyle adjustments.

In summary, the decision to remove the uterus, ovaries, and fallopian tubes should be based on a comprehensive evaluation of your symptoms, the size and impact of the fibroids, and your personal health history. It is essential to have an open dialogue with your healthcare provider about your concerns and preferences, as well as to discuss the potential benefits and risks associated with each surgical option. This will help you make an informed decision that aligns with your health goals and lifestyle.

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