Uterine Fibroids: Surgical Options and Risks for Women Over 40

Uterine fibroids

Hello, doctor.
My younger sister is 41 years old, unmarried, and has never had children.
Recently, she was diagnosed with a uterine fibroid measuring approximately 8 cm, accompanied by periodic pain.
The doctor has recommended surgery.
Should she opt for tumor removal or a hysterectomy? (She does not plan to marry or have children.) What are the risks and potential complications associated with each type of surgery? Thank you.

DJKFJ, 40~49 year old female. Ask Date: 2015/12/20

Dr. Lin Wenbin reply Obstetrics and Gynecology

Please go to the hospital for an examination.
In addition to surgery, there are now medications available to treat uterine fibroids.
Treatment options should be discussed based on individual circumstances.

Reply Date: 2015/12/20

More Info

When considering surgical options for uterine fibroids in women over 40, particularly for a 41-year-old woman who has been diagnosed with an 8 cm fibroid and experiences periodic pain, it is essential to weigh the benefits and risks of both myomectomy (removal of the fibroid) and hysterectomy (removal of the uterus). Given that she does not plan to marry or have children, the decision may lean more towards a hysterectomy, but it is crucial to understand the implications of both procedures.

Myomectomy is a surgical procedure that removes fibroids while preserving the uterus. This option is often preferred for women who wish to retain their fertility. However, in this case, since the patient does not intend to have children, the necessity of preserving the uterus may be less critical. The risks associated with myomectomy include:
1. Recurrence of Fibroids: There is a possibility that new fibroids may develop after the surgery, which could lead to further complications or the need for additional surgeries.

2. Surgical Risks: As with any surgery, there are risks of bleeding, infection, and complications related to anesthesia.

3. Uterine Scarring: Myomectomy can lead to scarring within the uterus, which may affect future pregnancies if they were to occur.

4. Pain and Recovery: Recovery from a myomectomy can be significant, and there may be postoperative pain and discomfort.

On the other hand, hysterectomy involves the complete removal of the uterus and is often recommended for women who have significant symptoms from fibroids, especially when they are not planning to conceive. The benefits of a hysterectomy include:
1. Elimination of Symptoms: A hysterectomy can provide immediate relief from symptoms such as heavy menstrual bleeding, pelvic pain, and pressure symptoms associated with fibroids.

2. No Risk of Recurrence: Since the uterus is removed, there is no risk of fibroid recurrence.

3. Long-term Solution: For women over 40, a hysterectomy can be a long-term solution, especially as they approach menopause.

However, there are also risks and potential complications associated with hysterectomy:
1. Surgical Risks: Similar to myomectomy, there are risks of bleeding, infection, and complications from anesthesia.

2. Hormonal Changes: If the ovaries are removed during the procedure (oophorectomy), this can lead to immediate menopause and associated symptoms such as hot flashes, mood changes, and increased risk of osteoporosis.

3. Psychological Impact: Some women may experience emotional or psychological effects after losing their uterus, which can be significant for some individuals.

4. Changes in Sexual Function: While many women report no change in sexual function after hysterectomy, some may experience changes in libido or vaginal dryness.

In conclusion, the decision between myomectomy and hysterectomy should be made after thorough discussions with a healthcare provider, considering the patient's symptoms, future reproductive plans, and overall health. Given that the patient is not planning to have children, a hysterectomy may be the more appropriate option, particularly if her symptoms are severe and impacting her quality of life. It is essential to discuss all potential risks, benefits, and postoperative care with her physician to make an informed decision that aligns with her health goals and lifestyle.

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