QuestionI am the 44 year old grandma of two who tried to have a thermablation in the gyn office, but failed due to a closed cerivx. My gyn tried again in the OR aided by hysteroscopy but still could not due to a large fibroid that "completely obliterated" his view of my uterus and tubes. I also have a 5cm pendunculated fibroid on top of my uterus which has caused my uterus to be retroflexed. A
hysterectomy is looking more and more appealing everyday!!
I am due to see him in 2 weeks so he can discuss my options. Would laparascopic hysterectomy work with the large fibroid?
AnswerDear Karen,
Sorry about the delay in answering - I am actually supposed to be on vacation from 12/21 through 1/6, but the system apparently did not set correctly. I happened to check in to make sure and saw there were 3-4 days worth of questions, so I will attempt some very brief answers while I have a house full of company pulling me in a thousand different directions!! :-)
Fibroids are actually quite common - between 50% and 80% of all women have at least one. For the most part, these fibroids cause no symptoms, though they can be problematic for about 20% of women. Uterine fibroids are tumors or growths, made up of muscle cells and other tissues that grow within the wall of the uterus (or womb). Although fibroids are sometimes called tumors, they are almost always benign (not cancerous). They are the most common, benign tumors in women of childbearing age, but no one knows exactly what causes them. Causes could be hormonal (affected by estrogen levels), genetic (running in families), environmental, or a combination of all three. Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. For the most part, fibroids stop growing or shrink after menopause. However, this is not true for all women with fibroids.
They can be frustrating to live with when they cause symptoms. Not all women with fibroids have symptoms, but some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination.
The only absolute CURE for uterine fibroids would be a hysterectomy. Otherwise, if you are prone to them, even after alternative treatments, they may grow back. The Maine Women's Health Study found that, following hysterectomy for moderate or severe non life-threatening symptoms, 72% of women felt "much better", another 16% felt a "little better" and 3% of the women felt worse than they did before surgery. Only 3% of the patients reported negative feelings about themselves as women as a result of having had a hysterectomy. However, at the time of the study, alternative treatments such as endometrial ablation, hysteroscopic, laparoscopic or abdominal myomectomy, uterine artery embolization, or focused ultrasound were not available or the gynecologists were not using these procedures. Hysterectomy may be determined to be the best option for a woman who has multiple fibroids, or very large fibroids, and who does not want to take a chance that another surgery may be needed for fibroids at a later time. However, a hysterectomy should be an option for women who have fibroids only when fertility is not an issue, only when other options have been tried, only when you are emotionally prepared, and only as a last resort.
Laparoscopic hysterectomy, and either leaving (supracervical hysterectomy) or removing the cervix (total hysterectomy), can often be performed for women who have fibroids. This has the benefit of less pain, a shorter hospital stay and a faster recovery than with an abdominal hysterectomy. With experienced doctors, women who have large fibroids can usually also benefit from a laparoscopic hysterectomy. For patients who have fibroids that are large and might otherwise be difficult to remove by vaginal hysterectomy, laparoscopic hysterectomy allows the surgeon to detach the blood vessels to the uterus while viewing them through the laparoscope. Laparoscopic hysterectomy does require extra training and experience on the part of the surgeon.
I guess that wasn't so brief, huh? I hope that helped you and answers your question. I wish you well and a Happy New Year.
Brenda
