Uterine Prolapse & Fibroids: Understanding Your Options

Question
I'm 44, have had three children vaginally, and now have problematic uterine fibroids that are causing bleeding nearly every day. My family doc referred me to a specialist, who's recommending a hysterectomy as my best option. I've done my research, and believe this is the case. One thing both of my doctors mentioned has me puzzled. Upon doing a physical exam, they both mentioned that my cervix was difficult to locate and the uterus was not in the normal position. The specialist said it was more posterior(?) than it should be. This has never been mentioned before in all my years of having babies and GYN exams, so I'm assuming this is a recent change. But neither doc seemed concerned about it, just mentioned it rather casually. I'm curious. Could my fibroids be responsible for pushing the uterus back (I don't have any huge ones, but multiple small ones)? I don't see my surgeon again until next week to talk about the hysterectomy in more detail and what to expect, so I'd like to know from a second source if the position of my uterus might make the surgery more difficult or more likely to cause complications. Thanks so much for your help!

Mia  

Answer
I don't know how large your fibroids are, or where in the uterus they are located. However, it is certainly possible for the fibroids to change the shape of the uterus and cause the cervix to change position. It can be further back in the vagina or up under the symphysis pubis and that would make it difficult to locate.At the age of 44, we no longer remove ovaries at the time of hysterectomy for benign disease (as fibroids are). We used to remove the ovaries of any women over 45 years of age to avoid the possibility of the ovarian cancer in the future. However, there is more risk of cardiovascular disease by removing the ovaries, so now they do not have to be removed at your age. The position of the cervix will not make the hysterectomy more difficult. Discuss with the gyn surgeon the alternatives in surgery between total abdominal hysterectomy and supracervical hysterectomy. If your cervix is left in place, you have less bleeding and a quicker recovery.