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Post-forty = automatic hysterectomy?

Hi Dr. Parker,

I am a forty-five year old woman with multiple fibroids, one of which is larger than 8 cm and high up in the uterus (below the belly button).  I have only very mild symptoms.

My GP referred me to a gynecologist who, after going quickly through all treatment options, told me that for women over forty she only recommends hysterectomy because they do not need their uterus anymore and in my case since I had not had any children, my vagina would be too tight for a laparoscopic or vaginal hysterectomy. An abdominal hysterectomy would be the only treatment she would recommend.

She gave this recommendation without feeling the fibroid position, without scans and without asking whether I had any symptoms. When I told her that I did not want a hysterectomy, she told me that a large fibroid might block my kidneys.

I thought that the position that women over forty were automatically hysterectomy candidates was no longer accepted. Am I correct in my sense that there is something not quite right going on here? What treatment options are there for a woman of my age?  What is the chance that a fibroid this size and in this position could affect my kidneys?

Thank you very much for an enormously helpful website.

T.P.

You are absolutely right and you should get a second opinion from someone who takes care of women with fibroids on a regular basis and is skilled at other options.  While blockage of the ureters has been reported rarely in the medical literature, I have never seen this happen in 31 years of practice.  Also, a kidney ultrasound can detect this before it becomes worrisome.

Your treatment options should include: no treatment unless your symptoms become bothersome; myomectomy, either laparoscopic or abdominal depending on the sizes and positions of the other fibroids; embolization; or focused ultrasound (results do not appear to be as good).  If you wished to have a hysterectomy, laparoscopic hysterectomy can often be performed by someone skilled in this procedure.

I hope this is helpful,

Bill Parker, MD

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

4 Comments

  1. Jacqueline Whyte
    Posted November 23, 2009 at 8:31 am | Permalink

    Hi Dr Parker, I have recently been diagnosed with multiple fibroids, the largest being about 4cm. I have recently experienced seriously heavy bleeding during my periods, but I am terrified about being told my only option is to have a hysterectomy. I am 45 years old and even though I am considered past child bearing age, I am reluctant to agree to such drastic actions. Realistically what are my options – and can diet and supplements really help reduce fibroids.
    Thanks
    Jacquie

  2. dee
    Posted November 24, 2009 at 11:39 am | Permalink

    I have been doing research to try to avoid a hysterectomy and really took comfort in the information on your website. I noticed that I have only been given one option by three different Dr.s in my area and finally [after a discussion with a friend] discovered a commonality. I am recently unemployed and my health insurance changed from one through my employer to a state program. I have two adult children and two younger ones at home and am over 44. At first I thought it was odd, but them several of my colleagues shared experiences with me where they were given options I was not given, offered treatments I was not made aware of and one, referred to another specialist by the same Dr. that examined me because “her’s was so large.” My fibroid is about the size of 26 wk gestation and was told because of the size there was nothing that could be done. Do you often see this bias in California? Can you recommend a physician in the Washington, DC area who is a specialist in fibroid treatment that will share all options regardless of the name of my insurance and allow me to make my decision?

  3. Posted December 1, 2009 at 11:05 pm | Permalink

    Jacquie,

    Myomectomy can certainly be done no matter what the sizes or number of fibroids are present. Submucous fibroids, fibroids that are bulging into the uterine cavity, can often be removed by hysteroscopic myomectomy as an outpatient and a 2 day recovery. See: http://www.fibroidsecondopinion.com/hysteroscopic-myomectomy/

    Intramural (within the wall) or subserous (growing outwardly) do not cause heavy bleeding and may not need to be removed at all. If they are causing other symptoms, then laparoscopic or abdominal myomectomy can be performed depending on their sizes and number.

    You should consider getting a second opinion with a gynecologist who treats a lot of women with fibroids.

    Bill Parker, MD

  4. Margarett
    Posted December 18, 2009 at 4:22 pm | Permalink

    I was recently diagnosed with intramural fibroids, the largest 21cm x 15cm x 14cm. I was told that due to the size/position (top of uterus) a horizontal incision is impossible and I will have a long vertical scar down my middle. A myomectomy has been discouraged and a hysterectomy recommended due to my age, 44 (given a 1% possibility of pregnancy), and the possible recurrence (25%) of new fibroids. I have no children though I would like to keep that option open. I am concerned that a hysterectomy seems to be the only option and if I opt for it, I will have a long vertical scar.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in San Diego, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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