Do You Need a Hysterectomy for Fibroids?

I believe hysterectomy for uterine fibroids should be performed as a last resort. Hysterectomy is a major operation and carries with it risks of infection, injury to other organs, anesthetic complications, and blood loss that can sometimes result in the need for transfusion. While complications are uncommon, they should not be taken lightly. Recovery from abdominal hysterectomy takes four to six weeks, recovery from vaginal hysterectomy takes about three to four weeks, and recovery from laparoscopic hysterectomy takes about two weeks. The cost of surgery is expensive, including doctors' fees, anesthesia fees, hospital charges, and operating room charges. In addition, there is the cost of time away from work or family. It's preferable to avoid major surgery if possible.

However, women with bothersome symptoms that affect their lives and who have not been helped by other treatment may benefit from hysterectomy. 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. As these and other new developments are learned by gynecologists and become more widely available, it is hoped that hysterectomy as treatment for fibroids will become less common.

Hysterectomy has one positive attribute as a treatment for fibroids; since the entire uterus is removed, the possibility of new fibroids growing back is eliminated. However, with myomectomy the likelihood of requiring surgery for fibroids a second time is very low and gets lower as you get older. For women who have symptoms from fibroids that require treatment and who do not wish to maintain their fertility, removal of the uterus may be discussed as one possible option. Hysterectomy may be appropriate 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. Hysterectomy can be an option for women who have fibroids, but only when fertility is not an issue, when other options have been tried, when you are emotionally prepared, only as a last resort.

It is important to remember that hysterectomy means removal of the uterus only, not including the ovaries and tubes. The medical word for removal of the ovaries and tubes is salpingo-oophorectomy. The issues regarding whether your ovaries should or should not be removed are also discussed at http://www.parkermd.com/about-hysterectomy.htm and http://www.ovaryresearch.com/.

Can Laparoscopic Hysterectomy Be Used to Treat Fibroids?
Laparoscopic hysterectomy, and either leaving (supracervical hysterectomy) or removing the cervix (total hysterectomy), can often be performed for women who have fibroids, with the benefits of less pain, shorter hospital stay and faster recovery than with abdominal hysterectomy. In experienced hands, women who have large fibroids can also benefit from laparoscopic hysterectomy. For more about laparoscopic hysterectomy, please see: http://www.parkermd.com/about-hysterectomy.htm

Reference List  

1. Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain. Obstet Gynecol 1994;83:566-72.