Authors: Spies JB, Bradley LD, Guido R, Maxwell GL, Levine BA, Coyne K.

Study From: Georgetown University Hospital, Cleveland Clinic, University of Pittsburgh, Walter Reed Army Medical Center, and United BioSource Inc.

Journal: Obstet Gynecol. 2010;116:641-52.

Problem: There are very few studies that measure how women feel after treatment for fibroids.

Study: Four medical centers collaborated to measure fibroid symptoms and quality-of- life both before and after hysterectomy, myomectomy, or uterine artery embolization (UAE) compared to each other and to women without fibroids.

Findings: 101 women without fibroids, 107 women having an embolization for fibroids, 61 having a myomectomy and 106 women having a hysterectomy for fibroids participated in the study. At the beginning of the study, the women filled out questionnaires asking about their level of activity, energy level, sexual function, pain, social functioning, general health and mental health. Women with fibroids scored much worse than women without fibroids.

With treatment, no women in any group died or had a permanent injury.

Six and 12 months later, questionnaires showed that, after any of the three fibroid treatments, most women felt as good as women without fibroids. At 12 months, women who had a hysterectomy had fewer symptoms (no bleeding) than women who had myomectomies or UAE.

Authors’ Conclusions: One year after treatment, all three fibroid treatments resulted in substantial symptom relief, to near normal levels, with the greatest improvement after hysterectomy. The authors felt this was because after hysterectomy women had no further bleeding.

Dr. Parker’s Comments: UAE, myomectomy and hysterectomy all make women feel better than before they had treatment and most women return to feeling normal. There were a few short-comings of the study, though. First, the study is a statistical analysis of groups of women and it is not possible to tell from the article if some women did not improve or had bothersome side-effects after treatment. Also, each woman chose her treatment and, therefore, might be inclined to score the questionnaires higher to support her choice. However, this is what happens in real life and if you feel better, who cares what the scientists think??

Study: Eighteen women, ages 31-49, who suffered from symptoms of fibroids and who had undergone a hysterectomy or myomectomy in the past 2 years were interviewed by the author. All of the women had further education or specialist professional training after high school.

Findings: Women choosing myomectomy believed the uterus had a purpose other than fertility. They were more likely to not trust their doctor’s recommendation to have a hysterectomy, and more likely to have sought out other gynecologists’ opinions. A similar number of male and female doctors suggested hysterectomy. Patients were more likely to have traveled to another area or state, and to pay some expenses out of pocket, in order to obtain myomectomy surgery.

Women who had a hysterectomy were more likely to have trusted what their regular gynecologist told them and had that doctor perform the surgery. Some of these women, in hindsight, felt that they should have sought out more information before having a hysterectomy. One reason women chose hysterectomy was because they believed their gynecologist’s comment that “the fibroids will just grow back” after a myomectomy.

Conclusions: The author concluded that women need to have access to more reliable information. “Information sources should include specialists other than one’s regular gynecologist, particularly if alternatives to hysterectomy are outside of the gynecologist’s preferences or areas of skill.” The internet played an important role for women accessing information.

Dr. Parker’s Comment: I think many women will identify with the points made in this study. I often see women for a second (or third, or fourth) opinion who have been told to have a hysterectomy based on uninformed or outdated information. Some doctors will not recommend a procedure they do not know how to do, or a procedure that may be more difficult for them to perform. Once fibroids are removed they do not “grow back” and the chance of new fibroids growing is very small.
See: http://www.fibroidsecondopinion.com/can-fibroids-grow/

If you are recommended to have a hysterectomy (or any surgical procedure) you should ask about alternatives available, and whether your doctor knows how to perform them or not. The internet, when used carefully, can be an excellent source of information.

Dear Dr Parker,

I am a forty year old female living in Australia and recently tests have shown that I have a very large fibroid growing on the Uterus Muscle. The fibroid is 17.5cm X 16.3cm X 6.8cm. I am worried that so far most have the notion that I would require a full hysterectomy in order to remove the mass. About four years ago I had GBS and now suffer from chronic fatigue and I am scared about having a hysterectomy. Have you removed fibroids this large from woman without the need of a full hysterectomy? I look forward to your reply…

Kind Regards

D.

D.

Yes, a fibroid this size can be removed by abdominal myomectomy with a bikini type incision. I have removed even larger fibroids this way. A hysterectomy is not necessary.

Bill Parker, MD

I was diagnosed with adenomyosis and my Dr. suggested to do a partial hysterctomy.. Is this the right thing to do.. I’m worried of what to feel after, if it will affect my sex life, will it really make a difference and if not what can happen if I don’t get the hysterectomy done?

Thank You,

N.

N.

The best way to diagnose adenomyosis is with MRI, so hopefully you have had this done to be sure. Unfortunately, hysterectomy is the only 100% cure for painful periods and irregular bleeding associated with adenomyosis. The progesterone IUD has about a 60% success rate and embolization has about a 50% success rate, so those are also options.

If you do not have a hysterectomy and other treatments fail, then you will continue to have whatever symptoms you have now. You can read more about hysterectomy and sexuality here: http://www.fibroidsecondopinion.com/hysterectomy-for-fibroids/ under the heading “Is There Any Benefit to Leaving the Cervix in Place?”

I hope this is helpful,
Bill Parker, MD

Dr. Parker’s Note: I have summarized most of the information from this paper in a new web page: Caring for Yourself After Surgery.

Authors: Minig, L; Trimble, E; Sarsotti, C; Sebastiani, M; Spong, C.

Journal: Obstetrics & Gynecology:  October 2009 – Volume 114, pp 892-900

Study from: National Institutes of Health, Bethesda, Maryland

Problem:  Following surgery, doctors give fairly standard instructions regarding what activities the patient can, and cannot, do.  Unfortunately, there is little science to back up these recommendations.

Study: The authors reviewed studies related to post-operative instructions from medical journals, medical textbooks in obstetrics, gynecology, and general surgery, the American College of Obstetricians and Gynecologists Practice Bulletins and Committee Opinions and clinical guidelines of Royal College of Obstetricians and Gynecologists of the United Kingdom in order to evaluate current recommendations.

Authors’ Conclusions: Resumption of usual activities after gynecologic surgery helps integrate women back into their normal life. Available data do not support many of the recommendations previously provided. Restrictions on lifting and climbing stairs should be reconsidered. Guidance on driving should focus on the concern about driving while using narcotic medications rather than concern about opening the wound. Much more study is needed to better define all the above issues.

Dr. Parker’s Comments: As the authors state in the introduction to the article, “recommendations for activity after discharge remain based on tradition and anecdote”.  To the authors’ credit, they investigated current recommendations and came up with little evidence to support what we usually tell women.

The authors suggest that the new recommendations be fully tested by scientific study, but since this is unlikely to happen soon (or ever), it is best to discuss the new recommendations with your doctor.

Patients are often each others’ best resource for finding and sharing information about recovery after surgery. I encourage you to post comments on this post if you have something helpful to share.