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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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