“Which surgery is best for uterus removal?”
I am a 49 year old female and I keep forming fibroids in my uterus. Which surgery is best for uterus removal?
4 Answers
Laparoscopic surgery, may need to convert to open.
That all depends upon the size, number and location of the fibroids in your uterus. If your uterus is less than 16cm, it is possible to remove the uterus with the laparoscope and/or vaginally. There are some surgeons who are still using a morcellator to remove a large fibroid uterus, but this should be done with caution as complications have been reported. Get the
best surgeon you can find and discuss this with him or her.
Sincerely,
Dr. Janice Alexander, RN, MD
best surgeon you can find and discuss this with him or her.
Sincerely,
Dr. Janice Alexander, RN, MD
Dr. Victoria Mondloch
OB-GYN (Obstetrician-Gynecologist) | Gynecology
Your question is not an easy answer. But first, let me tell you that recurrent fibroids mean an Estradiol dominance; that means that you make a higher percentage of Estradiol (E) than the 2nd female hormone or Progesterone (P4). Having an E dominance helps stimulate fibroids to grow and stimulates the growth of new fibroids. Fibroids are also recurrent, usually within 2-3years if the E dominance doesn’t rebalance. The better chemical balance is to have a P4 dominance but most healthcare providers don’t follow your hormone levels so you wouldn’t know what your body chemistry was telling you.
Age 49 also has a significantly higher incidence of E dominance due to irregular periods and not ovulating each month which means you don’t make P4 if you don’t ovulate. Age 49 usually means 1 year away from average age of menopause (age 50); this year before menopause, or perimenopause is known for it’s significant hormone swings up and down of Esradiol levels, usually with lower or absent P4 levels. This means that you may actually grow any fibroids bigger and faster in a shorter period of time.
Now to answer your question; the best way to choose the right type of uterus removal or hysterectomy is
1. know the size of the uterus, usually described as #weeks pregnant; for example, 8wks, 10wks, 12wks and so on. This matters because 12wks size or less has a higher percentage of being removed as a vaginal hysterectomy. If the uterus is between 12wks and 20wks (top of the uterus can be felt at your belly button level (umbilicus level), then adding a laparascope or belly button camera that can help to surgically visualize and then control the blood supply to the uterus, tubes and ovaries under direct visualization. This means that the hysterectomy can be started laparascopically and then finished vaginally; this means smaller mini-incisions versus a large abdominal incision that takes longer to recover from. But that large uterus then still needs to come out through the vagina, kind of like delivering a baby vaginally.
2. Are the fibroids to the uterus multiple, changing the outside shape of the uterus to such an irregular size that trying to take it out vaginally won’t fit; then the hysterectomy needs to be abdominal.
3. Do you also have a bladder that is falling down, causing urine leakage (incontinence) that could be helped by ‘tucking it up’ or doing a bladder repair at the same time as the hysterectomy? If you are having a vaginal hysterectomy, doing a bladder repair is easily added to your procedure without any further external incisions.
4. Do you also have a rectal hernia that could be helped by ‘tucking it down’ or doing a rectal repair at the same time as a vaginal hysterectomy can easily be added to your procedure.
5. Is there a question of pre-cancer of the uterus, significant anemia or recurrent bad Pap smears? All of these questions also need to be asked and answered to know if a vaginal or abdominal hysterectomy is the best choice.
6. Is there a history of recurrent ovarian cysts or polycystic ovarian disease or a BRCA positive genetic picture to the patient making them a higher risk of ovarian cancer? These would make the case for having your ovaries removed along with the uterus. In the past, taking out ovaries along with the hysterectomy was the standard of care because they were close to becoming ‘non-functional’; this approach is no longer an automatic recommendation as many practitioners feel that it is not necessary or helpful to take out normal ovaries, even if close to menopause.
I realize that this is not a short answer; but it is a more complete answer and will give you a head start on how to talk to your doctor about which approach is best for you. But regardless, have your female and male hormone levels checked as E dominance can also put you at higher risk of bad mammograms and breast cancer, even if you have a hysterectomy!
Dr. Victoria Mondloch
victoriajmondlochmdsc.com
Age 49 also has a significantly higher incidence of E dominance due to irregular periods and not ovulating each month which means you don’t make P4 if you don’t ovulate. Age 49 usually means 1 year away from average age of menopause (age 50); this year before menopause, or perimenopause is known for it’s significant hormone swings up and down of Esradiol levels, usually with lower or absent P4 levels. This means that you may actually grow any fibroids bigger and faster in a shorter period of time.
Now to answer your question; the best way to choose the right type of uterus removal or hysterectomy is
1. know the size of the uterus, usually described as #weeks pregnant; for example, 8wks, 10wks, 12wks and so on. This matters because 12wks size or less has a higher percentage of being removed as a vaginal hysterectomy. If the uterus is between 12wks and 20wks (top of the uterus can be felt at your belly button level (umbilicus level), then adding a laparascope or belly button camera that can help to surgically visualize and then control the blood supply to the uterus, tubes and ovaries under direct visualization. This means that the hysterectomy can be started laparascopically and then finished vaginally; this means smaller mini-incisions versus a large abdominal incision that takes longer to recover from. But that large uterus then still needs to come out through the vagina, kind of like delivering a baby vaginally.
2. Are the fibroids to the uterus multiple, changing the outside shape of the uterus to such an irregular size that trying to take it out vaginally won’t fit; then the hysterectomy needs to be abdominal.
3. Do you also have a bladder that is falling down, causing urine leakage (incontinence) that could be helped by ‘tucking it up’ or doing a bladder repair at the same time as the hysterectomy? If you are having a vaginal hysterectomy, doing a bladder repair is easily added to your procedure without any further external incisions.
4. Do you also have a rectal hernia that could be helped by ‘tucking it down’ or doing a rectal repair at the same time as a vaginal hysterectomy can easily be added to your procedure.
5. Is there a question of pre-cancer of the uterus, significant anemia or recurrent bad Pap smears? All of these questions also need to be asked and answered to know if a vaginal or abdominal hysterectomy is the best choice.
6. Is there a history of recurrent ovarian cysts or polycystic ovarian disease or a BRCA positive genetic picture to the patient making them a higher risk of ovarian cancer? These would make the case for having your ovaries removed along with the uterus. In the past, taking out ovaries along with the hysterectomy was the standard of care because they were close to becoming ‘non-functional’; this approach is no longer an automatic recommendation as many practitioners feel that it is not necessary or helpful to take out normal ovaries, even if close to menopause.
I realize that this is not a short answer; but it is a more complete answer and will give you a head start on how to talk to your doctor about which approach is best for you. But regardless, have your female and male hormone levels checked as E dominance can also put you at higher risk of bad mammograms and breast cancer, even if you have a hysterectomy!
Dr. Victoria Mondloch
victoriajmondlochmdsc.com
That is a very difficult question and will depend on multiple factors (size of your uterus /prior gyn or abdominal surgery/prior pregnancies and if they resulted in vaginal vs Cesarean births and how many)
Basic types (in my order of preference and others):
1. Vaginal-surgery performed all through the vaginal opening. Least invasive with no abdominal incisions.
2. Minimally invasive:
Basic types (in my order of preference and others):
1. Vaginal-surgery performed all through the vaginal opening. Least invasive with no abdominal incisions.
2. Minimally invasive:
