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Dr. Andrew Rynne

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Suggested hysterectomy for fibroid uterus. Had uterin embolization. Safe to have vaginal hysterectomy?

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1677 Questions

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Posted on Mon, 24 Dec 2012 in Women's Health
Question: i have fibroid uterus. my OB GYN doctor suggested hysterctomy; to remove the uterus, because their growing. Just had a uterin embolization Nov 2011. Not much difference in size or in number of the multiple fibroids. My concern is the abdominal scarring and other possible complication. I asked about vaginal hysterectomy, but doctor says my uterus is too big. Is there a way for a surgeon to make it possible for a vaginal hysterectomy with multiple fibroids; biggest fibroid about 6.5 cm?
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Answered by Dr. Timothy Raichle 2 hours later
Hello, I would be happy to help you with your question.

I have some questions for you and then I can provide you with the best answer:

1. What is the overall size of your uterus? Can you feel it on your abdomen?
2. Have you ever had a vaginal birth before?
3. What is your height and weight?
4. Did they discuss a "laparoscopic" approach to taking it out?

Please let me know and I would be more than happy to help you with your question!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Timothy Raichle 11 hours later
There are multiple tumors. From 2.5 cm to 6.5 cm. I can not feel them, but my abdomen seems bloated at times and I'm either having freguent urination or constipation. Yes, I have had 2 vagina births. I am 5'6" and about 150 lbs. They have not discussed laparoscopic approach.

Thank you in advance for returning my answer after this foloow-up question

My email address is YYYY@YYYY
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Answered by Dr. Timothy Raichle 6 hours later
Thank you for the followup clarification. This is very helpful. From what you are describing, it sounds like there are clear indications for removing your uterus. You have large fibroids and symptoms related to the fibroid uterus: abnormal bleeding?, bloating, pressure, constipation, frequent urination.

There are three ways to remove a uterus:

1. A vaginal hysterectomy - this is the most traditional way to perform this surgery. It is made easier by prior child birth, and made harder when the uterus is large and bulky (as with fibroids). It sounds like they are not comfortable with this approach so I would not pursue it further.

2. An "open" hysterectomy - performed through an incision similar to that used to perform a Cesarean Section. This is a safe way to remove a bulky uterus, but the down-side is that it is a slightly longer recovery than the other approaches. There is minimal risk of adhesion related to this surgery. In competent hands, this can be done safely. There is a risk of extra bleeding (and transfusion of blood), and a small risk of injury to surrounding structures (such as the bowel and bladder). These risks are minimal, and having performed hundreds of such procedures, this might actually be the safest route to go (the only downside is the recovery)

3. A "laparoscopic" hysterectomy - performed using cameras and instruments through small incisions in your belly. This can be difficult if the uterus is large and is sometimes limited by available resources and the skill level of the surgeon. The benefit is that the recovery is better than #2 above

So having gone through this though process, I would say that you need to defer to what your OB/GYN is comfortable with. Besides deliveries and C-sections, hysterectomies are one of the most common procedures that we perform. It can be done safely. Your height and weight place you at a relatively normal body weight making the surgery that much safer. I am sure that you will feel better once this is done, but the recovery will remain your biggest hurdle. Talk with your doctor about what this will be like!

I hope this helps. Please ask if you have additional questions. I would be happy to help you until you are satisfied with this answer.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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