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Old 11-14-2011, 08:03 AM
 
Location: Up above the world so high!
45,270 posts, read 86,025,648 times
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Quote:
Originally Posted by suzy_q2010 View Post
First of all ladies, to clarify the definitions:

  • Hysterectomy: removal of the uterus.
  • Oophorectomy: removal of an ovary. It may be unilateral (one ovary) or both (bilateral).
  • Salpingectomy: removal of a Fallopian tube. It also may be unilateral or bilateral.
A gynecologist does not use the term "complete" hysterectomy. That is a lay term for removal of the uterus and both tubes and ovaries. A doctor would call it a "total hysterectomy and bilateral salpingo-oophorectomy. The "total" means the entire uterus was removed. A"subtotal" hysterectomy means the body of the uterus was removed but the cervix was not. Most hysterectomies are "total" in that regard. Sometimes one tube and ovary is left. It is possible to remove the tube and leave the ovary, but commonly the tube is left with the ovary if both are normal.

The issue in this thread is the best treatment of fibroids, and that really depends on the age, menopausal status of the patient, and whether the ability to get pregnant is a concern.

  • For the patient who wants to get pregnant, the fibroid(s) can be removed, often laparoscopically, using a telescope inserted through a small incision near the navel and several additional small incisions. This leaves the uterus intact, but scarring may predispose to rupture of the uterus during pregnancy, especially in labor. Therefore a Cesarean before labor may be recommended. Some fibroids can be removed from inside the uterus via hysteroscopy, in which a telescope is inserted through the cervix into the uterus, if they are under the uterine lining and accessible from that route.
  • If pregnancy is not desired, there are alternatives to surgery. In a patient who is likely to enter menopause fairly soon, there are medications that can shrink fibroids. However, they are expensive and have side effects, including menopause like symptoms. So they are not suitable for long term use. After menopause, fibroids do tend to shrink because of lack of estrogen, though the amount of shrinkage varies a great deal. Another alternative, if the main symptom is bleeding, is to destroy, or ablate, the uterine lining via hysteroscopy. There are several techniques to do this. And the newest approach involves threading a catheter into the main arteries of the uterus and embolizing the fibroids. Microscopic spheres are injected into the arteries to block the blood supply to the fibroids and cause them to shrink. The embolization is done by a radiologist, usually as an outpatient. The disadvantage of any procedure that leaves the uterus in place is that new fibroids may develop. Uterine ablation and fibroid embolization do have potential complications, and some women end up having hysterectomies anyway.
  • Some women may want to consider hysterectomy if their fibroids are large, menopause is not imminent, and they want definitive treatment. Large fibroids may or may not be associated with heavy bleeding, but they commonly cause the bladder pressure several of you have reported. They can also be uncomfortable due to sheer weight and can cause bowel pressure. A uterus larger than about that of a three months pregnancy size may not shrink after menopause enough to relieve pressure symptoms. Shrinkage after embolization also varies. These days, most hysterectomies that in the past would have required an incision similar to a Cesarean incision can be done with the laparoscope. The reduces the recovery time afterwards. The uterus can also be removed vaginally, with no abdominal incisions at all, if it is not too large, especially in women who have had vaginal births. The vast majority of women who have hysterectomies for fibroids are pleased with the results.
  • The decision to remove normal ovaries or not must be individualized. Obviously, an abnormal ovary would most likely need to be removed. For young women who have many years before natural menopause, keeping normal ovaries would be the most common option. This prevents "surgical menopause" and the need to possibly take hormone replacement for an extended period. Women who do not wish to take hormones or who have contraindications to taking them will want to keep their ovaries. The risk of breast or ovarian cancer can be evaluated on a case by case basis. As the age of the patient approaches menopause, some women may want to opt for removing the ovaries. If a hysterectomy is done in a patient who is already through menopause, it becomes easier to decide that there is little to be gained by leaving the ovaries. One consequence of not removing the ovaries, however, is the possibility of developing painful scar tissue which may result in additional surgery later on.

Any woman with fibroids needs to have a thorough discussion with her gynecologist about her options, nonsurgical and surgical, and if surgery is selected, make an individualized plan for what is done with normal ovaries. This maximizes the chance that she will be completely satisfied with her treatment.

Nicely said, great info
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Old 11-14-2011, 11:15 AM
 
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Thanks for the general info. Made an appointment to see a new Obgyn this month that is a woman, young and studied at Princeton. I wasn't concerned about my ovaries being taken by the way.
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Old 11-14-2011, 11:18 AM
 
Location: Up above the world so high!
45,270 posts, read 86,025,648 times
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Quote:
Originally Posted by bbekity View Post
Thanks for the general info. Made an appointment to see a new Obgyn this month that is a woman, young and studied at Princeton. I wasn't concerned about my ovaries being taken by the way.
Yeah, the ovary thing kind of got thrown in on top of your question about fibroids

Glad you are going to get another opinion on the hysterectomy. Hope you are able to hang on to your ovaries if they go for the uterus. And again, I have never felt better since getting rid of that thing
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Old 11-14-2011, 02:53 PM
 
Location: Knoxville, Tennessee
22,533 posts, read 46,060,389 times
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I just turned 50. Had my uterus and one ovary removed when I was 45. I had very heavy periods and at least one fibroid that was the size of a grapefruit and many more.

I didn't have any more periods but oddly enough became much sicker after the surgery. I gained 80 pounds at one point, although I lost 40. I have severe edema and the same darn pain I had before the surgery. No one knows why. I've been to several specialists.

Would I do it again if I had the choice? I don't know. It could be something else that is wrong with me but I have only felt worse since the surgery and I surely look worse. In fact I was working then but haven't worked in a few years.
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Old 11-14-2011, 04:04 PM
 
1,141 posts, read 1,326,141 times
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bbekity,

Please read the book, "The Hysterectomy Hoax" by Stanley West. A hysterectomy is only needed in the presence of cancer. There are definite side effects post surgery that vary in severity depending on the woman. Our bodies function as a whole unit. And the uterus' use and benefit extend beyond childbearing.

Most doctors are not educated and trained on how to save a woman's organs. Dr. West operates out of New York City. I traveled from Ohio to NYC to have my surgery and was back home in 2 days.

You can save your organs, no matter your age.

Good luck and health to you!

Last edited by winterbird; 11-14-2011 at 04:12 PM..
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Old 11-14-2011, 04:13 PM
 
575 posts, read 848,634 times
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Quote:
Originally Posted by winterbird View Post
bbekity,

Please read the book, "The Hysterectomy Hoax" by Stanley West. A hysterectomy is only needed in the presence of cancer. There are definite side effects post surgery that vary in severity depending on the woman. Our bodies function as a whole unit. And the uterus' use and benefit extend beyond childbearing.

Most doctors are not educated and trained on how to save a woman's organs. Dr. West operates out of New York City. I traveled from Ohio to NYC to have my surgery and was back home in 2 days.

You can save your organs, no matter your age.

Good luck and health to you!
But what about large fibroids that press on other organs like my bladder for instance? Having an enlarged uterus the size of a four month pregnancy doesn't sound like something that should remain that way? Hopefully this new Dr. will give me a proper diagnosis. The last Dr. was just worried that because of it's size, it might burst and cause hemorrhaging.
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Old 11-14-2011, 04:30 PM
 
Location: Tigard, Oregon
851 posts, read 2,475,250 times
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Quote:
Originally Posted by bbekity View Post
But what about large fibroids that press on other organs like my bladder for instance? Having an enlarged uterus the size of a four month pregnancy doesn't sound like something that should remain that way? Hopefully this new Dr. will give me a proper diagnosis. The last Dr. was just worried that because of it's size, it might burst and cause hemorrhaging.
bbekity - IHMO you are absolutely doing the right thing by getting a second opinion. Let us know how it goes!
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Old 11-14-2011, 04:36 PM
 
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My fibroids caused my uterus to swell to the size of a 38-week pregnancy. As you can imagine every doctor I visited recommended hysterectomy. A couple of "specialists" said they could attempt the surgery but that there was no guarantee I would wake up with my organs intact. Or wake up at all.

Please get the book. It is worth every penny. You can speak with Dr. West directly if you phone his office. He has performed more myomectomies (surgery to remove fibroids) than any other doctor in the world. And he trains other doctors as well.

Reproductive Medicine by Dr. West

PM me if you'd like. I can speak with you personally.

Last edited by winterbird; 11-14-2011 at 04:52 PM.. Reason: correction
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Old 11-14-2011, 04:55 PM
 
Location: Georgia, USA
21,481 posts, read 26,078,274 times
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Quote:
Originally Posted by winterbird View Post
bbekity,

Please read the book, "The Hysterectomy Hoax" by Stanley West. A hysterectomy is only needed in the presence of cancer. There are definite side effects post surgery that vary in severity depending on the woman. Our bodies function as a whole unit. And the uterus' use and benefit extend beyond childbearing.

Most doctors are not educated and trained on how to save a woman's organs. Dr. West operates out of New York City. I traveled from Ohio to NYC to have my surgery and was back home in 2 days.

You can save your organs, no matter your age.

Good luck and health to you!
There are many conditions besides cancer for which hysterectomy is a legitimate choice and most gynecologists are quite familiar with all the options. It's part of what they spend four years or more after medical school learning to do.

The only people who can determine whether a hysterectomy is indicated are the patient and her doctor.

There are potential side effects to treatments for fibroids that do not include hysterectomy. Ablation of the uterine lining is not 100% successful in stopping excessive bleeding. After embolization of fibroids, some women can have severe pain.
After myomectomy, there is no guarantee that new fibroids will not grow, and there are increased risks with pregnancy afterwards. Myomectomy also predisposes to adhesions, or scar tissue, sometimes resulting in the need for additional surgery.

And women will find docs who are able to do all these procedures much closer to home than NYC.
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Old 11-14-2011, 05:07 PM
 
1,141 posts, read 1,326,141 times
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[quote=suzy_q2010;21714053]"There are many conditions besides cancer for which hysterectomy is a legitimate choice and most gynecologists are quite familiar with all the options. It's part of what they spend four years or more after medical school learning to do."

I totally agree with you.

"The only people who can determine whether a hysterectomy is indicated are the patient and her doctor."

I agree with you 100%.

"There are potential side effects to treatments for fibroids that do not include hysterectomy. Ablation of the uterine lining is not 100% successful in stopping excessive bleeding. After embolization of fibroids, some women can have severe pain. After myomectomy, there is no guarantee that new fibroids will not grow, and there are increased risks with pregnancy afterwards. Myomectomy also predisposes to adhesions, or scar tissue, sometimes resulting in the need for additional surgery."

It's definitely important to be aware of potential side effects with any procedure (including hysterectomy) that a patient chooses.

"And women will find docs who are able to do all these procedures much closer to home than NYC."

Absolutely. No one has stated that it is necessary for a patient to travel to NYC.

Last edited by winterbird; 11-14-2011 at 05:37 PM..
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