Too fat for a hysterectomy?

[RedDoughnut]

I've had problems with very heavy bleeding for well over a year.
A fibroid was thought to be to blame but that's been vaginally removed and the bleeding/clots is just as bad
The mirena coil came out.
I can only think the next step will be hysterectomy
My womb was described as bulky. I've had c sections years ago.
But my BMI is nearly 40.

I imagine they’d offer you an ablation or a GNRH analogue first. Then if no benefit they’d discuss hysterectomy.

I’m on a waiting list for a hysterectomy and have just been in hospital for a few days due to heavy bleeding from fibroids. They won’t do the hysterectomy with haemoglobin levels under 100, and I’ve been told I have to have zoladex injections to induce temporary menopause (to stop the bleeding) for three months before the surgery. Is that an option for you? The GP can administer the injections.

Do you think they are hoping you hit menopause and everything stops and you then won’t need the hysto?

massive sympathies from someone who’s iron levels went down to nothing from periods! It was so hard to exercise, but once the iron stabilised I was able to address other nutrient deficiencies and then lose 12kgs. Because I had the energy to move and my body wasn’t craving sugar for energy! Good luck op it’s a shit situation to be in. (Also my period were just as heavy when I was 55kgs as when I was 80kgs after my first child)

By the way, the waiting list for hysterectomy is horrendous in my Trust, 12-18 months, and it took over three years of jumping through hoops to even get on the waiting list. If there’s any way you can see someone privately, then I would. I wish I’d done this from the outset, it would have saved years of poor quality of life and distress.

Eh? It’s easy to lose weight when you’re under stress - you don’t feel hungry, your stomach is in knots, etc. The weight falls off me.

No one is denying the risks to health from obesity. However I believe a person’s weight can also be used as an excuse by the NHS to ration care and cut costs. It also pushes the patient back to the bottom of waiting lists. Many years ago my DM had an emergency hysterectomy. She was very overweight at the time but she recovered very well from it. She was also in her fifties at the time.She was in later life refused a hernia repair operation because she was still very overweight. The consultant was vile to her. She opted to have the operation done privately and the very same consultant was miraculously then unconcerned about her weight. It shouldn’t be the case but I am sure OP would get a hysterectomy performed privately.

What about an Endometrial ablation ? Even if it doesn't work long-term you could have that, feel much better, look at loosing some weight and then you'll be fitter for anaesthetic.
I actually had my hysterectomy with spinal and sedation and don't remember any of it. Ga is not your only option.
For what it's worth if there is an easier option that reduces symptoms, not necessarily gets rid of them I'd go for that in the first instance. A hysterectomy is major surgery and mine caused life changing issues that weren't for the best.
Read the nice guidelines and go in knowing all your options.

The OP will be heavily anaemic from the bleeding. As I’ve said, I’ve just been in hospital with heavy PV bleeding and my haemoglobin is so low I can’t even walk down the stairs without getting breathless and feeling dizzy, so exercising is currently out of the question. Reducing your food intake while in this state is also not conducive to recovery.

I had an ablation and it failed within six months, similar story, horrendous clots and flooding. I used to wear several pads at a time at work and still ended up in a puddle when I stood up after a two hour meeting one day.

I had Zoladex to induce a chemical menopause plus HRT to counteract the side effects of it. I felt absolutely great on it, no bleeding, no pain, but I gained a stone in weight every three months I was on it. Had it for 18 months which is the maximum my consultant would prescribe it for. But at that point I'd had enough because I just kept getting fatter on it. From a size 10 to a size 18. Stopped gaining weight as soon as I stopped Zoladex and HRT. Losing it was/is still not easy.

Losing weight is more difficult for some people than others and can be especially difficult with gynae issues in your fifties.

Swings and roundabouts I think.

A bulky womb hints adenomyosis which can only be cured by a hysterectomy.

But this operation can also be done via epidural and robotic surgery so there are alternatives to a GA which will be dangerous with your weight.

However ...... I found when I had adenomyosis the hormones I took, lack of ability to exercise through flooding everyday (I stopped having a cycle and bled daily), then the northisterone I took daily to stop this, the various mirena they gave me which came out and lack of sleep through flooding - actually made me put on weight. Also the need to eat carbs and sugary things due to how constant bleeding made me feel and my ferritin was 4!!!

I had the surgery last year with a BMI of 31. They didn't question my weight or BMI (I've no idea practically the difference between low and high 30's for bmi though).

I'd arrange reversible to a gynaecologist. They are the ones who can make the decision and if it really is necessary for you to lose weight but the hormone issues are preventing this they can refer you to the right people to support this.

People underestimate the whole body and mind effects of heavy ongoing periods.

Gynae wouldn't let me have an ablation because my bmi was 44. It took a year but I got it to 33.9 on the day of surgery as I needed to be below 35. They put me on the mini pill. It just made matters worse. It took 3 years post that to get better.

What irritated me was the female staff were really quite rude towards me. Yet the male gynaecologists were very sympathetic. They said if ablation didn't work they'd put me forward for a hysterectomy. But the 2 females were really quite bitchy and fat shaming.

The reason I ended up getting referred was due to seeing a youngish (30's) male locum Gp.

One female one helpfully told me "you aren't physically losing as much blood as you think". My ferritin was 4!

I would find someone to cover my class to go to the loo, return 10 minutes later and 10 minutes after that already be flooded through tampon and maternity pad. I couldn't do my job yet no one would take me seriously.

Trying to get someone to understand I couldn't even go to a supermarket during covid because the toilets were shut was harder than recovering from the surgery itself.

And I also would loose clots the size of lemons. I once asked the female Gp who dismissed it as not as much actual blood as I thought if she had any idea what it's like to lose what would be like tipping 5 pots of jelly down the loo every hour?!

Hi OP, has a surgeon actually said they can't operate or are you just understandably panicking? Wait and see what is said and in the meantime try and lose a little if you can. I've been doing slimming world and have lost 3 stone as I have surgery looming. No one said anything about not doing the surgery only that recovery MIGHT take a little longer.

Ignore the ridiculous ill informed comments about weight loss vaccinations 🙄

TrueScrumptious
Eh? It’s easy to lose weight when you’re under stress - you don’t feel hungry, your stomach is in knots, etc. The weight falls off me.

I waiting to have a further tests because a previous test has come back with a really high worrying result.

I've done nothing but eat and have put on lots of weight. Not everybody reacts to stress like you!

I have adenomyosis. My womb has become so bulky that the Mirena doesn't stay put, one expelled itself and the current one has embedded itself in the muscle wall.

An ablation doesn't work for adenomyosis (the endometriotic tissue extends into the muscle wall of the uterus, so even if you burn away the top layer, the rest still bleeds underneath and causes more pain).

In the trust where I live, those with a BMI over 30 are eligible for a hysterectomy if they lose 10% of their body weight. I am approaching menopause age, so my gynaecologist won't do a hysterectomy anyway.

The treatment that has helped me is zoladex (goserelin); since starting this I have no bleeding and much less pain. Unfortunately the gynaecology department will only approve 6 months. When I lost so much blood in one day that my haemoglobin dropped by 1/3 overnight, they approved a second course.

Adenomyosis is exacerbated by oestrogen, which has implications on any HRT treatment during / after menopause.

There's really quite a lot of old fashioned thinking on this thread. Having a BMI of 40 is really nothing very unusual these days - it's interesting how on many other threads the overwhelming opinion is that doctors are all backwards for even referring to BMI because it's not a terribly helpful tool, and yet here so many people are saying that a BMI of 40 (without any other information) makes GA dangerous!

The risks of surgery with obesity are of perioperative morbidity and mortality not just to do with the anaesthetic and TBH, it these days it'll take a lot more than a BMI of 40 to make an anaesthetist nervous! Any risk of surgery has to be balanced against the risks of other management options or of not doing anything. Clearly if someone is bleeding heavily enough to be needing blood transfusions (with the associated risk of transfusion reactions, etc) and there are no other appropriate management options/other options have failed, then the balance of risk/benefit would be in favour of doing a hysterectomy. The 'waiting list for a hysterectomy' is irrelevant here because it's a relative emergency. A spinal anaesthetic may be an option for a vaginal hysterectomy if the surgeon thinks that's a sensible option.

The risk of periop m&M increases if obesity is associated with other problems, like diabetes, sleep apnoea, heart problems, but even then in the scenario of uncontrolled bleeding the benefit may out weigh the risk.

The risk:benefit balance may also be different for different operations in the same person, so using the example PP sited above of someone having an emergency hysterectomy whilst obese then being declined a hernia repair may make sense - an elective hernia repair is more likely to fail/become infected with associated obesity (and I'm not sure I'd have been keen on the same person who'd declined to do it in the NH doing it in the private!).

While the economic implications of different options aren't usually the primary motivation behind decision making, it is also worth thinking about how the cost that someone having repeated admission for transfusions etc while they spend a year trying to lose weight might rack up, vs having a single admission for an operation that may fix the problem completely....

Slightly less risk of that than of dying under general anaesthetic, isn't there now?

Obesity puts you at greater risk from any surgery. They may be able to do a vaginal hysterectomy which reduces some of the risk and recovery time compared to a TAH, but despite how annoying it is to need to diet, if you need surgery in the future, it will save you a lot of time (and fewer times being bumped off the lost at pre-op) to get started.

It's quite clear it's not going to be easy to find the headspace to lose weight while you are suffering so much.

I don't know much about the options but I just wanted to offer sympathy because it sounds incredibly tough

At 54, you're past the average age of menopause by a couple of years. It may not be much longer, and then this will all be over, with or without a hysterectomy.

Yes, of course. But equally not everyone reacts to stress by gaining weight, which was what was said. It’s probably half lose weight, half gain.

Easy for you.

Everyone is different. I was slim until my mid thirties (size 8, dropping to a size 4-6 when anorexic). I too would have made assumptions like yours. Then I got ill and couldn't exercise and gained some weight (in the 5 years it took docs to diagnose me). Then I was put on steroids and ballooned due to water retention plus the ravenous appetite they gave me. I will never again judge people who gain weight/find it hard to lose it. They may have battles i know nothing about.

I had a hysterectomy a while ago and I was worried for the same reasons as you.
I even mentioned it to the consultant before the op and he said that it's different when you're lying flat on the operating table. I had the op, no problems at all.
I wouldn't worry about it. The doctors have seen all shapes and sizes.
Good luck!

@Greybeardyyes you are right there are some unfortunate replies on this thread. I do think there are just as many posters who are trying to support the OP though.
I think you go on to refer to my comments. My DM was refused a hernia operation purely on the basis of NHS rationing/waiting lists (years ago so nothing new under the Sun). This was proved when she was able to have the surgery privately. Her weight was used merely as an excuse as I explained. It was not in my view a clinical decision to refuse her the operation on the NHS. This was the point I was trying to make to the OP. Perhaps not very clearly!
The surgeon was a horrible man but a highly respected and competent surgeon. I don’t really understand your comment that my DM shouldn’t have let him operate on her. She recovered well and lived into her nineties.
I agree with you in that you would think the NHS would have the sense to realise the economic benefits of a single procedure that solves an issue versus repeated expensive admissions/treatments. The NHS do not. That is why so many people are suffering ongoing ill health in this country due to the reactive rather than a proactive way the NHS have of doing things.

I had c section at 40 bmi and no issues were mentioned before or after, and FAR bigger women have gastric surgery?

I also had this experience. I did look into private but it was £7,500 at the time and I had no way of affording it.