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.

It might well be true but given that the odds of dying under general anaesthetic are around 1 in 100,000, the relative risk is still very low, even when doubled.

Can I jump on this thread please?

Aged 52, post menopausal and on HRT. Been experimenting awful pain on the left side for a few months now.
It's a sharp stabbing/ wrenching type pain.

I've got a mirena coil in for the progesterone part of my HRT.

I've been told I've got a bulky uterus and have also been experiencing some severe abdominal pain.

I'm speaking to the GP tomorrow and am going to request a full pelvic and transvaginal scan. Also a gynae referral.

I'm suspecting fibroids and adenomyosis is causing these issues.

Can anyone else relate?

Thanks

i'm an anaesthetist 🙂

Can you ask if they can do a hysterectomy with a spinal block/epidural instead of a general anaesthetic? I had gynae surgery during my last c section and they used both so if the spinal started to wear off they could top up the epidural, this way there's no intubation and less risk due to high BMI.

So what would go in your risk assessment for someone with a BMI over 30? And what risks would you inform your patient of?

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.

Oh ffs, what an absolutely ridiculous answer. That is what happens for you, lucky you. Are you that narrow minded that you can't understand that not everyone is like you? Do you have huge blood clots and bleeding to a point that you severe anaemia that leaves you needing blood transfusions? If not you probably don't have crippling fatigue and struggle to breathe just standing up. It is not easy to lose weight in that situation at all

Not necessarily, mine is the size of a 28 week pregnancy because it is riddled with adenomyosis.

I am luckily enough to be able to go private but am waiting for a confirmation of my date for a total abdominal hysterectomy (thanks to being repeatedly fobbed off by the NHS for years it's now got too bad and too big to do laparoscopically) as that is the only thing that actually works for adeno.

Ignore the dramatic 'you are going to die' posters, I had a long conversation with my consultant and it's not like you go from no risk to huge risk, the risks just increase a bit. But as someone who is also super anaemic for similar reasons to you, that risk also needs to be balanced with the risk of a heart attack or heart/organ failure from from having ongoing severe anaemia.

Not 100% certain that knowing my personal approach to the patient with a BMI over 30 is that helpful. It's worth noting that about 60-65% of the adult population is overweight/has obesity so it's pretty much bread and butter stuff for all anaesthetists.

My original point was that the statement that 'At that weight your increased risk of death under GA is double as you are classed as morbidly obese' is unhelpful because 1) the OP doesn't tell us a weight, but rather a BMI, 2) as several other posters have hinted, a hysterectomy doesn't always need a GA - so that makes the idea of the risk of death under GA less helpful, 3) not all obesity is the same (the OS-MRS score gives some indication of the risk of mortality associated with bariatric surgery but may have application in other types of surgery), 4) the implication of the comment is that the risk of death under GA due to obesity is significant - not quite the same thing, but the risk of death due to anaesthesia is about 1:100,000 for all comers... even if the incidence doubled with 'morbid' obesity that would still make death an extremely rare event. The risk of death IIRC in all comers having abdominal hysterectomy (quick glance suggests ~6:100,000) is a bit higher than that, but is still rare. The statement too which i was replying was really just scaremongering.

The risks are of course 'perioperative' rather than purely anaesthetic and a few people in the thread have stated that it's the risk of 'the anaesthetic' that's the issue - it is not. As I suggested in another post the risks have to be balanced against those of doing nothing/following another course of action (including waiting for a weight management programme before operating).

Obesity certainly can make things more challenging perioperatively and can contribute to serious complications but it's not an absolute given and sweeping statements really aren't that helpful.

And just for interest, it's perhaps worth throwing in the idea of the the 'obesity paradox' whereby some patients with class 1/2 obesity (so that doesn't include customers with BMI in the 40s) may actually experience less M&M than those with a normal BMI!

HTH

I had a hysterectomy three and a half weeks ago, and weigh over 100k.

I have recovered beautifully, no one ever mentioned my weight as an issue. (The scarring from c sections was a concern, and they thought it may have to be done abdominally, but in the end, nope!)

I know I am only a few weeks in, but I just wanted to let you know that, no. You will be fine. Talk to your gynecologist.

@RedDoughnut I'd recommend joining the hysterectomy sisters facebook group for support, everyone there understands what you are going through. Unfortunately there is a large MN contingent that won't have a clue yet will still come on to comment on your weight and how you should just lose it (because people with weight issues are stupid and must just be told how simple it is)

Came on to say the same. It's a helpful and supportive group.

I’m going to enjoy chucking my weight loss book at the gynae, cannot wait for the day to come. Bring it on in a reputed nhs 24 weeks wait just before Christmas week 23! He/she been made aware I’m on weight loss jabs…. too late even a midwife thinks there can never be any adverse changes to Saxenda since 2020 ahhhh, as the nhs love to fit bands before carrying out a hysterectomy apparently (oh really) ! Hahaha. Alright! Let’s hear about this gastric band which would cost upward of 7-10k for starters…

Just to say, an x ray picked up something that wasn't quite right, but the radiologist said, nothing to worry about... Turned out I had to have a complete hysterectomy and ovaries removed. I was very overweight. The anaethisist* said he would have prefered if I was lighter, but there was no choice. They removed a 6 lb cyst from an ovary, which could have burst at any time. I recovered perfectly well. I was over 60. I think surgeons will intervene despite weight issues. Hope all goes well .

We are all different

I lose weight when under stress. Not everyone runs got the biscuit tin!

@Anoushkaka are your smears up to date? Any mention of hypoplasia after the hycosy?
I've a BMI of 49 and 1 month post abdominal radical hysterectomy - also had iron transfusions. I'm feeling healthier than I have done for years - I can move and walk without haemorrhaging. It's literally changed my life.
Worth looking at benenden healthcare plans?

Nobody is too overweight for anaesthetic just the higher the bmi the more risk it could pose ( how do you think people have a gastric band/ bypass they arnt awake) , i would speak to your gynaecologist and the anaesthetist.

Also look into medical menopause it's where they can send you into menopause temporarily depends on age on how long they can do it for ( I was 30 so only could have it for a year then had the hysterectomy) but my gynaecologist did tell me if I was older closer to the natural age of menopause then I could of had it until I actually hit menopause. It can also shrink fibroids in some cases

Thank you for the comments.

I think my biggest fear is the gynaecologist will say I have a normal amount of bleeding following the fibroid removal.
I'm just so tired of bleeding.
I have had periods for 40 years. I have b,Ed more over this last 12 months than all my previous periods put together.

@RedDoughnut I had a open hysterectomy in 2017, i was about 38 bmi.

Happy to answer any questions x

I had a hysteroscopy and biopsy but my adenomyosis didn't show on it, it was only when they removed the womb it was found x

My mate had a vaginal hysterectomy last year following years of exceptionally heavy bleeding at random intervals. Not sure of her BMI but she weighed about 19 stone 5 and is of average height. She recovered well and is so glad she pushed for it. She’s been losing weight since because she was finally in the right headspace after the op. It wouldn’t have been feasible before because the effect of her gynae issues on her mood and motivation was immense.

A hysteroscopy would not necessarily find adenomyosis. It can sometimes be seen with modern ultrasound, but unfortunately it sometimes isn't confirmed until they look at the womb after hysterectomy.

Same sort of issues and again I'm a bit overweight. I've been induced into the menopause with zoladex and in the meantime I'm shifting the weight. It's not easy but I know I need to do it. Zoladex obviously means no periods at all but a side effect can be weight gain.
I decided I'd rather put on weight that I can try my hardest to lose than keep bleeding and be in agony every month.
Once I've got the weight off I can get my hysterectomy and it will be worth the battle. And I will be thinner 😂

@InTheGardenShed

Yes exactly, we're all different. I'm an ex-anorexic and you lose weight while stressed, and the OP is different. In her situation it's difficult to lose weight when under such stress

Gynaecologist said I was heading for a hysterectomy but...I'm too fat
He wants my BMI to be 30. I'd have to lose 5 stones, which is ironically my goal earlier in the year ,before I became anaemic , and I'd lost nearly 1 stone but regained ( unsurprisingly)

Meanwhile he wants me try Zoladex. He won't put me on the hysterectomy waiting list until I've tried that.
However the waiting list is over a year!

Now off to read about Zoladex. And not eat!