Treatment for fibroids

[Gwenhwyfar]

I went to the gynaecologist today for an annual checkup as is usual where I live (not Uk). She found a fibroid, maybe two by doing an ultrasound. I was not that shocked because I know they're common in our forties and I'd looked up urination problems during periods and that was one of the options.
However, I was quite shocked at the treatment, not medication but a hysterectomy. Seems quite extreme to me. It's true that I have no need for my womb, but would not want to go into menopause any younger than necessary so would definitely want to keep my ovaries.

Can anyone tell me what happens after such a hysterectomy. Could it provoke menopause even if I keep my ovaries. Is it a difficult operation?

I have to book a pelvic MRI first. Any experience of that would also be helpful.

Thanks in advance.

I had exactly this aa my fibroid was huge, I looked 6 months pregnant. I had my womb out but kept my ovaries and cervix and haven't looked back!
No issues, no periods, no early menopause.. I still have all my hormones so why would I. Recovered quick from op even though it was full open surgery.
Go for it OP!

Also to answer another question, yes I still feel my monthly cycle.. bit grumpier just before period would have been etc

I can only say that having a hysterectomy was a massive improvement for me. I had large fibroids for years. I had a myomectomy when I was 32 which preserved my uterus. I had 2 pregnancies, one (beautiful) baby and had a total hysterectomy at 51. I resisted for yearsbodily integrity and all that. It's been so greatno pain, no heaviness, no having to get up all night to wee. I was much better 3 weeks out and better than I had been in years within another couple of weeks. Since I was 51, they took my ovaries and Fallopian tubes, but left my cervix. I went on HRT in the hospital and didn't have a problem with entering menopause surgically.

Mine's not as big so I'm really not sure about having major surgery even with keyhole and all the issues it could cause later.

After years of painful heavy erratic periods that were eventually helped by marina coil I had several large fibroids found 'incidentally' on a lumbar MRI after menopause.
They haven't given me any trouble and I wouldn't even know they were there.

@Gwenhwyfar What issues though?
You don't need your womb if you are not wanting children.
If you can live with your symptoms then don't go for it

I don't think it's particularly helpful to share stories of massive fibroids. Obviously the correct strategy if you are having horrific periods and your fibroids are causing you serious issues, is to deal with them.

But OP says she was unaware of her fibroid before it was detected on a routine scan, that she isn't suffering terribly with her periods and so on. Opting for surgery when the fibroids aren't a "problem" to my mind is overkill. There are so many other options - mirena, the transexamic acid for the bleeding (this worked really well for me for a while), ablation, embolisation etc etc. To immediately leap to hysterectomy just seems like total overkill.

I have 2 fibroids that were found when I had ultrasounds when pregnant with DC2. That was 10 years ago, and presumably I still have them, but they've never caused me any problems.

Treatment is only necessary if they're causing problems, and in the UK the NHS will want you to try other treatment first, like contraceptive pill or hormonal treatment, before they will do a hysterectomy, as a hysterectomies can come with their own risks.

But they get bigger. Fast.

Yes they can do. But might not. It's not a definite thing which is why watchful waiting is probably the better course of action. Or trying the other options first before surgery.

I had actually considered fibroids when I had googled painful urination during periods, but I also read that they were very common in women in their 40s so it wasn't a complete shock. I mentioned having heavier periods than in the past and before she examined me the doc put that down to my age.
While the fibroids themselves weren't a complete shock the thought of a hysterectomy was.

No I don't need my womb, but I also don't feel I need major surgery. I've been reading recently things like a whole week where you can only just look after yourself, two weeks when you can't move much and up to 6 weeks till you get your energy back. Pain afterwards, maybe a catheter, maybe swelling afterwards. So many things just for a heavier period and an irritable bladder. I just feel I could be doing more harm than good.

I had a huge fibroid in my 30s (over 10cm wide) which was removed by myomectomy followed by a hysterectomy (I kept my cervix and ovaries)

Recovery was very hard as mine was emergency surgery and I had some serious complications but once I was back on my feet I felt fine with no hormonal issues at all.

I have since had one of my fallopian tubes and one ovary removed by keyhole surgery as it was badly scarred during the emergency surgery and was causing me a lot of pain but even with just one ovary, so far perimenopause is going OK, just a few more mood swings than usual 🤣

I'm also in Continental Europe ( I suspect we might be in the same country from what you've said) I think that hysterectomy is quite a common solution for fibroids here, my gynecologist was very clear about how we needed to solve the problem before it got worse......

Good luck with whatever you decide to do!

I had two fibroids and they would be checked every 6 months, measured etc. All was good for a while - maybe a couple of years. The Gynae at the time did talk about a hysterectomy. In the interim I had a bladder repair op and the surgeon did recommend that I get the blood supply to the fibroids cut. I didn't and live to regret it.

I was menopausal during all of this and on HRT and one started to grow massively. I only knew because I felt a pain when I lay on my stomach at exercise class. By that time it was so large ( like a 28 week uterus) that I had to have a full incision hysterectomy as they wanted to take the fibroid out intact to test it in case it was more than that. The recovery was challenging but not too bad. Worse was the surgical menopause that came hot on the heels of it and I restarted HRT. I am still on it 7 years later as you are never through menopause. It is an ongoing condition.

Bear in mind there are several different kinds of fibroid and treatments vary according to that. I would seek a second opinion as to your options.

NHS page about fibroids says they do not "need" to be treated if not causing problems. Says that they "often" shrink after menopause without treatment.

I don't think NHS writes anything without lots of supporting evidence.

Cleveland clinic (US) says small fibroids often don't need treatment.

This private US provider lists factors that seem to be associated with fewer fibroid problems, and implies they don't tend to grow after menopause. Also lists some OTC medications. Obesity & sedentary lifestyle seem to be risk factors for worse fibroid problems. You can try to reduce those factors.

Only OP can decide if she wants to try the non-surgical actions, be proactive y booking surgery or wait and watch.

Just leave it then OP, if it's not bothering you that much and you don't want the operation. But it was the best thing I did even forgetting about the fibroid for a second.
I see so many of my friends who are done having kids, suffer with womens issues that could be sorted by whipping it out. Best thing I did!

I find it a bit risky to just leave it. I would rather have some kind of treatment, but I find a hysterectomy to be too much. Last period for example was unusually heavy for me, but not painful and I didn't get the bladder pain I got last month.

Thanks.
I don't think my fibroids are small so the Cleveland advice might not be for me. I'm not obese, but sedentarism can't be avoided with my job.
In the same way that some have questioned whether the push for a hysterectomy is a money making thing, I always worry that NHS decisions on treatment are based on saving money and not only on need.

Well there are definitely other things to try first, they probably skip straight to hysterectomy as the other things usually don't last so this is a permanent solution.
I read about the one where they cut off the blood supply by inserting plastic pellets into the blood vessels feeding it.

They also offered me those injections that pause your ovaries which means no hormones which means the fibroids shrink. But grow again once injections stopped plus it gives you meno symptoms.
Sadly it's the hormones that make them grow, which also keep us out of menopause.
That's why I chose to get rid of the womb but keep my ovaries. All the hormones with no fibroids

I had fibroids. One thing that worked REALLY well was Raspberry Leaf tablets (not tea, only tablets). Cured 50% of my bleeding and all of my cramps.

Yes, this seems to be the only medication that shrinks the fibroids as opposed to just dealing with the symptoms and it brings on menopause, which I wouldn't want.

No I didn't want it either and didn't want to risk my ovaries not kicking back in properly once injections stopped.

I read about the one where they cut off the blood supply by inserting plastic pellets into the blood vessels feeding it

Uterine Artery Embolisation. I was considering that, until I met a woman who'd had it. She said it was really painful when the fibroids were dying, then pieces of necrotic fibroids were coming out of her fanny. 🤢

I had a total hysterectomy last year for fibroids. I had lots of little ones. They'd tried the pill, ablation, transexamic acid and the coil, and nothing had worked.

Recovery from a hysterectomy is hard. You're knackered for 8 weeks. You can move around, but even walking 10 minutes will require a recovery nap! You'll get through it but it's not easy. I've had c-sections and it's 10x worse than that.

I'm more worried now about the long-term risks, like prolapse. You can't lift heavy stuff after a hysterectomy (over 10kg) ever again, according to some doctors. It also is a risk to do some exercises (crunches, some Pilates, running) in case of prolapse. They have to cut ligaments during the operation that can't be reattached as strongly.

But then again, I've met women who do weightlifting and triathlons. 🤷‍♀️

The worst part was the first 3 weeks, and now the surgical menopause. I'm in my 50s so my consultant advised me to remove my ovaries too (under 52, they prefer you to keep them). Ovaries can (I've heard) sometimes fail after the operation, as it can interfere with their blood supply,

I'm fine now but I sometimes wonder if I should've tried more natural remedies before having the op. But by that point, I was having 2-week-long heavy painful periods, and was anaemic. I needed HRT to manage my perimenopause symptoms but that probably made my fibroids grow too.

TLDR: I'd try natural remedies, and get my fibroids measured regularly to see if it's working.