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.

Thanks Soft Pillow. My gynae is still saying hysterectomy. I know that certain kinds of fibroids are deemed more suitable for ufe than others and I don't understand my mri results enough to tell what type I have. I won't see the next gynae for a couple of months.
We have direct access to some specialists here, but I'm not sure about interventional radiologists.

@Gwenhwyfar

Please read this site in detail before you decide.

www.fibroids.co.uk/

Hysterectomy is drastic and should be your choice only if all other options are ruled out.

Thanks. That site is basically an advert for UFE. I'm pretty interested in UFE anyway, just need to know whether I am a good candidate for it and how to get it when the gynae is so convinced about a hysterectomy.

So another update: I saw the gynaecology surgeon. I told her that hysterectomy would be a last resort for me and asked about UFE. She replied that UFE was a last resort for them as they considered it more risky for the ovaries.

She gave me two options if I didn't want surgery, both of which I consider a bit crap:

1. Ryeqo which she said treated the symptoms, but not the cause and she claimed had no side effects. My own google search shows that they have loads of side effects and that it basically suppresses the natural hormones only to partially replace them with synthetic ones. I don't want this and I also don't see the point of only treating the symptoms since the symptoms are manageable.
2. Esmya/ Ulipristal acetate which could shrink the fibroids, but is dangerous for the liver and requires monthly blood tests.

I don't want either of these treatments :(

I always worry that NHS decisions on treatment are based on saving money and not only on need.

The NHS bases decisions on cost-effectiveness, and risk-benefits, following published protocols & procedures.

Other health systems have to be seen to "do" something for you because action is seen as somehow always better than inaction. Health care is focused around making patient believe they got something, that something was "done" for them, whether it is likely to help or not.

Other systems you get antibiotics... because that's not leaving a mild infection to sort itself. You get over-treatment & over-investigation & over-diagnosis because people reckon they deserve it & paid for it.

You don't want this sodding hysterectomy. You haven't reported any symptoms you find intolerable. Daft to proceed to major surgery imho

A hysterectomy for a fibroid with no symptoms sounds mad. I dont understand why they would prefer that over ufe.

I was put on esmya before my i had ufe....it gave me the worst pain ever..worse than childbirth..took myself off it.

"Other systems you get antibiotics... because that's not leaving a mild infection to sort itself. You get over-treatment & over-investigation & over-diagnosis because people reckon they deserve it & paid for it."

Where I live they don't hand out antibiotics like sweets. I know they do in some countries and I do think there are some people here who try to 'shop' for the doctor who will give them the medicine they want.

"Other health systems have to be seen to "do" something for you because action is seen as somehow always better than inaction."

Yes and no. Where I live, there is a part that we pay for either directly or via our non-profit insurance organisations, but there is also a subsidised part so they do not necessarily want to waste public money unnecessarily. As someone mentioned above, I think they just have a tradition of suggesting hysterectomies for all these problems and it's a surgery that (for the doctor!!!) is simple and routine.

My GP was happy with my suggestion to not do anything extreme, but my gynae (different one to the surgeon I saw yesterday) didn't want to just leave it because on top of the fibroids that can grow, my womb is also 'voluminous'.

The reason they gave for avoiding UFE was that it could cut the blood supply into my ovaries too. It's true that I don't want that.

Your experience with Esmya doesn't bode well...

Hmm. Surely with ufe they can precisely place where they want the blood supply to stop. But I am not a Hcp

This is what she told me. Whether true or not, I suppose I have to accept that or go to a different hospital (where I might be told the same thing).

Tbf I didn't ask about ovaries as I was 50 when I had it done

The chances of UFE going wrong are slim - especially when compared to surgery where loads could go wrong.

If you shop around for a very experienced and reputed Interventional radiologist you can minimise the chances of things going wrong. But no procedure is going to be zero risk.

I have had surgeries go terribly wrong and paid the price all my life. Doesn't mean surgeries are bad or to be avoided but they should be the last resort if possible.

I don't get why you're still so resistant, it's the best thing I've done having my womb out and wish all women post children could enjoy this feeling of no bleeding, pain and other gynae issues! Still got my ovaries. Fibroids get bigger quickly.
All the other methods are temporary

I suppose I have an idea in my head that surgery should be a last resort. Even though gynaecologists consider hysterectomies to be simple procedures, it seems to me that all major operations come with risks and also disadvantages. I've read people's experiences and watched videos. It seems you can be in quite serious pain in the days afterwards and be off work for a couple of weeks at least. Even simple things like walking upstairs (I live upstairs) and carrying things can be difficult.
There are risks like complications, having the bowel nicked, etc.
There are disadvantages like problems with continency, sexual health, an earlier menopause and putting on weight.

Considering that my symptoms are mild it seems mad to me to go through all that.

You mention pain, but I only get mild period pain. Recovery from an operation seems much more painful to me.

Yes, surgery complications are an issue. A colleague was supposed to have recovered completely from his back surgery in a couple of months, but he's still in pain six months later because something went wrong with the operation.

It was a painful few weeks absolutely. And yes having an op versus not having an op will bring risks but they are small.
But that few weeks are a tiny blip in my life and were so worth it.
My periods were never bad either but still it's amazing not having that time every month.
I understand if your fibroids aren't causing you issues then an op seems massive. But like I said they get big quickly and then do cause issues.
In your position if I felt like you, with your mindset then I wouldn't have anything done until they became a problem to me and surgery would seem like a relief.

Why did you want to do it if your periods were never bad?

Mine was the size of an 8 month baby and ached and was heavy. So yeah it had to go 😆

It started off small 4 years before that.
Amazingly periods unaffected by it. Have to say I wasn't bothered by it when it was small so understand your reluctance. I just know now what a joy it is to be free of a womb.

Thanks for the explanation.

@Gwenhwyfar - hello, I've come back to report to you and anyone else interested that I had my fibroid embolisation last week and the pain is overrated! It was painful, sure - for 24 hours after which I was comfortable with paracetamol and stopped that within 2 days. I was warned of much worse pain to come but it's been ok. There is weakness and a bit of dull ache but not bad enough to warrant medication. I'm back to work next week.
I can't say I feel any different as far as the fibroid is concerned but I didn't have bad symptoms to begin with. I'll know in a few months how successful it's been in shrinking the fibroid. Let me know if you have any questions..

Thanks Soft.

NB: this is a ZOMBIE thread, bumping because I like updates.

@Gwenhwyfar : how are you now? Did you have any treatment?

Hi. My last but one ultra sound showed the main one had grown a bit, but the last ultrasound showed it hadn't grown any further since then so, as I have few symptoms, we're still just monitoring for now.

Ta for update. x