Hysterectomy or Myomectomy?
- Myomectomy is the ONLY option available for those patients desiring fertility. There is no other option available that will increase the chances of becoming pregnant. Embolization should NOT be used do its negative impact on pregnancy implantation.Lupron is of no benefit, and other procedures such as ablation will create infertility.
- Myomectomy is NOT the best option for patients not intending to become pregnant or past reasonable childbearing age. Myomectomy is a more involved surgery than hysterectomy with a longer recovery. With myomectomy, the fibroids have to be “cut” or dissected away from the uterus. Several incisions into the uterus are often necessary to remove the fibroids. Each of these incisions has to heal, resulting in cramping and pain from the uterus. Myomectomy also requires larger incisions, since the fibroids are removed through the abdominal wall. Larger incisions result in longer recovery and increased pain, with recovery therefore being longer than hysterectomy. There is also increased scar tissue formation after myomectomy due to the many incisions often used to remove the fibroids.
- For those patients not desiring fertility, or past reasonable child bearing age, hysterectomy is the procedure of choice. Hysterectomy is an easier surgery to recover from than myomectomy, and at CGS, hysterectomy rarely EVER requires open surgery. Hysterectomy also prevents fibroids from coming back. There is no downside to hysterectomy as long as the ovaries are kept in place for those patients who have not gone through menopause.
- At CGS, our goal is to ensure you choose the best surgery for your condition so that you never require additional surgery to treat the same condition. This is so important when it comes to the surgical management of fibroids. Fibroids grow with estrogen, and patients do not stop producing estrogen until menopause, the average age being 50 – 52. In other words, if you leave the uterus and you are not intending to become pregnant OR if you a women past childbearing age OR if you have a very low chance of becoming pregnant, the fibroids will usually recur if myomectomy is chosen over hysterectomy.
- The doctors at CGS do NOT want to operate again for the same problem. Second and third surgeries are inconvenient, painful, and increase the risks of surgery due to adhesions from the first surgery. It is important that patients choose the correct procedure for the treatment of uterine fibroids.
The following is a summary of the advantages of hysterectomy over myomectomy for fibroids in patients in which fertility is not desired or is not possible.
- Smaller incision size – as little as two ¼ inch incisions with Dualport GYN hysterectomy versus more and larger incisions for myomectomy.
- Faster recovery with less pain and easier recovery overall than myomectomy. Patients are back to work in 7 days on average versus 2 weeks for myomectomy.
- Less bleeding, with rare need for blood transfusion.
- Elimination of the menstrual cycle. This does NOT mean that you are not making hormones. If the ovaries are kept in place and not removed during the surgery, hormone production is the same as before the surgery. Hysterectomy does NOT mean removal of the ovaries.
- Elimination of heavy bleeding, pain, frequency of urination, back pain, pelvic pressure, constipation.
- Abdominal distension or “swelling” is resolved immediately after hysterectomy, as are the above symptoms.
- Anemia is corrected after hysterectomy, resulting in greater energy levels and increased activity and endurance.
- Imaging studies such as sonogram, MRI, and others are no longer necessary to evaluate the recurrence or size of fibroids.
- Pap smears are not required with hysterectomy. If supracervical hysterectomy is chosen, Pap smears are necessary annually.
- Most importantly, with hysterectomy FIBROIDS CANNOT RECUR and cause the symptoms to return. With preservation of the ovaries, there is NO downside to hysterectomy. The function of the uterus is to hold a baby ONLY – there are no hormones or compounds produced by the uterus that will increase your wellbeing or health.